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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
What behaviours support resilience?
Building/having support networks reflective ability Assertiveness Avoiding procrastination Developing goals Time management and work-life balance
26
What are personal sources of burnout?
Perfectionism, denial, avoidance, micromanaging, unwilling to seek help, being too conscientious
27
What are professional sources of burnout?
Culture or invulnerability, culture or presenteeism, blame culture/silence
28
What are systemic sources of burnout?
Overwork, shiftwork, lack of oversight Chaotic work environments Lack of teamwork, fractured training
29
What is an occupational history?
Chronological list of all patient's employment with intention of determining whether work has caused or exacerbated ill health
30
Explain the fit note
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
31
What are fit note options regarding return to work?
Phased return to work Altered hours Amended duties Workplace adaptation
32
What is the definition of sustainability?
Ability to continue over a period of time
33
What are low carbon clinical care features?
Prioritises environmental health Substitute harmful chemicals with safer alternatives Reduce and safely dispose of waste Use energy efficiently, switch to renewable energy
34
Describe the effect of unemployment on health
Strong association between unemployment and poor health - mental health, psychological distress - general health
35
What is the main cause of death in men age 15-34?
Suicide
36
Describe issues with unexpected death
Profound shock No chance to say goodbye or take back words Accidents may be compounded by multiple deaths, legal involvement, press coverage
37
What is terminal care?
Last phase of care when patient condition is deteriorating and death is close Often misleadingly associated with cancer
38
Describe palliative care
Emphasises QoL Performed by MDT Communication between members essential Mostly in primary care with help from specialists
39
How can we identify if a patient is at a palliative stage?
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
What is the palliative performance scale?
Used to determine a score or the patient Read horizontally until best fit for patient is reached and then a score assigned
41
Discuss palliative care in primary care
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
What symptoms are involved in palliative care?
None should be ignored Pain often feared Anxiety, nausea and insomnia may be significant and distressing symptoms
43
How does WHO describe palliative care?
- 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
Who may be involved in palliative care MDT?
Health and Social Care Team Macmillan nurses, CLAN, Marie Curie Nurses, religious or cultural groups
45
What makes a 'good death'?
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
How should you approach breaking bad news?
``` 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
How to respond to request for euthanasia?
``` Listen Acknowledge issue Explore reasons Explore ways to give patient more control Look for treatable problems Remember spiritual issues Admit powerlessness ```
48
What are the stages of adjustment in grief as described by Parkes?
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
What are some reactions to bad news?
``` Shock Anger Denial Bargaining Relief Sadness Fear Guilt Anxiety Distress ```
50
What is sociology?
The study of the development structure and functioning of the human body
51
How does sociology apply to healthcare?
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
Describe the sociology of the medical profession
``` Systmatic theory Authority recognised by its clientele Broader community sanction Code of ethics Professional culture sustained by former professional sanctions ```
53
Describe the role of the healthcare professional in the sick role
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
What is the NS-SEC?
National statistics Socio-economic classification
55
Describe the headings under NS-SEC
1. 1; large employers and higher managerial/administrative occupations 1. 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
Why was the NS-SEC created?
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
What are social/socio-economic influences on our health?
``` Gender Ethnicity Physical environment/housing/ homelessness Education Employment Income/social status/financial security Health system Social environment ```
58
What are potential barriers to the use of health services?
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
Describe culturally competent care
Combination of attitudes, skills and knowledge that allows an understanding and therefore better care of patients with different backgrounds to our own
60
Describe employment as a social factor
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
How does WHO define health inequalities?
the difference in health status or in the distribution of health determinants between different population groups
62
What barriers stop those with a learning disability from getting good quality healthcare?
- 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
What are challenges for refugees arriving in a new country?
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
What is the inverse care law?
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
What are the key points in the scottish government "equally well" document?
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
What can reduce health inequalities?
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
What are the benefits of volunteering?
``` Gain confidence Make a difference Meet people Be part of a community Learn new skills Take on a challenge Have fun ```
68
Describe Horsfal recommendations to the GMC
Not only clinical skills and knowledge but also resilience and coping techniques
69
What are the Wilson and Jugner criteria for screening?
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
Occupational questions
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
MIld-moderate mental health conditions occurring in society
Depression Generalised anxiety disorder Panic disorder Social anxiety disorder Obsessive-compulsive disorder Post-traumatic stress disorder
72
team members and roles
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
Potential factors in illness
Poor diet Inadequate sleep Excess screen time Lack of exercise/too much exercise Academic difficulties Home/relationship difficulties Bullying Social isolation Mental illness
74
Benefits of exercise
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
Important points in breaking bad news
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
Indications for requiring palliative care
``` 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
What attributes did the our voice citizens panel consider to make a good doctor?
Good listener Friendly/approachable Knowledge/qualifications
78
What did the our voice citizens panel consider to be aspects of a good consultation?
Feeling listened to/not being rushed Clear communication Resolution/diagnosis/outcome

Primary Care (2 decks)

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