VLE & SocPop

Question 0

What are the 4 forms of autonomy?

Answer 0

Principled autonomy: Implies obligations as well as rights
Relational autonomy: Importance of family in decision making
Autonomy as identity: Important in situations where capacity is lacking e.g. dementia
Procedural autonomy: Criteria for legal capacity

Question 1

What are the 3 conceptions underlying autonomy?

Answer 1

Bodily inviolability: Links to legal concept of battery
Freedom from interference: Free choice, implications for restraint
Self determination: Implies life goals, higher and lower order desires

Question 2

What is principled autonomy?

Answer 2

Responsibility on the decision-maker to make choices within the specified moral framework in order to be truly autonomous
Requirement that the patient makes a settled choice in relation to medical treatment responsibly and in consideration of others

Question 3

What is relational autonomy?

Answer 3

Autonomy is embedded in social relationships
Autonomy is expressed in terms of social relationships
Implications for health care: Role of family in medical decision making

Question 4

What is procedural autonomy?

Answer 4

Capacity and consent criteria
Person required to demonstrate certain criteria before judged to have autonomy, usually cognitive criteria
– Capacity test (MCA 2005)
– Requirement for ‘substantial degree of understanding’
– Requirement for critical reflection

Question 5

What is the Legal requirement to respect autonomy?

Answer 5

Treatment without consent is battery (common law)
A person is not to be treated as unable to make a decision unless all practicable steps to help him to doso have been taken without success Standard of care for provision of information -what that person would want to know (negligence)

Question 6

What relates autonomy to capacity?

Answer 6

Capacity is decision specific, Autonomy is a continuum
Person lacks capacity to make one decision, may have capacity to make many others
Even for the specific decision where capacity is lacking, it may still be possible to respect autonomy to some degree

Question 7

What is a doctors duty of care?

Answer 7

To respect autonomy, act in a patient’s best interests, protect a patient from harm
If an adult has capacity their autonomous decision must be respected even if this results in harm to that person (e.g. refusal of life sustaining treatment) If a person lacks capacity a doctor must treat them according to the principle of best interests and must protect them from harm. Challenges arise for doctors in situations of uncertainty

Question 8

An adult patient refuses treatment thought by theclinical team to be in their best interests. What do you need to think about?

Answer 8

Do they lack capacity? MCA criteria for capacity
Is their decision properly informed?
Are they being coerced/unduly influenced?
If they lack capacity, how much does their refusal influence your assessment of their best interests?
To what extent can you restrain them to treat in their best interests?

Question 9

What is abuse?

Answer 9

Misuse of power and control that one person has over another. Where there is dependency, there is a possibility of abuse or neglect unless
adequate safeguards are put in place

Question 10

Which people are commonly at risk of abuse?

Answer 10

Older person who is particularly frail
Individual with a mental disorder, including dementia or personality disorder
Person with a significant and impairing physical or sensory disability
Someone with a learning disability
Person with a severe physical illness
Unpaid carer who may be overburdened, under severe stress or isolated
Homeless person
Person living with someone who abuses drugs or alcohol
Women who may be particularly vulnerable as a result of isolating cultural factors

Question 11

What are the principles of safeguarding vulnerable adults?

Answer 11

Empowerment - Presumption of person led decisions and informed consent
Protection - Support and representation for those in greatest need
Prevention - It is better to take action before harm occurs
Proportionality – Proportionate and least intrusive response appropriate to the risk presented
Partnership - Local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse
Accountability - Accountability and transparency in delivering safeguarding

Question 12

What are the 4 concepts of well being and best interests?

Answer 12

Mental state theory: Experiential, what brings about the most happiness for this person
Desire fulfilment theory: Best interests consistent with the person’s autonomous choices
Objective list theory: Set of agreed criteria for achieving well being eg
independence, ability to have meaningful relationships
Composite theories: Combination of different theories

Question 13

What are best interests?

Answer 13

An adult with capacity is the arbiter of what is in his or her own best interests (respect for autonomy)
Mainly considered by others in relation to those who lack capacity or autonomy
When considered by others there is a requirement to take into account the wishes of the person in so far as is possible (respecting autonomy)

Question 14

What does the MCA state is in the best interests checklist?

Answer 14

Must consider, so far as is reasonably ascertainable:
Person’s past and present wishes and feelings (and any relevant written statement made by him when he had capacity)
Beliefs and values that would be likely to influence his decision if he had capacity
Other factors that he would be likely to consider if he were able to do so which could include his current level of happiness

Question 15

How do you decide whether restrain is appropriate?

Answer 15

In considering whether to restrain a person or to deprive them of their liberty in order to treat them in their best interests you need to consider
The harm that will occur to the person if you do not restrain and treat them
The harm of restraining them (physical and psychological)
The minimum level of restraint required
The proportionality of the restraint to the benefit of the treatment

Question 16

What is the legal framework for restraint and deprivation of liberty?

Answer 16

Restraint (short term): Mental Capacity Act
Restraint or detaining a person so that they are not at liberty to leave (longer than necessary for immediate treatment): Deprivation of Liberty Safeguards (DOLS: formal process at an organisational level with
independent oversight)

Question 17

What are the models of disability?

Answer 17

Medical model
Social model
Interactional or integrated model

Question 18

What is the medical model of disability?

Answer 18

Disability intrinsic to the individual – individual deficit
Restrictions experienced, attributed to individual characteristics – physical or cognitive impairments
Interventions/services focus on changing or curing the individual with the deficit
Health care professionals role central in treatment
Disabled people are defined and controlled by medicine

Question 19

What are criticisms of the medical model?

Answer 19

Individualises the issue of disability
Places power in hands of the medical profession
Promotes negative image, disempowered image of disabled people
May be seen as a ‘personal tragedy’
Disabled people’s movement challenged this by raising personal experience of disabled people as primary source of knowledge
Identifying disability as public issue rather than private issue
suggests it needs socio-political responses

Question 20

What is the social model of disability?

Answer 20

Came about as a result of disabled people’s movements
Shifts focus from individual and intrinsic to the social and extrinsic
Problem faced by individuals not primarily caused by impairments/condition but by the way society is organised
Makes a distinction between impairment and disability
Impairment is bodily, mental or intellectual limitation or condition Disability is loss or limitation of opportunities to take part in society on an equal basis due to social and environmental barriers
Disability not seen as inevitable consequence of living with impairment
Emphasises to adjust environment within which disabled people live: ie remove physical, attitudinal and social barriers to participation
Highly influential model: identifies disability as social oppression that is linked with a strategy for social and political change
Emphasises rights of disabled people to normal life

Question 21

Give an example of a condition which questions the medical model and supports the social model of disability

Answer 21

Disability is context specific
Example of Achondroplasia: condition resulting in short limbs (is this impairment?)
disability occurs due to lack of adjustments to the environment and due to social and attitudinal barriers

Question 22

What is the Interactional or integrated model of disability?

Answer 22

Idea that disability results from complex interactions between impairments and the social and cultural contexts
Many experiences previously viewed as inevitable consequences of impairment now regarded as unacceptable and unnecessary
discrimination – violations of human rights

Question 23

What is the function of the International Classification of Functioning?

Answer 23

Aims to address difficulties with previous classification system: Addresses difference of emphasis implicit in the medical and social models of disability
Establish a common language for describing health to improve communication between different users such as healthcare workers, researchers, policy makers and the public
Provide an international coding system for classifying coding and
functioning

Question 24

What tools are there for promoting human rights and equality?

Answer 24

International: UN Convention on Rights of Persons with Disabilities (UNCRPD)
National: e.g. UK Equalities Act (2010)

Question 25

What does the UN Convention on Rights of Persons with Disabilities say about disability?

Answer 25

Establishes that disabled people are not ‘other’, have the same rights and as others
Human rights legislation established a universal standard or benchmark which can be applied
If a disabled person’s experiences fall short of this universal standard, it is understood as a human rights violation

Question 26

Give some examples of rights covered by the UNCRPD

Answer 26

Equality before the law without discrimination
Right to life, liberty and security of the person
Equal recognition before the law and legal capacity
Freedom from torture
Freedom from exploitation, violence and abuse
Right to respect physical and mental integrity
Freedom of movement and nationality
Right to live in the community
Freedom of expression and opinion
Respect for privacy
Respect for home and the family
Right to education
Right to health
Right to work
Right to adequate standard of living
Right to participate in political and public life
Right to participation in cultural life

Question 27

What is the UK Equality Act in relation to disability?

Answer 27

Requires equal treatment in access to employment, services, regardless of protected characteristics of age, disability, gender reassignment, marriage, civil partnership, race, religion or belief, sex, and sexual orientation
Definition of disability: A person is disabled if s/he has a physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities

Question 28

Why is human rights and equality legislation needed in relation to disability?

Answer 28

Disabled people experience social, economic and health inequality: lower levels of participation in all aspects life

Question 29

Describe the epidemiology of disability and circumstances that disabled people are more likely to encounter

Answer 29

11 million disabled people in UK: 16% working age adults, 45% of people over state pension age, 6% children and young people
More likely to experience poverty than other people
Significantly less likely to be in employment
More likely to experience discrimination at work
3 times as likely to not have any qualification
Over 1/4 say they don’t have choice and control over their daily lives
1/3 report difficulties accessing goods and services
More likely to experience poor health outcomes even unrelated to their impairment eg people with learning disabilities

Question 30

What types of barriers exist to disabled people?

Answer 30

Environmental
Social
Attitudinal

Question 31

What is the hierarchy of evidence?

Answer 31

Systematic reviews: meta-analyses, non meta-analytic reviews
Experimental studies: Randomised controlled trials, Controlled trials
Observational studies: Cohort studies, Case-controlled studies
Descriptive Studies: Cross sectional designs

Question 32

What is a systematic review?

Answer 32

Identify effective, harmful and ineffective health care
Collate empirical evidence that fits pre-specified eligibility criteria to answer a specific research question
Done in as reliable a way as possible – systematically
Explicit methods selected to minimize bias

Question 33

What are the key characteristics of a systematic review?

Answer 33

Clearly stated objectives with pre-defined eligibility criteria
Explicit, reproducible methodology
Systematic search which identifies all studies meeting eligibility criteria
Assessment of validity of findings of included studies, looking for bias
Systematic presentation and synthesis of findings of included studies

Question 34

What is a meta-analysis?

Answer 34

Results of individual studies combined to produce overall statistic
More precise estimates of the effects of health care than those derived from individual studies included in a review
Subject to biases that arise from the study selection process, may produce mathematically precise but clinically misleading result

Question 35

What is a review?

Answer 35

General term for all attempts to synthesize the results and conclusions of two or more publications on a given topic

Question 36

What is an overview?

Answer 36

When a review strives to comprehensively identify and track down all the literature on a given topic (systematic literature review)

Question 37

Why use systematic reviews?

Answer 37

Clinicians need to be evidence-based: making judicious use of the evidence, ensuring practice is up-to-date
Busy clinicians need quick and effective ways of identifying what works best for their patient
Refine unmanageable amounts of information
Added power brought by synthesising the results of a number of smaller studies

Question 38

What types of questions could be answered by a systematic review?

Answer 38

Identify whether what we’re doing makes a difference
Causes of health problems
Know whether we can predict problems and intervene early
Know whether we can prevent problems
Best ways of diagnosing/identifying problems
Extent of a particular problem
How people feel about health interventions or reasons for behaving as they do
How expensive what we are doing is, value for money

Question 39

What type of evidence is required to analyse how effective interventions are in preventing or reducing the risk of disease?

Answer 39

Review of prevention studies e.g. RCTs

Question 40

What type of evidence is required to analyse whether a particular public health intervention does more harm than good?

Answer 40

Review of treatment studies e.g. RCTs

Question 41

What type of evidence is required to analyse whether particular methods of screening enable us to predict particular problems and intervene early?

Answer 41

Diagnostic/screening studies comparing a new diagnostic method with a gold standard
RCTs examining the effectiveness of a screening programme

Question 42

What type of evidence is required to analyse the risk factors associated with a particular condition?

Answer 42

Review of aetiological studies e.g. cohort or case-controlled studies

Question 43

What type of evidence is required to analyse anticipating outcomes of particular conditions for groups of individuals?

Answer 43

Review of prognostic studies e.g. cohort or case-controlled studies

Question 44

What type of evidence is required to analyse the experience or meaning of a particular condition or treatment i.e. what does it feel like or mean?

Answer 44

Review of experiential studies e.g. qualitative

Question 45

What evidence is required to analyse the extent of a particular problem or if it has increased over time?

Answer 45

Review of prevalence studies e.g. cross-sectional studies

Question 46

What evidence is required to analyse if the expense of what we do is justified?

Answer 46

Review of cost-effectiveness studies e.g. RCTs

Question 47

What aspects of health care can be analysed using quantitative studies?

Answer 47

Prevention/Treatment/therapy 
Causation 
Diagnosis/Prognosis 
Cost/cost-effectiveness 
Prevalence

Question 48

How should a research question be correctly arranged?

Answer 48

Population; Intervention; Comparator; Outome [PICO]

Question 49

What is a Qualitative (narrative) summary?

Answer 49

Narrative about participants, intervention, setting, outcomes, study types, whether intervention appears to do good or harm

Question 50

What is a Quantitative (statistical) summary?

Answer 50

Present results separately for each individual outcome from individual studies
Combine the results in a meta-analysis

Question 51

What is a weighted mean effect size?

Answer 51

Effect measures for continuous data in meta analysis
e.g. weight; blood pressure
mean t1 – mean t2 weighted by individual variances for each study

Question 52

What is standardised mean effect size in a meta analysis?

Answer 52

Data from different standardised scales
eg Edinburgh postnatal depression scale; General Health questionnaire
Mean t1 – mean t2 / pooled SD

Question 53

What is a relative risk or odds ratio used for in a meta analysis?

Answer 53

Effect measures for binary/dichotomous data (disease/no disease)
RR= p exposed / p non-exposed

Question 54

Describe the scale of effect sizes

Answer 54

0. 2/0.3 = Small ES
1. 5 = Medium ES
2. 8 upwards = Large ES

Question 55

What are limitations of systematic reviews?

Answer 55

Disguise/oversimplify distinctions between primary studies with regard to inclusion/exclusion criteria or the nature of an intervention
Reviews of similar topics may reach different conclusions depending on the form of the review question
Make it difficult for practitioners to apply results of studies to specific characteristics of the situation in which they find themselves
Findings from systematic reviews not always consistent with findings of large-scale high quality trials

Question 56

What are types of bias?

Answer 56

Selection bias: bias in the way included studies selected e.g publication bias
Attrition bias: differences between comparison groups in loss of participants from the study
Performance bias: differences in care provided to participants in comparison groups other than the intervention under investigation
Detection bias: differences between comparison groups in outcome
assessment

Question 57

What are funnel plots?

Answer 57

Way of assessing whether results of a review have been influenced by publication bias
Symmetric interpreted as probably no publication bias
Asymmetric interpretation is that publication bias is likely

Question 58

What questions can be asked to critically appraise a systematic review?

Answer 58

Is the study valid?: clearly focused question? include right sort of study
Are the results reliable?: all relevant studies identified? quality of included studies appraised? If results combined – was this done appropriately? How are results presented – what is the result? How precise are the results?
Can I generalise from this study to my workplace?: Can they be applied to local population? Were all important outcomes considered? Should policy or practice change as a result?

Question 59

What are Ethical justifications for members of the public assisting in emergency situations?

Answer 59

Duty: As a citizen: a moral duty to assist someone in need
Benefit (consequentialism): May save someone’s life or prevent further harm
Virtue ethics: Compassionate response to someone in need

Question 60

What are ethical justifications for doctors assisting in emergency situations?

Answer 60

Duty: Professional duty of care, General moral duty to assist is greater because of your professional standing
Benefit (consequentialism): A doctor is more likely to be able to benefit a person because of their particular knowledge or skill
Virtue ethics: Compassion is expected in a good doctor

Question 61

What is the legal position on assisting in a medical emergency situation?

Answer 61

In UK, no general legal obligation to assist in an emergency situation
Doctor not under legal obligation to assist unless there is an established professional duty of care: E.g. in a hospital setting
General practitioners may have contractual obligation to provide treatment in emergency during core hours within their practice area
If a doctor identifies themself as such and offers assistance in that capacity a legal duty of care is established
Unlikely that a legal claim in negligence would be successful unless the standard of care fell below what would be expected of a doctor in that situation
Important not to go beyond your clinical competence

Question 62

What professional guidance does the GMC provide on assisting in an emergency situation?

Answer 62

You must offer help if emergencies arise in clinical settings or in the community, taking account of: your own safety, your competence,
and the availability of other options for care

Question 63

What indemnity exists to protect doctors in emergency situations?

Answer 63

NHS Litigation Authority provides indemnity to employees in respect of clinical negligence claims
Most doctors employed by NHS covered for duties listed in their contract by Hospital & Community Health Services indemnity scheme

Question 64

What issues are not covered by indemnity?

Answer 64

Disciplinary issues (by employer)
Referrals to the General Medical Council
GP contractors, locum GPs and salaried GPs
Does not apply to: stopping at accidents/good Samaritan acts not listed in contract, clinical trials not covered under legislation, work for any other agency on a contractual basis, work for voluntary/charitable bodies, work overseas

Question 65

Who provides indemnity for Good Samaritan acts?

Answer 65

Medical Protection Society/Medical Defence Unions provide indemnity for Good Samaritan Acts in all jurisdictions

Question 66

What are the Medical Protection Society: The five Cs regarding indemnity?

Answer 66

Clinical competence
Clinical negligence  
Communication 
Consent 
Case notes

Question 67

What does the GMC say on informal medicine?

Answer 67

Treating acquaintances, friends and family

Wherever possible you must avoid prescribing foryourself or anyone with whom you have a close personal relationship

Question 68

What are the arguments for informal medicine?

Answer 68

Relationship of trust between doctor and patient
Greater understanding of the person and the context by doctor
Leads to a better standard of care
Reduced burden on NHS

Question 69

What are the arguments against informal medicine?

Answer 69

Emotional involvement may lead to lack of objectivity
Assessment at home not as good as clinical setting so standard of care may be lower
Impaired relationship with own GP
Confidentiality
Doctor may not wish to explore sensitive topics
Patient may feel unable to refuse treatment/seek alternatives

Question 70

What does the GMC say on personal and professional boundaries?

Answer 70

Make sure conduct justifies patients’ trust & public’s trust in the profession
Social media blurred boundaries between public and private life, online information can be easily accessed by others
Be aware of limitations of privacy online, regularly review privacy settings for profiles. Patients, your employer & potential employers may be able to access personal information
Must not use professional position to pursue sexual or improper emotional relationship with a patient or someone close to them
Personal relationships with former patients may also be inappropriate depending on: length of time since professional relationship ended, nature of previous professional relationship, whether patient was vulnerable at the time of professional relationship, whether they are still vulnerable, whether you will be caring for other members of the patient’s family

Question 71

What does the GMC say on medical students and professional practice?

Answer 71

Medical students have legal restrictions on clinical work they can do, should be aware of often acting in position of a qualified doctor and their activities will affect patients
Patients may see students as knowledgeable, consider them to have the same responsibilities and duties as a doctor
Basic medical training gives opportunity to learn professional behaviour in supervised environment, safe for patients
An opportunity for medical schools to identify types of behaviour that are not safe, to take appropriate action to help students improve their behaviour; if this is not possible, make sure they do not graduate as doctors
Students must be aware that behaviour outside clinical environment, including personal lives, may impact fitness to practise. Behaviour at all times must justify the trust the public places in the medical profession

Question 72

What are Personal and professional obligations as a medical professional?

Answer 72

Professional status imposes ethical, professional and legal duties
Basis of patient doctor relationship is one of trust and trustworthiness
Legal and professional duties based on what we as a society expect of a doctor
A doctor may have to weigh personal and professional obligations: e.g. duty to patients and duty to family

Question 73

What are Health Advantages of Work?

Answer 73

Income 
Status: Self esteem
Purpose 
Influence 
Security

Question 74

Who does the cost of ill health affect?

Answer 74

State: benefits, taxes, extra healthcare
Individuals: loss of income, emotion and physical costs
Employers: cost of staff turnover, time spent managing absence, OH

Question 75

What is the most common reason forclaiming health-related

benefits?

Answer 75

Mental ill health

Question 76

Who are financially inactive people?

Answer 76

Students
At home
Long-term sick
Retired

Question 77

What are Factors that stand in the way of people staying in work when they are ill?

Answer 77

Culture, beliefs and attitudes: Misconceptions about health and work – need to be 100% fit, Poor retention in work of those with disabilities or chronic disease
Inadequate systems: Inflexible system of sickness certification – sick note, No pathways of rapid intervention stay in work or return to it
Lack of Primary Care involvement: Rehabilitation to work not a performance measure for local health bodies, Configuration of OH services: lack of availability, not available in primary care

Question 78

What is the new government scheme designed to help people stay in work?

Answer 78

Fit for work program 
Likely to be off for 4 weeks/Off for 4 weeks
Consent 
Referral to Fit for Work Service  
Telephone consultation 
Return to Work Plan

Question 79

What can worklessness lead to?

Answer 79

Poorer physical health: More likely to die sooner
Poorer mental health
More medical care
Poorer social integration
Loss of self-confidence
Less monetary resources
Effect on next generation: (e.g. Child deaths from injury correlate with low employment status and worklessness of parents)

Question 80

What has been the changing pattern of work in the UK over the years?

Answer 80

Change from industrial society to a service and information society

Question 81

Describe the change in nature of work that has occurred in the UK over the years?

Answer 81

Manufacturing, Physical, Fixed products, Large firms, Strong Unions, Job for Life, Long Contracts, Full Time, Male Workforce, Women at home, Retire at 65yrs
Changed to: Service Industries, Sedentary, Variety of products, Small and Medium Enterprises, Reduced Membership, Portfolio Careers, Mobile Workforce, Part Time, Flexitime, Diverse Workforce, Women at Work, Work beyond 65yrs

Question 82

What are health risks at work currently in the UK?

Answer 82

Mental Health: depression, anxiety
Musculoskeletal 
Skin 
Respiratory 
Infection

Question 83

What is Occupational Medicine?

Answer 83

Effects of Work on Health, Health on Work
Discipline concerned with the effects of work on health and the influence of pre-existent health problems on the capacity to work

Question 84

What is Occupational Health? ILO/ WHO Definition

Answer 84

Promotion and maintenance of highest degree of physical, mental and social well-being of workers in all occupations
Prevention amongst workers of departures from health caused by working conditions
Placing and maintenance of worker in an occupational environment adapted to physiological and psychological capabilities
Adaptation of work to man and of each man to his job

Question 85

What is a hazard?

Answer 85

Something that might cause harm

Question 86

What is a risk?

Answer 86

The likelihood of harm actually occurring

Question 87

What is a risk assessment?

Answer 87

Identify the hazard
Assess the risks (to health)
Manage/control the risks

Question 88

What are Categories of Hazards?

Answer 88

Physical  
Chemical 
Mechanical (ergonomic)
Biological 
Psycho-social
Organisational

Question 89

What risks exist to junior doctors?

Answer 89

Patients
Investigations 
Therapeutic agents
Environment 
Biological: infectious agents
Chemical: Aldehydes, Anaesthetic agents, Antineoplastic drugs, Latex
Physical: Ionising radiation, Manual Handling
Psycho-social

Question 90

What are Risks from Inoculation injury from source positive patient?

Answer 90

Hep B - 1 in 3
Hep C - 1 in 30
HIV - 1 in 300

Question 91

What are Psychosocial Hazards for a junior doctor?

Answer 91

Working Hours/Shift Systems
Organisational Hierarchy 
Bullying 
Under-stimulation/Over-stimulation 
Commuting 
Stress

Question 92

What might cause Mental Health at Work issues?

Answer 92

Demands: Workload Vs Capacity, Domestic/ family
Control: Pace and organisation of work
Support: Colleagues, managers, human resources and occupational
health, Outside – specialist agencies, health professionals, family and friends

Question 93

What is the incidence of mental health problems?

Answer 93

1 in 6 adults will currently have a mental health condition

Further 1 in 6 will have poor mental health: Poor sleep, Worry, Fatigue, Irritability

Question 94

What are blue flag workplace issues with back pain?

Answer 94

Fear of re injury
High physical demands of job
Low expectation of return to work 
Low job satisfaction
Low support
Lack of adjustments
Poor communication

Question 95

What are red flags with back pain?

Answer 95

Sphincter disturbance
Gait disturbance
Saddle anaesthesia
Age under 20 or over 50
Non mechanical pain
Thoracic pain
History of cancer, HIV, steroids
Unwell, weight loss
Widespread neuro abnormality
Structural deformity

Question 96

What are Work-related neck & upper limb disorders?

Answer 96

Shoulder pain 
Epicondylitis 
Tenosynovitis 
Non-specific diffuse forearm pain
Carpal Tunnel Syndrome: prolonged and extreme wrist flexion, forceful and repetitive wrist movement, direct pressure on the carpal tunnel, use of hand-held vibrating tools

Question 97

How can we Reduce the risk of upper limb disorders?

Answer 97

Improved ergonomics of tool design, equipment and work layout to improve posture, reduce forces and repetition
Job rotation to reduce time at a repetitive task
New employee to work at a slower rate initially
Rest breaks to allow recovery time
Redeployment if the above measures aren’t effective
Rehabilitation of affected worker: Reduce hours, Reduce work-rate

Question 98

What can be Causes of Occupational Asthma?

Answer 98

Bakers: Flour and enzymes
Isocyanates: Paint sprayers, Polyurethane foam, Glues and laminates
Animal handlers
Wood workers

Question 99

How can we tell if something is Illness at Work or Work Related Illness?

Answer 99

Coincidental / Inter-current
Made worse by Work
Caused by Work
History, Examination, Investigations

Question 100

What does asbestos exposure put you at risk of?

Answer 100

Mesothelioma

Question 101

Who Assesses fitness for work?

Answer 101

GP is rarely involved with determining fitness to start work

Normally Employer’s responsibility (with advice from their Occupational Health Adviser)

Question 102

What are Return to Work Considerations?

Answer 102

Return to work should be one of key clinical outcomes by which success of treatment is measured
Needs to be an integral part of the case management plan
After only six weeks sickness absence, almost one in five people will eventually leave paid employment

Question 103

How does Sickness absence certification work?

Answer 103

Sickness absence self-certification Up to 7 days

Beyond 7 days: Medical Certificate Now called fit note

Question 104

What is a Fit note and what does it do?

Answer 104

Provide certification for statutory sick pay
Play a key role in advising patients about return to work
Help patients develop a return-to-work plan
Facilitate return to work through communication with patients and employers

Question 105

What considerations about the medical condition should be taken into account with planning return to work?

Answer 105

Nature of the medical condition
Appropriate clinical guidelines for management of the condition
Work factors that might aggravate health problems
Patient’s expectation and needs in relation to work

Question 106

If a patients fit note says that they MAY be fit for work, what factors need to be considered?

Answer 106

What can they not do?
Amended duties: activities to be avoided
Altered hours: changes to the times or duration of work
A phased return to work: a gradual increase in work duties or hours
Workplace adaptations: changing aspects of the workplace

Question 107

How is disability assessed for fit for work purposes?

Answer 107

Without medication/prosthesis or other aid

If without them he would be substantially impaired, he is disabled

Question 108

What can be put in place to help someone assessed to be disabled under the fit for work program?

Answer 108

Make ‘reasonable adjustments’ to avoid being put at a disadvantage compared to non-disabled people in the workplace: Hours, Equipment

Question 109

What are Occupational Health Services?

Answer 109

Not part of the NHS
No legal obligation for employers to provide an Occupational Health Service
Management of Health and Safety at Work Regs 1999: appoint competent persons to fulfill their statutory responsibilities

Question 110

What are Special Occupations requiring Statutory obligation to provide occupational health due to risk from specific health hazards associated with their work?

Answer 110

Ionising radiation
Lead 
Asbestos 
Compressed Air 
Diving

Question 111

What is the OH Teams role?

Answer 111

Providing independent and impartial advice to both employer and employee
Investigating and diagnosing those who are sick or injured due to their work
Assisting return of sick and injured to work at the earliest opportunity
Matching people with jobs appropriate to their health, fitness and susceptibility status

Question 112

What is the Role of the Health and Safety Executive?

Answer 112

Shaping and reviewing regulations
Producing research and statistics
Enforcing the law

Question 113

What type of help is provided by Access to Work?

Answer 113

Special aids and equipment  
Adaptations to equipment  
Travel to work  
Travel in work  
Communication support at interviews  
Wide variety of support workers
Mental Health Support Service