Questions Flashcards
Why medicine?
- well-thought out decision.
- Dr Pimple Popper, captivated by patient centred approach and her ability to make patients comfortable.
- From their I read more and more into medicine and became more and more fascinated.
- Science: more interested in human biology, than eg. ecology. Enjoy how science applies to human.
- People: always wanted career with people, evident from voluntary roles undertaken.
- Challenges.
Why not nursing?
- Increasingly non-doctor health professionals are taking more responsibility, which helps to alleviate stresses and pressures doctors experience.
- Ultimately, doctor makes final decisions, which equates to higher responsibilities for patients.
- Some roles/aspects eg surgery are only available to doctors.
- Ability to heavily specialise - unlike nurses who retain skills that can more easily apply to a wider degree of areas.
Why Manchester?
- Communication skills learning centre provides great feedback - become more comfortable with interacting with patients and clinical examinations.
- Large amount of independent learning due to PBL course.
- PBL course, interacting with others in my year and having a discussion - helps build skills for working in an MDT.
- Large city in comparison to where I live, lots to explore and people to meet.
- Full body dissections - consolidate learning.
Who would you give an organ to?
- Justice and clinical needs
- Impact on society, eg do they have any dependents? However this cannot be quantified and so ultimately won’t influence your decision.
- Commitment to post-op care - are they willing to take immunosuppressants? Limit alcohol intake etc?
- Discussion with MDT about which patients are best match, eg. blood type, organ size, distance between donor + recipient hospitals as these will impact success of transplant.
What is empathy and why is it important?
Ability to understand a person’s feelings and viewpoint.
Helps understand root cause of behaviour/anxieties which helps create a clearer way of moving forward.
Give an example of where you have displayed teamwork:
John Watson - violent child.
- Mini activities session with all classes.
- Student became violent towards teacher = has to ensure their safety, other students safety and staff safety.
- I was tasked with escorting other students back to classroom in calm and effective manner.
- All roles within a team are important, no matter the scale and contribute to positive outcomes.
Give an example of where you have displayed leadership:
- Volunteering with KEEN.
- Attending craft session, and after a few weeks was asked to lead a session.
- Initially nervous, but took on board advice given by session leaders and observed their approach.
- Challenges = communication, folding paper into correct shape, tried many different approaches, eventually asked parent to help.
- Importance of adaptations
An example of where I’ve shown empathy:
- Caring for nan with dementia.
- Can have days where she is sad.
- Easy to use distraction techniques like music but doesn’t get to the root of the issue.
- Concept of meeting her where she is, rather than expecting her to come to where I am.
- Step into her world and mirror her emotions - knowing she is accepted and heard can bring tremendous relief.
- Open ended questions and validating how she feels.
BAME Staff:
Inequalities?
How are these being addressed?
- Inaccurate representation amongst board members.
- Recruitment issues due to lack of diversity at senior levels.
- Discrimination.
- NHS People Plan to increase BAME representation across workforce.
- NHS striving to engage further with staff and staff networks
BAME patients:
- Black women 5x more likely than white women to die in childbirth.
- Detrimental health outcomes associated with socio-economic status of BAME groups.
Brexit and the NHS:
- False pretence of extra funding.
- Staffing crisis - harsher immigration laws means shortage of over 40,000 nurses.
- Supply chain of medicines and impacts on medicine deliveries eg. insulin for diabetics.
Abortion:
- 24 weeks of pregnancy in most cases, only legally allowed if 2 drs agree that it will negatively impact woman’s mental or physical health to continue.
- Pro-life vs pro-choice legal debate
- Legalisation of second abortion pill at home 2018, prevents risk of women miscarrying on journey home which is traumatic - opposed by pro-life groups that it trivialises abortion, pushes patients to experience trauma with no supervision, and cannot monitor if taken without force.
A&E:
- NHS cannot meet 4hr standard due to austerity and staffing pressures.
- Longer waiting times due to rising attendance, lack of bed from delayed discharges and staffing shortages.
- Plans to scrap 4hr target by Matt Hancock (twat), but Drs say this will just result in problems being buried.
Vaccinations:
- uptake of 13 childhood vaccines fallen between 2018-2019.
- Wakefield MMR scandal reduced patient trust.
- Falling numbers could also be because parents have forgotten seriousness of illness and have no urgency to vaccinate.
- NHS long term plan aims to improve local coordination and immunisation conversation in low uptake areas + MMR check for children aged 10-11 with GPs.
COVID-19 Vaccinations
- Availability issues mean that gov is prioritising vaccinating max number of eligible people, rather than fully vaccinating ‘vaccinating more with half efficacy is better than half efficacy in only half’.
- Pfizer vaccine trial did not compare different dose spacing.
- Oxford vaccine did include trials, finding a longer gap led to a greater immune response.
- Issues with this 12 week gap being seen as ‘off label use’.
- BMA ‘cause huge logistical problems, with a terrible impact on emotional well-being of vulnerable’.
- Will consent still be valid?
- Vaccine resistance.
- Lowering public trust, so full evidence for decisions around vaccine should be readily available to public.
Junior doctor contract:
- JD concerned contract would increase stress, tiredness and burnout and thus affect patient care.
- Antisocial hours increase not reflected in pay.
- 4 strikes took place, with a large turnout, September strikes called off over fears about patient safety.
- Impacts of strikes were significant and led to updates.
How do you think junior doctors deal with stress in the workplace?
- stress from antisocial hours, psychologically and mentally challenging situations, balancing a career with personal life, postgraduate exams, fear of making mistakes.
- additional reading and following social media accounts.
- Cope by eg. asking for help when problem is out of expertise, delegating tasks, knowing when to get help.
- Relaxing outside of work is important, eg hobbies.
- Talking with other colleagues is also helpful.
What did you learn from your work experience?
Communication is key - relate to KEEN and volunteering.
Effective teamwork - violent child and adult crash call simulation.
Cannabis
Cannabis derived medicine
- 2018 can be prescribed by specialist doctors in exceptional circumstances.
Many patients won’t be able to get it soon as CMO has issued scientific trials for safety.
Charlie Gard
Diagnosed with MDDS = extremely rare.
Impossible to tell whether he was in pain and asleep/awake.
High Court recommended life support be stopped.
US Dr claimed he could treat with 10% chance of improvement - untested on humans and animals with C conditions, but had some positive effects on similar conditions.
Issues of autonomy, however judges ruled it would cause increased pain.
Incredibly hard for everyone involved.
Antibiotic resistance
Reasons for = antibiotics over prescribed, livestock is dosed with antibiotics, GPs feel pressure to prescribe, lack of education (not help with viruses, failure to follow treatment course correctly)
Solutions = prescribe more sparingly, reduce infections post-surgery, restricting those used on livestock, PHE pushed for education of infection-preventing public hygiene.
Boosting research = using AI to tackle AR, hoping earlier diagnosis and treatment with appropriate antibiotic resistance.
PrEP - pre exposure prophylaxis
Drug taken by HIV- before sex usually with HIV+ person - 99% effective if taken daily and correctly.
+maintaining relationships
+ no side-effects for majority
+freely available in S and W, E set to follow suit
- can have serious side effects on kidney and bone health
- may lead to greater rate of other STIs
- may promote drug resistant HIV, if person is unknowingly HIV+
Active/passive euthanasia
Voluntary/involuntary euthanasia
Assisted suicide/assisted dying
Active = person deliberately intervenes to end life. Passive = death caused by withholding/withdrawing treatment.
Voluntary = at request of person who dies Involuntary = patient dies but they want to live =MURDER!!
A.Suicide = person who performs final act, not doctor.
A.Dying = when a patient who is already dying, asks for help to die.
Euthanasia
Illegal in UK - as is assisted-suicide - but legal in other areas like Netherlands.
+ prevents intolerable suffering.
+ AUTONOMY - patients should be able to decide when to end their lives in palliative care.
+ doesn’t stop people ending their lives.
- contradicts non-maleficence?
- pressured to end life to stop burden on carers
- effects on vulnerable groups - sends a message that when life falls short of certain conditions, it shouldn’t continue.
Bawa-Garba case
Her mistakes:
- late antibiotics due to business
- late report of infection due to failures in hospital IT system.
- did not document stopping usual medications in notes.
- mistook patient for one with DNAR.
Hospital failings:
- hospital was understaffed.
- no senior consultants on site so no one to report to.
- nurses did not notify her that condition was deteriorating.
GMC wanted her struck off for good, but other Drs appealed this and she could return to work.
