Public health

Question 1

Which factors influence Gillick competence?

Answer 1

• The child’s age, maturity and mental capacity
• Their understanding of the benefits and risks
• Their understanding of any alternative options, if available
• Their ability to explain a rationale around their reasoning/decision making

Question 2

How do you assess capacity?

Answer 2

Step 1:
Does the patient have a disturbance in the functioning of their mind/brain which means they could lack capacity? If yes, proceed to step 2

Step 2: 
Does the patient have the ability to:
- Understand information given
- Retain information
- Weigh up/evaluate benefits and risks
- Communicate their decision back to you

Question 3

What is the definition of somatisation?

Answer 3

When medical symptoms are caused by psychological or emotional factors

Question 4

What is the definition of Munchausen’s syndrome?

Answer 4

Producing symptoms to assume the sick role

Question 5

What is the definition of malingering?

Answer 5

Producing symptoms for a secondary gain

Question 6

What is meant by duty of candour?

Answer 6

• Tell patient when something has gone wrong
• Apologise for error
• Offer an appropriate resolution
• Explain potential short-term and long-term effects of the error

Question 7

What is an error of omission?

Answer 7

Error resulting from actions not taken

Question 8

What is an error of commission?

Answer 8

Error resulting from wrong action taken

Question 9

What is meant by near miss?

Answer 9

Potential adverse events that could have caused harm but did not, either by chance or because someone or something intervened

Question 10

What is a never event?

Answer 10

A never event is an event which should never happen. Serious, largely preventable patient safety incidents which should not occur if the available preventative measures have been implemented

Question 11

What are the four criteria of medical negligence?

Answer 11

1. Duty of care?
2. Breech in duty of care?
3. Did the patient come to harm?
4. Did the breech cause the harm?

Question 12

What is meant by utilitarianism?

Answer 12

Maximising wellbeing of the population as a whole (for the greater good)

Question 13

What is meant by egalitarianism?

Answer 13

Equal rights/opportunities for all

Question 14

What is meant by deontology?

How does this contrast with consequentialism?

Answer 14

Morality of an action is based on whether the action in itself is right or wrong

Morality of an action is based on the outcome/consequences (not whether the action which led to the outcome was right or wrong)

Question 15

What is meant by libertarianism?

Answer 15

Based on autonomy, freedom of choice and individual judgement

Question 16

What are the four pillars of medical ethics? What do each of these mean?

Answer 16

• Autonomy: the individual right to self-determination
• Beneficence: the duty to ‘do good’
• Non-maleficence: the duty to ‘do no harm’
• Justice: to be fair and just (equality/equity)

Question 17

What is meant by inverse care law?

Answer 17

The availability of medical care/resources tends to vary inversely with the need of the population served

Question 18

What is meant by incidence?

Answer 18

The number of new cases of a specific disease in a population in a given time period

Question 19

What is meant by prevalence?

Answer 19

The number of individuals with the disease in a population at a specific point in time (point prevalence)

Question 20

What is QALY? What does it measure?

Answer 20

• QALY = Quality Adjusted Life Year
• Measures disease burden, including both quality and quantity of life lived
• 1 QALY = 1 year of life lived in perfect health