SFSBM Flashcards
medical pluralism
no single medical philosophy or system can be expected to meet the health care needs of all members of that society
non-allopathic =
not proven by scientific investigation
pure vs impure placebos
PURE: lack pharmacologically active ingredients for the condition being treated
IMPURE: substances/interventions that have some clinical value for some ailments but not for the condition prescribed
nocebo effect
- some aspect of the pt experience that worsens their health outcome
- separate from specific effects of medical intervention
- ex: practitioner behavior/attitude
allostatic load
- consequences of allodynamic regulatory wear/tear on brain/body leading to multisystem dysregulation
- allostasis: drive to maintain homeostasis
- explains how accumulated effects of lifelong stressors translate to poor health
high risk strategy
focuses efforts on those with the greatest risk for future harm
low risk strategy
population based - intends to target all members of society irrespective of risk
-no benefit at all to most individuals
lead time bias
screening program detects the presence of disease many years before it becomes symptomatic —- time from diagnosis to death appears longer
length bias
screening program detects slowly progressive diseases so it appears that successful screening programs are associated with lower mortality rates
5 As
of lifestyle counseling
- Assess
- Advise
- Agree (goal setting based on stage)
- Assist (prescribe lifestyle prescription)
- Arrange follow up
triple aim
improve:
1) integrated system of care
2) population health
3) value (cost)
primary care
first source sought in response to illness
- outpatient
- entry point to system
secondary care
provided upon referral
- specialist
- inpatient or outpatient
tertiary care
highly specialized expertise/equipment
- provided in a regional medical center
- not available in every hospital system
IPO (independent provider organizations)
clinicians that organize themselves into various managed care models
-contract with insurance companies (are NOT insurers themselves)
staff model HMO
provide care + insurance
- salaried physicians
- monthly pt fee
- provides most care
group model HMO
physicians and medical professionals belong to a multi specialty physician group
- HMO pays the group in bulk
- physicians only see patients that signed up for the HMO that contracted them
open panel HMO
similar to a multi specialty physician group but members are allowed to treat non HMO patients
network model HMO
combo of group and open
-independent HMO contracts some multi specialty practices, independent practices, and fully independent physicians
accountable care org (ACO)
set up similarly to HMO, but NO insurance function]
-shared savings, better metrics
tertiary prevention
preventing morbidity/mortality from a disease late in the disease course
delivery system reform incentive payment (DSRIP)
incentive payment model that rewards providers for performance on delivery system transformation projects that improve care for low income patients
-funded via medicaid waivers
federal public plan
- designed to work within current ACA structure
- add a public plan to health insurance marketplaces that were established by ACA
- ONLY include private health insurance plans
- goal: create more competition with private insurance
health insurance premiums based on
- age
- smoking status
- geographic location
- individual vs family coverage
medicare part A
hospital insurance
medicare part B
medical insurance (outpatient care)
medicare part C
Medicare Advantage
- private
- provides all medicare benefits
medicare part D
outpatient prescription drugs only
moral hazard
one party gets involved in a risky event knowing that it is protected against the risk and the other party will incur the cost
-occurs with all insurance
tragedy of the commons
tendency to overuse a resource because the cost the individual incurs only a small fraction of the cost which is shared
-ex: open bar
babbling occurs
9-14 months
before age 1
school aged children
- increased group (team) activities
- need consistency, reinforcement
- need to be challenged
- need clear consistent rules
- need clear standards for success
early adolescence
11-14
- physical changes
- developing interests
- need adult supervision
- need structure and monitored expectations
- want greater privacy
- more aware of emotions
- reflect on self
mid adolescence
- more time with peers
- strong desire to belong
- beginning partnering
- abstract reasoning (diabetes), problem solving
- wants more independence
- expects competence, and to make contributions to social groups
late adolescence
- greater self direction, self monitoring
- greater capacity for judgement, impulse control
- more involvement in longer term relationships
- parents/adults more in role of advisor/mentor
- more consistent values/beliefs
female growth/development timing/order
pubs
boobs
spurts
squirts
(8-14)
male growth/development timing/order
hairy
balls
grow
(10-18)
cognitive development: 0-2 years
sensorimotor
cognitive development: 2-7 years
preoperational
- symbolic thought
- irreversibility
- centration
- egocentrism
cognitive development: 7-11 years
concrete operational
- mental operations applied to concrete events
- mastery of conservation
- hierarchical classification
cognitive development: 11+ years
- abstract ideas
- logical
- systematic thinking
building blocks of family life
- coherence
- organization
- communication
- values/beliefs
components of parenting
- nuturance
- structure
- affiliation
- attachment
