WEEK 3 Flashcards
What three components make up the Kleinman’s model of healthcare systems?
Popular sector
Folk sector
Professional sector
What constitutes the popular sector?
Family, friends, media and the internet
What constitutes the folk sector?
Common traditional remedies, old-wives tales and complementary alternative therapies
What constitutes the professional sector?
Doctors and other healthcare professionals
How is demand for treatment altered between individuals?
Different standards of health and illness (eg. elderly may have lower standards than younger people)
Define healing and wholeness
Whatever process results in the experience of greater wholeness of the human spirit
How do people make decisions on approaching the formal healthcare system?
Signs and symptoms
What are symptoms?
Feeling states patients experience which alert them to the possibility that all is not well
What are signs?
Pointers the doctor identifies which signify the existence of the underlying pathological lesion
What are the six stages of illness?
1) Person experiences symptoms
2) May seek advice from friends and relatives
3) May seek professional advice from a doctor
4) Doctor confirms patient is sick (legitimises sick role)
5) Sick role
6) Recovery
Why do you only see the tip of the iceberg of people with symptoms in healthcare settings?
A large proportion of people with symptoms don’t seek medical help
What are the determinants for increased consultation?
Age Gender Ethnicity Deprivation Smoking status
What is the process that people go through when deciding whether to consult with a doctor or not?
1) Are the symptoms normal or abnormal?
2) Should I see the doctor on this occasion?
3) What else can I do?
4) What are the costs and benefits of seeing the doctor?
What are Zola’s 5 social triggers which encompass the way in which symptoms come to be seen as abnormal?
1) Perceived interference with vocational or physical activity
2) Perceived interference with social or personal relations
3) Occurrence of an interpersonal crisis
4) Temporalising of symptomatology
5) Sanctioning (“you should get that checked”)
What are Mechanic’s 10 variables known to influence illness behaviour?
1) Visibility, recognisability or perceptual salience of signs and symptoms
2) The extent to which the symptoms are perceived as serious
3) The extent to which symptoms disrupt family, work and other social activities
4) Temporalising of symptomatology
5) The tolerance threshold of the individual and those evaluating the signs and symptoms
6) Available knowledge, information and cultural assumptions of the evaluator
7) Basic needs that lead to denial
8) Competition between needs and illness responses
9) Competing interpretations of symptoms
10) Availability of treatment resources, physical proximity and physiological and monetary costs of taking action
Define utilitarianism
Maximising happiness for the most people possible, minimising suffering
What is the principle of utilitarianism?
Right or wrong depends on the outcome
What is the utilitarian stance on truth telling?
Tell truth if it leads to a good outcome, lie only if it leads to a better outcome
What is the difference between ‘act’ and ‘rule’ utilitarianism?
‘Act’ considers each act separately whereas ‘rule’ extrapolates rules such that if everyone behaves in this way it would lead to the best outcomes
What are the three main advantages of utilitarianism?
1) Pretty intuitive/aligns with how some people view morality
2) Form of distributive justice, therefore deals with good of societies, not just individuals
3) Flexible (although less so with ‘rule’ utilitarianism)
What are the three main disadvantages of utilitarianism?
1) Consequences can be difficult to predict
2) Consequences can be far-reaching or impossible to measure
3) People given no intrinsic value in this system
Define deontological ethics
The belief that actions are inherently right or wrong, regardless of their outcome
What is the deontological stance on lying?
It is inherently wrong, even if outcome is greater
What does the deontological position allow?
A set of rules to be created and applied universally allowing us to always be ‘in the right’
What are the four main advantages of deontological ethics?
1) Accords human beings’ moral worth
2) Reflects at least some people’s moral perception
3) Places value on intention
4) Offers certainty
What are the four main disadvantages of deontological ethics?
1) Too rigid (rules always have exceptions)
2) Makes exception to acts that cause immense suffering in defence of a principle
3) Duties often conflict
4) Relies on our rationality
Define ethical pluralism
The idea that there are many ethical theories that can be used together
What are Ross’s seven duties?
1) Fidelity (promise keeping)
2) Reparation (making up for past harm)
3) Gratitude
4) Justice
5) Beneficence (doing good to others)
6) Self-improvement
7) Non-maleficence (avoiding harm)
What are the four principles of medical ethics (by Beauchamp and Childress)?
Autonomy
Beneficence
Non-maleficence
Justice
What is the myth of objectivity?
The idea that none of us are really objective and arrive at each decision with a pre-existing bias
Is emotion important as a doctor?
Yes, Aristotle says it’s the ‘guide of reason’
Why is it bad to believe you’re objective?
It makes it harder to see that you’re wrong
Define virtue ethics
Cultivation of a moral character with the right values that you try to emulate (“What would a good person do in this situation?”)
What is phronesis?
Practical wisdom/virtue
What are the three main advantages of virtue ethics?
1) Phronesis seems to align with many people’s way of decision-making
2) Most people admit to having role models
3) Developmental model, acknowledging imperative to improve
What are the five main disadvantages of virtue ethics?
1) Doesn’t aid decision-making (nebulous)
2) What/who is virtuous?
3) Self-centred
4) Encourages perfectionism
4) May perpetuate ‘problem’ norms and values
What is the trust model?
Without trust we can’t function as a society and honesty is required for trust, being dishonest leads to decreased trust and is therefore unethical
What is the Francis Report?
A report produced into the Mid Staffordshire scandal led by Robert Francis QC
What was the main outcome from the First Francis Report?
A lack of compassion was seen towards patients
Give three examples of mismanagement in the Mid Staffs scandal
1) Chronically understaffed wards
2) Inadequate training of staff
3) Failure to address serious problems or monitor performance
What was the driving cause of the Mid Staffs scandal?
Staff cuts to meet financial targets to become a foundation trust
What were the consequences of the Mid Staffs scandal to patients?
Physical needs not met (dehydration, poor hygiene/wound healing/immune function)
Emotional/social needs not met (stress resulting in poor immune function/wound healing and altered neuroendocrine function)
What were the consequences of the Mid Staffs scandal to staff?
Culture of fear, bullying and intimidation
Overstretched due to understaffing
What was one of the overall outcomes from the Mid Staffs scandal and subsequent report?
The duty of candour
What is the duty of candour?
Being honest with your patients about mistakes or errors that have happened in their care regardless of if the information is requested
What is the law surrounding the duty of candour for organisaitons?
Organisations should:
Inform people about incident
Provide reasonable support, truthful information and an apology
What is the GMC’s view surrounding the duty of candour for healthcare professionals?
Healthcare professionals must:
Inform patient about incident
Apologise
Offer an appropriate remedy or support if possible
Explain fully the short and long term effects of what has happened
