WEEK 1: THE TWO AGENDAS Flashcards
Define the following concepts:
Disease
Illness
Sickness
Health
*Disorder of structure or function in an animal or plant of such a degree as to produce or threaten to produce detectable illness or disorder.
The pathological process, deviation from a biological norm.
*Illness is the patient’s experience of ill health, sometimes even when no disease can be found.
*Is the role negotiated between society and the person henceforward called ‘sick’, and the society is prepared to recognize and sustain him.
*Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
What are some of the perspectives on disease or ill health – e.g., causation or otherwise?
*LAY BELIEFS
Disharmony, violation of taboos, ancestor’s warnings, malevolent sorcery [witchcraft] – African, Papua New Guinea
Lack of balance of basic body elements: heat, cold, strong emotions –Chinese, ancient Greek – need for equilibrium.
*MEDICAL
Biomedical - led to more individualistic approach, cause and responsibility with individual rather than family or community.
Describe the medical models of disease causation.
Germ theory
–single cause theory
The classic epidemiologic triad of host, agent, and environment
Multi-causality model
- Sherwin’s Diet heart hypothesis
Describe the germ theory.
*Single cause theory
-All diseases were presumed to be caused by germs and by germs alone.
When infection with SARSCOV-2 (germ) occurs then the disease Viral Corona virus disease-2019 (COVID-19) should surely follow.
SAME EXAMPLES with TB, Ebola, HIV
State the 3 components of the classic epidemiologic triad.
Host, agent and environment
Describe the classic epidemiologic triad theory of disease causation.
*Identifies host, agent, and environment as causing disease
-Provided a better model for understanding the complex realities of disease causation.
-The model is however appropriate for the understanding of infectious diseases.
-The CONCEPT of an AGENT as cause of disease still central
-Acknowledges the variety of relevant factors in the host and the multitude of environmental influences.
Chronic non communicable diseases challenge the AGENT focus..
Describe the multiple causality model of disease causation.
Better expressed the complex reality of multiple causes of disease
Epidemiologists began thinking in terms of chains of causation.
A causal event, then at the antecedents of that event, then at the antecedents of the antecedent, and so on.
E.g. Sherwin’s heart hypothesis
Describe Sherwin’s Diet Heart Hypothesis 1978.
1.a diet high in saturated fat and cholesterol leads to high blood lipids
2.which lead to atherosclerosis (coronary artery disease)
3.which leads to coronary heart disease and the clinical event of a myocardial infarct (heart attack).
State the limitation of Sherwin’s diet heart hypothesis.
*The link between diet, high blood lipids and atherosclerosis is also promoted by other factors
Genetic factors
Aging
Hypertension
Smoking
Alcohol
Stress
What is the patient’s agenda?
Why is it important to understand the patient’s agenda?
*The patient’s agenda refers to their ideas, concerns, and expectations according to their response to interview questions.
Why is it important to understand the patient’s agenda?
*We are likely to use time and resources more efficiently
-Easy to diagnose asthma in a child, but ignoring what this means to the mother can affect adherence to treatment. This wastes our own time and money.
-We can’t always make a diagnosis of disease but improves our chances of making a correct diagnosis
-It helps us plan the next stage of managing the problem.
-Further exploration of symptoms relating to possible illness.
Define the two agendas.
BIOMEDICAL
*Disease
*Pathological explanations
-Germ theory
PSYCHOSOCIAL
*Illness
*Unvoiced agenda items from patients:
-Worries about possible diagnosis and prognosis
-What the future holds
-Possible side effects
-Information relating to the social context
Describe steps doctors should take in identifying the patient’s agenda.
*Identify problems that patient wishes to address
*Listen attentively
*Confirm, list, screen for other problems
*Negotiate the agenda
Describe how doctors should explore the patient’s agenda.
*Building rapport with patient
-Identifying reasons for consultation
-Exploring patients’ problem
-Opening question- Encourage patient to tell own story
*Listen attentively
*Pick up on non-verbal cues
-Clarify patient’s statements
-Periodic summaries
*Patient concerns, expectations, effects of the illness
-Encourage patient to express their feelings
Describe the two frameworks for the two agendas.
Agenda 1: the doctors’ agenda: Disease framework
Agenda 2: the patients’ agenda: Illness framework
What is the other name for biopsychosocial model?
Disease-Illness model
Why consider the biopsychosocial model?
*Explains influences on health and is in line with WHO definition of health.
-Social factors
-Environmental factors
-Psychological factors
-Individual factors
*Provides a comprehensive framework for understanding health.
Describe the two parts of gathering information.
*An initial exploratory stage dominated by listening and
responding to the patients story.
*A further exploratory stage that entails:
A more directive and interrogative approach
A search for further important or missing information
seeking a deeper understanding of the patient’s problems.
Describe the two parts of gathering information.
*An initial exploratory stage dominated by listening and
responding to the patients story.
*A further exploratory stage that entails:
A more directive and interrogative approach
A search for further important or missing information
seeking a deeper understanding of the patient’s problems.
Describe the Illness Content Skills used when getting information from the patient.
*The Narrative thread
Doctor: “Perhaps you start at the beginning and tell me how this all began…?”
Patient “ it began when I felt dizzy”
*Using Open-ended questions first – within the open-to closed cone of questioning
Doctor: “So tell me more about the dizziness…?”
*Clarification
What is meant by ‘dizziness’’
*Asking directly for the patient’s perspective
Ideas, concerns, expectations, feelings, effects
What can misunderstanding Of The 2 Agendas result in?
*Results in poor outcomes
-non-adherence
-unwanted prescriptions
-Health provider trotting
-Loss of confidence in modern medicine
-Alternative medicine
-Self help remedies
-Traditional healer consultations
