Revision Questions Flashcards
Name professional attitudes expected of medical staff and students
- care of patient 1st concern
- protect and promote health
- good standard of practice keeping up to date
- treat patients as individuals
- work in partnership with patients
- honest and open
- confidentiality
Role of medical schools and GMC?
- sets guidance in Tomorrow’s Doctors
- taught by medical schools
- examined formally using exams, reflective essays, attendance and punctuality etc
Benefits of good communication?
- more accurate diagnosis
- more accurate data gathering
- increased adherence with treatment
- more effective patient-doctor relationship
- increased satisfaction
Consequences of poor communication?
- inaccurate diagnosis
- less recognition of ice
- non-adherence to treatment
- decreased satisfaction
- more complaints
Can communication skills be taught?
Yes:
- skilled training leads to improvement
- self reflection
- specific, descriptive, non-judgemental feedback
Why is Calgary Cambridge important?
- every patient has own problems and it explains it with own framework
- understanding CC model can help to treat them better and communicate within their own framework
Which models explain differences in people?
- biomedical model relies on biology
- social models explain differences via social interactions
- faith system
- epigenetics (combines biological and social)
What makes science social?
- decisions about research funding
- pharmaceutical industry
- ethical issues
- nature of scientific work
What is eugenics?
- improving a population by controlled breeding
- encourages good genetics, discourages bad genetics
What is positive eugenics?
Encourages good genetics
What is negative eugenics?
Discourages bad genetics
What are the 6 criteria to patient centred care?
- explores patients main reasons for visit
- seek integrated understanding of patients world and looks at whole person
- finds common ground on problem, mutually agreeing on management
- enhances prevention and health promotion
- enhances continuing relationship between patient and doctor
- is realistic
What is the patient expected to do in sick role?
- must want to get well as quickly as possible
- should seek professional medical advice and cooperate with the doctor
- allowed to shed normal activities and responsibilities e.g. work
- regarded as being in need of care and unable to get better by his or her own
What must a doctor do to uphold the sick role?
- apply a high degree of skill and knowledge
- act for welfare of patient, not self interest
- be objective and emotionally detached
- be guided by rules of professional practice
What 4 sources are used when making a clinical decision?
- patient preferences
- available resources
- research evidence
- clinical experience
Why is evidence-based decision making important?
- deals with uncertainty
- medical knowledge incomplete/shifting
- patients receive most appropriate treatment
- constant need for info/improvement
- improving efficiency of healthcare services
- reduces practice variation
4 ways in which evidence based decision making can be implemented?
- evidence based clinical guidelines
- summaries of evidence provided to practitioners
- access to reviews of research evidence
- practitioners evaluating research for themselves
What right does a doctor have in the sick role?
- right to examine patients
- granted autonomy in professional practice
- occupies position of authority in regard to the patient
Criticism of the sick role
- symptom iceburg
- chronic illness and MUS (if cause unknown, patients can’t enter sick role due to uncertainty)
- patients try to label themselves as sick
- conflict between best interests for the patient and cost to society in allocation of resources
Give 3 aspects of opportunity cost decisions
- time (time spent on one person could be spent on another)
- overspending budget cuts another elsewhere
- good medical practice means you must be aware of the cost of the care you deliver
Sources of NHS funding?
- tax finance (national insurance)
- some user charges e.g. prescriptions
How is the NHS organised?
- 209 clinical commissioning groups (buyers)
- public hospitals and GPs (sellers)
What is flat of the curve medicine?
Where lots of things do not improve health but increase cost
What is the best choice of treatment?
Must have clinical effectiveness and cost effectiveness
What are the two agendas?
- disease
- illness
What is the difference between disease and illness?
- disease is what is wrong with the body
- illness is the way the patient experiences the disease
Why is it important to discuss the two agendas?
- disease, means you treat the correct condition and improves biomedical health
- illness, can discover how illness impacts a patients life which improves patient satisfaction and enhances doctor-patient relationship
Potential difficulties when assessing patients best interest?
- difficulties in predicting future outcome
- conflict between benefits of treatment and patients own views
- patient may be unable to communicate relevant information
- conflict between patient and doctors views of best interest
- emotional attachment may distort doctors views
Where can you look at disease distribution?
- globally
- regionally
- locally
Why do we need to study population?
- to find out about risk
- need to use evidence of what has previously happened to a population to work out how drugs act etc
3 types of epidemiology
- descriptive, tells us how things are distributed
- analytical, how we can exploit those distributions to ask questions
- experimental, change the distributions ourselves to see what happens
How can epidemiology be useful in smoking research?
- identify the cause of disease
- guides preventative action, identifies targets for new information
- surveillance of populations and smoking can measure effects of intervention
Give examples of lay people
- friends
- relatives
- pharmacists
What is the symptom iceberg?
- only a small minority of symptoms are seen by health professionals
- patients only report 5-15% of symptoms
Who is most healthcare work done by?
Lay people - lay referral system
What demographic/social factors influence help seeking and illness behaviour?
- gender
- age
- social class
- race
- culture
What are Zolas triggers to help seeking behaviour?
- interference with work or activity
- interference with social relations
- interpersonal crisis e.g. death in family
- putting a time limit on symptoms
- sanctioning, relative/friends tell them to seek help
What influences help seeking behaviour?
- perceptions and evaluation of symptoms
- perceived risk
- previous experience
- psychological factors (fear)
- denial
- concern about using NHS resources
Barriers to help seeking behaviour?
- provision and availability of services
- access to transport
- disruption to work
- attitudes of staff
- inverse care law
- geographical distance
- time, effort
- long waiting times
What are the WHOs 5 aspects of health promotion?
H - Healthy public policy A - Action in the community R - Re-orientating health services P - Personal skills S - Supportive environment
What are the 4 different approaches to health promotion?
- medical, focuses on disease and prevention
- behavioural, focuses on attitudes and lifestyles
- client-centred, focuses on empowering individuals
- societal, focuses on political and social action
What is primary health prevention?
- aims to prevent onset of disease
- screening risk
- health protection
- health education
What is secondary health prevention?
- detect and cure disease at early stage
- e.g. cancer screening
What is tertiary health prevention?
Minimise the effects or reduce the progression of irreversible disease
What is Beattie’s typology of health promotion?
- health persuasion
- legislative action
- personal counselling
- community development
What are social inequalities in health?
Differences in people’s health linked to social inequalities in their lives
Are new diseases inversely related to social class?
No, but as disease progresses the social gradient tends to re-emerge
What is the gini coefficient?
Measure of inequality, area between Lorenz curve and perfect distribution
Give some examples of social inequalities in health?
- routine manual workers have higher chance of infant mortality
- mortality from injury and poisoning in children is higher in lower social groups
- teenage pregnancy more common in lower social groups
What did the black report show?
- confirmed social health inequalities are involved in mortality
- shows health inequalities were widening
When was the black report published?
1980
What are the 4 explanations of socioeconomic inequalities in the black report?
- a statistical artefact
- natural selection, peoples health drives their social class, healthy people are more likely to get promoted, whilst unhealthy people are likely to lose their jobs
- result of differences in health behaviour
- poverty causes poor health
How do childhood circumstances influence inequalities?
- childhood is a period of rapid development and heightened sensitivity to environmental influences
- fathers occupation at birth is a strong indicator of life expectancy
What are some government initiatives to help reduce child poverty?
- national minimum wage
- increase child benefit
- increase income support
- teenage pregnancy strategy
Why has child poverty increased?
- unemployment
- lower pay
- more single parent families
- freezing/abolition of some benefits
- more indirect taxation
What is the marmot report 2010?
Proposes evidence based strategy to address health care inequalities
What are the 6 policies of the marmot report?
- create and develop healthy and sustainable places and communities
- ensure healthy living standard
- enable everyone to maximise capabilities and have control over lives
- fair employment and good work for all
- give a child the best start in life
- strengthen the role and impact of ill-health prevention
Why do people self care?
- many people will self treat before seeing a doctor
- many cultures have strong non-western medical traditions
Why are CAMs used?
- easily accessible
- control over treatment
- dissatisfaction with health care
- poor doctor-patient relationship
- desperation
- perceived effectiveness and safety
Why is prognosis important?
- it can help diagnostic and treatment decisions
- it is important for patients to know the likely course of disease
What are the types of theory that decision making focuses on?
- descriptive, what are you doing?
- normative, what should you be doing?
- prescriptive, how can we improve what you are doing?
What is the hypothetic-deductive model?
- cue acquisition
- hypothesis formation
- cue interpretation
- hypothesis evaluation
Where can good evidence be found?
- cochrane database
- evidence-based journals
- medline
What are 3 requirements for valid consent?
- informed
- voluntary
- with capacity
What are the 4 forms of consent?
- oral
- expressed
- written
- implied
What information does the patient require as part of the consent process?
- potential benefits
- potential risks
- alternative treatment options
When is consent required?
- before examination
- before treatment or care
- disclosure of confidential information
- screening
- teaching
- research
Why is consent needed?
- improves trust between patient and doctor
- legal requirement
- respects autonomy
- professional duty
What is the Bolam principle?
Practitioners are not negligent if they act in accordance with practice accepted by a responsible body of medical opinion
Which act focuses on who has capacity?
Mental capacity act 2005
Who does the mental capacity act apply to?
People 16 and over
Why are P drugs used?
- pharmacists can ask customers questions about who it is for, symptoms etc
- ensures no ‘red flags’ about how long the patient can use it for
- duration of a symptom may mean it is not safe to treat
When can a POM change to a P?
No danger when used correctly without the supervision of a doctor
When can a P change to an OTC?
Safe to sell without the supervision of a pharmacist
Name 3 community pharmacy teams
- minor ailment schemes
- emergency contraception
- smoking cessation
- health education
Self medication scale of analgesics say that the belief of patients can fit into which 3 categories?
- people reluctant to take mild analgesics
- people who ‘don’t think twice’ about taking mild analgesics
- people who prefer to let pain ‘run its course’
What is quantitative data?
Discrete: - only certain values possible
Continuous: - any value is possible
What is qualitative data?
Multinomial: - categories aren’t ordered
Ordered: - categories exhibit logical order
Dichotomous: - two categories that oppose
At what point is statistical significance generally accepted?
- P = 0.05
- strong evidence against null hypothesis, can reject null hypothesis
- statistically significant
What is standard error?
- describes how good a given estimate is
- tells you how good your sample statistic is
- looks at how accurate your estimation of the mean is
