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Primary Care > Third Year > Flashcards

Third Year Flashcards

1
Q

Describe realistic medicine

A
  • Build a personalised approach to care
  • Change our style to shared decision-making
  • Reduce unnecessary variation in practice and outcomes
  • reduce harm and waste
  • manage risk better
  • become improvers and innovators
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2
Q

How are doctors improvers and innovators?

A

Introduction of surgical pause

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3
Q

What are the 5 questions patients are advised to ask their doctor by ChoosingWiselyUK?

A
  • is the test, treatment or procedure really needed?
  • what are the potential benefits and risks?
  • possible side effects?
  • are there similar, safer or alternative options?
  • what would happen if I did nothing?
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4
Q

What is health promotion?

A

An overarching principle/activity which enhances health and includes disease prevention, health education and health protection

May be planned or opportunistic

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5
Q

What are theories of health promotion action?

A

Educational; provides knowledge and education to enable necessary skills to rate informed choices re health

Socioeconomic; national policies

Psychological; complex relationship between behaviour, knowledge, attitudes and beliefs. Emphasis on individual readiness for change

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6
Q

What is health education?

A

an activity involving communication eith individuals or groups aimed at changing knowledge, beliefs, attitudes and behaviour in a direction which is conducive to improvements in health

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7
Q

What is health protection?

A

involves collective activities directed at factors which are beyond the control of the individual

tend to be regulations, policies or voluntary codes of practice aimed at prevention of ill-health or enhancement of well-being

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8
Q

Why is health promotion essential?

A

Growing healthcare costs

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9
Q

What are advantages of health promotion?

A

Prevention of disease rather than treatment of established disease

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10
Q

what are disadvantages of health promotion?

A

may medicalise healthy individuals

Possible increased worry

May not effectively target most at risk groups

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11
Q

What is empowerment?

A

The generation of power in those individuals and groups which previously considered themselves unable to control situations nor act on the basis of their choices

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12
Q

What are benefits of empowerment?

A
  • ability to resist social pressure
  • ability to utilise effective coping strategies when faced by unhealthy environment
  • heightened consciousness of action
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13
Q

What are the points on the cycle of change?

A

Precontemplation –> contemplation –> ready for action –> action

Action can then lead to maintenance

Maintenance may be upheld or regression could occur

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14
Q

What are examples of planned health promotion in primary care?

A
  • posters
  • chronic disease clinics
  • vaccinations
  • travel clinic
  • smears
  • bowel screening
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15
Q

What are examples of opportunistic health promotion in primary care?

A

Advice within consultation i.e. smoking, diet, taking bp

Alcohol intervention

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16
Q

What are examples of government health promotion?

A

Legislation
- legal age limits, smoking ban, health and safety, clean air act, highway code

Economic
- tax on cigarettes and alcohol

Education
- HEBS

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17
Q

What are the categories of government health promotion?

A

Legislation
Economic
Education

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18
Q

What is primary prevention?

A

Measures taken to prevent onset of illness or injury

reduces probability and/or severity of illness or injury

eg. smoking cessation or immunisation

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19
Q

What is tertiary prevention?

A

Measures to limit distress or disability caused by disease

Any intervention after disease onset that limits the effect of the disease

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20
Q

Describe the role of parenting in lifelong health

A

Habits and lifestyles established in adolescence

Smoking more than 2x as likely if parents smoke

Neglect and abuse recur

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21
Q

What are important aspects of consultations regarding children?

A

Listening, watching, observing, examining properly

Putting child and parent at ease

Be seen to take it seriously

Parental understanding is important, explain in clear language what you are thinking and what the plans are

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22
Q

define resilience

A

the capacity to recover quickly from difficulties, toughness or being able to bounce back

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23
Q

What dimensions does resilience cover?

A 
Self efficiency
Self control
Self regulation
Planning
Perseverance
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24
Q

What personal strengths underpin resilience?

A
  • high frustration tolerance
  • self acceptance
  • self belief
  • humour
  • perspective
  • curiosity
  • adpatability
  • meaning
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25
Q

What behaviours support resilience?

A

Building/having support networks

reflective ability

Assertiveness

Avoiding procrastination

Developing goals

Time management and work-life balance

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26
Q

What are personal sources of burnout?

A

Perfectionism, denial, avoidance, micromanaging, unwilling to seek help, being too conscientious

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27
Q

What are professional sources of burnout?

A

Culture or invulnerability, culture or presenteeism, blame culture/silence

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28
Q

What are systemic sources of burnout?

A

Overwork, shiftwork, lack of oversight

Chaotic work environments

Lack of teamwork, fractured training

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29
Q

What is an occupational history?

A

Chronological list of all patient’s employment with intention of determining whether work has caused or exacerbated ill health

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30
Q

Explain the fit note

A

Replaced the sick note in April 2010

To facilitate earlier discussion about returning to work and rehab, nor includes items of considerations for employers

Advice to patients, not binding on employer and doesn’t affect Statutory Sick Pay

required if off more than seven consecutive days

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31
Q

What are fit note options regarding return to work?

A

Phased return to work

Altered hours

Amended duties

Workplace adaptation

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32
Q

What is the definition of sustainability?

A

Ability to continue over a period of time

33
Q

What are low carbon clinical care features?

A

Prioritises environmental health

Substitute harmful chemicals with safer alternatives

Reduce and safely dispose of waste

Use energy efficiently, switch to renewable energy

34
Q

Describe the effect of unemployment on health

A

Strong association between unemployment and poor health

  • mental health, psychological distress
  • general health
35
Q

What is the main cause of death in men age 15-34?

A

Suicide

36
Q

Describe issues with unexpected death

A

Profound shock
No chance to say goodbye or take back words

Accidents may be compounded by multiple deaths, legal involvement, press coverage

37
Q

What is terminal care?

A

Last phase of care when patient condition is deteriorating and death is close

Often misleadingly associated with cancer

38
Q

Describe palliative care

A

Emphasises QoL
Performed by MDT
Communication between members essential

Mostly in primary care with help from specialists

39
Q

How can we identify if a patient is at a palliative stage?

A

Supportive and Palliative Care Indicators Tool

A guide for doctors to consider their patients who have a life limiting diagnosis or worsening chronic condition

40
Q

What is the palliative performance scale?

A

Used to determine a score or the patient

Read horizontally until best fit for patient is reached and then a score assigned

41
Q

Discuss palliative care in primary care

A

Practices have a register of palliative patients

Practice team meet regularly to discuss

Enhances communication between team members

OOH also notified of palliative cases

42
Q

What symptoms are involved in palliative care?

A

None should be ignored

Pain often feared

Anxiety, nausea and insomnia may be significant and distressing symptoms

43
Q

How does WHO describe palliative care?

A
  • Provides relief from pain and other distressing symptoms
  • affirms life and regards dying as normal process
  • intends neither to hasten or postpone death
  • integrates psychological and spiritual aspects of patient care
  • offers a support system to help patients live actively as possible until death
  • offers support system for family
  • team approach
44
Q

Who may be involved in palliative care MDT?

A

Health and Social Care Team

Macmillan nurses, CLAN, Marie Curie Nurses, religious or cultural groups

45
Q

What makes a ‘good death’?

A

Pain-free

Open acknowledgement of imminence

Death at home with friends and family

“aware” death in which personal conflicts and unfinished business are resolved

46
Q

How should you approach breaking bad news?

A 
Listen
Set scene
Find out patient understanding
Find out how much they want to know
Share info using common language
Review and summary
Opportunity for questions
Follow up and support
47
Q

How to respond to request for euthanasia?

A 
Listen
Acknowledge issue
Explore reasons
Explore ways to give patient more control
Look for treatable problems
Remember spiritual issues
Admit powerlessness
48
Q

What are the stages of adjustment in grief as described by Parkes?

A

Shock and numbness; may bring on impaired judgment and short focus/attention

yearning and searching; may withdraw/want to be left alone, anger, guilt, restlessness

Disorientation and disorganisation; the loss becomes a reality, confusion and unsettled

Reorganisation and resolution; increased decision making, increased self-confidence and focus

49
Q

What are some reactions to bad news?

A 
Shock
Anger
Denial
Bargaining
Relief
Sadness
Fear
Guilt
Anxiety
Distress
50
Q

What is sociology?

A

The study of the development structure and functioning of the human body

51
Q

How does sociology apply to healthcare?

A

Studies people’s interactions with those engaged in medical occupations

Studies the way people make sense of illness

Studies the behaviour and interactions of health care professionals in their work setting

52
Q

Describe the sociology of the medical profession

A 
Systmatic theory
Authority recognised by its clientele
Broader community sanction
Code of ethics
Professional culture sustained by former professional sanctions
53
Q

Describe the role of the healthcare professional in the sick role

A

Professional must be objective and not judge patients morally

Must not act out of self-interest or greed but put patients interests first

Must obey professional code of conduct

Must have and maintain necessary knowledge to treat patients

The right to examine patient intimately, prescribe treatment

54
Q

What is the NS-SEC?

A

National statistics Socio-economic classification

55
Q

Describe the headings under NS-SEC

A
  1. 1; large employers and higher managerial/administrative occupations
  2. 2; higher professional occupations

2; lower managerial, admin and professional occupations

3; intermediate occupations

4; small employers and own account workers

5; lower supervisory and technical occupations

6; semi-routine occupations

7; routine occupations

8; never worked and long-term unemployed

56
Q

Why was the NS-SEC created?

A

Constructed to measure the employment relations and conditions of occupations

Central to showing socioeconomic positions in modern society and help explain variations in social behaviour

Also reasonably validated both as a measure and good predictor of health, education and many other outcomes

57
Q

What are social/socio-economic influences on our health?

A 
Gender
Ethnicity
Physical environment/housing/ homelessness
Education
Employment
Income/social status/financial security
Health system
Social environment
58
Q

What are potential barriers to the use of health services?

A

Patient level; language concerns, understand the system, beliefs

Provider level; understanding of differences due to ethnicity, provider skills and attitudes

System level; organisation of appointments and referrals

59
Q

Describe culturally competent care

A

Combination of attitudes, skills and knowledge that allows an understanding and therefore better care of patients with different backgrounds to our own

60
Q

Describe employment as a social factor

A

Provides income and financial security

Provides social contacts

Provides status in society

Provides a purpose in life

Unemployment associated with raised morbidity and premature mortality

61
Q

How does WHO define health inequalities?

A

the difference in health status or in the distribution of health determinants between different population groups

62
Q

What barriers stop those with a learning disability from getting good quality healthcare?

A
  • lack accessible transport links
  • patients not identified as having a LD
  • staff having little understanding of LD
  • failure to recognise that a person with a LD is unwell
  • failure to make correct diagnosis
  • anxiety of lack of confidence
  • lack of joint work from different care providers
  • not enough involvement from carers
  • inadequate after care or follow-up
63
Q

What are challenges for refugees arriving in a new country?

A

Family integrity and social adjustments

Language barriers

Poorly controlled or undiagnosed health conditions due to previous medical system eroding

Previous exposure to violence, torture, warfare and internment

Depression, anxiety, PTSD prevalent

Anti-immigrant sentiments

64
Q

What is the inverse care law?

A

Published in the lancet

Described that those who most need medical care are least likely to receive it

those with least need of health services tend to use them more and also more effectively

65
Q

What are the key points in the scottish government “equally well” document?

A

Health inequalities a significant challenge in Scotland

Poorest in our society die earlier and have higher rates of disease

Healthy life expectancy needs to be increased across the board

Tackling health inequalities requires action from national and local government as well as other agencies

Priority areas are children and killer diseases i.e. heart, mental health, drugs

Radical cross-cutting action needed to address Scotland’s health gap between citizens

66
Q

What can reduce health inequalities?

A

Effective partnerships across range of sectors and organisations

Evaluate and refine integration of health and social care

government policies and legislation

Time to invest in more vulnerable groups

Improving access to health and social care services

Reduction in poverty

Social inclusion policies

Improved employment opportunities for all

Ensuring equal education access

Improved housing in deprived areas

67
Q

What are the benefits of volunteering?

A 
Gain confidence
Make a difference
Meet people
Be part of a community
Learn new skills
Take on a challenge
Have fun
68
Q

Describe Horsfal recommendations to the GMC

A

Not only clinical skills and knowledge but also resilience and coping techniques

69
Q

What are the Wilson and Jugner criteria for screening?

A

Will the test detect the condition at an early pre-clinical stage?

Is the disease an important public health problem?

Is the natural history of the disease adequately understood?

Is a test available for the condition?

Is the test sensitive (low false negatives)?

Is the test specific (low false positives)?

Is the test safe?

Is the test acceptable to the public and professionals involved?

Is the cost of the test reasonable?

Does the overall cost-benefit analysis make it worthwhile e.g. number of tests required to save one life?

Is treatment for the condition being screened for of proven effectiveness?

Is treatment for the condition being screened for safe?

Is treatment for the condition being screened for acceptable to public and professionals?

Are facilities for diagnosis and treatment available?

70
Q

Occupational questions

A

Does he work with chemical irritants?

How much exposure does he have to these irritants (intensity/duration)?

Do his symptoms improve when not at work e.g. onshore, holiday?

Is personal protective equipment (PPE) used?

Does the patient comply with PPE use?

Does the company enforce PPE use?

Do other work colleagues have similar symptoms?

Has he any hobbies/pets/other activities which may be a likely cause?

Does he use hand cream or other topical agents he may be allergic to?

71
Q

MIld-moderate mental health conditions occurring in society

A

Depression

Generalised anxiety disorder

Panic disorder

Social anxiety disorder

Obsessive-compulsive disorder

Post-traumatic stress disorder

72
Q

team members and roles

A

District nurse and/or practice nurse; e.g. pressure areas, bloods, BP monitoring

Home carer; practical tasks e.g. bathing, dressing

Pharmacist; Advice on medication, dossett box

Care Manager; Assessment and organisation of care

OT; Adaptating living environment to maximise independence e.g. stair lift, hoist, shower modification

Physiotherapist; Maintain any remaining mobility, walking aids

GMED/NHS 24; Out of hours care if unexpected problems

Nurse practitioner; Initial assessment during house call if change in health, GP supported prescribing

Dietician; Advice on diet to minimise further deterioration in renal function

Practice staff e.g. receptionist; Passing on concerns/first point of contact

Physician’s assistant; GP supported medical assessment and care

Paramedic Practitioner; Acute assessment

Social worker; Benefits, contact with agencies

Link Practitioners; Signposting to third sector agencies

73
Q

Potential factors in illness

A

Poor diet

Inadequate sleep

Excess screen time

Lack of exercise/too much exercise

Academic difficulties

Home/relationship difficulties

Bullying

Social isolation

Mental illness

74
Q

Benefits of exercise

A

Builds confidence and social skills

Develops coordination

Improves concentration and learning

Strengthens muscles and bones

Improves health and fitness

Improves sleep

Aids weight loss/reduces risk excess weight gain

Makes you feel good/improves feeling of general well-being

75
Q

Important points in breaking bad news

A

Listen to the patient and their carers

Set the scene

Check whether wants to speak alone or with someone present

Find out what the patient already understands

Find out how much the patient wants to know

Share the information using a common language/avoid jargon

Review and summarise the information

Allow opportunities for questions

Agree follow up and support

76
Q

Indications for requiring palliative care

A 
Relying on others for care
Spending >50% day in bed/chair
Long term O2 therapy
Various recent hospital admissions
Not expected to be alive in next 6-12months
Breathless with minimal exertion
77
Q

What attributes did the our voice citizens panel consider to make a good doctor?

A

Good listener
Friendly/approachable
Knowledge/qualifications

78
Q

What did the our voice citizens panel consider to be aspects of a good consultation?

A

Feeling listened to/not being rushed
Clear communication
Resolution/diagnosis/outcome

Primary Care (2 decks)

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