Year 1 Flashcards
What percentage of medical graduates become GPs?
47%
Discuss the meaning of holistic care
Caring for the whole person as well as their illnesses. This is often achieved by allowing ‘the story’ to evolve and develop rather than applying a protocol to every situation.
Review an example of a working day in general practice
No typical day. Divided into sessions (half days). Surgeries, Duty Doctor responsibilities, House calls, teaching, managerial tasks, special interest clinics.
Consider personal qualities which may be required in general practice
Caring nature, commitment to high quality care, awareness of ones limitations, ability to seek help, commitment to CPD, appreciation of teamwork, interpersonal and comms skills, clinical competence, organisational ability, ability to manage oneself, ability to deal with uncertainty
Discuss variation between practices
No typical practice. Practices are responsive to local health needs and vary widely. Trends towards larger practices rather than singlehanded rural ones. Practice or building may be owned by the partners or the NHS.
Discuss aspects of running the business of a general practice
GPs are usually independent contractors to the NHS and buy/rent premises and employ staff as a business. Some GPs are employed by GP partners to work as salaried GPs and are paid a fixed salary and do not share in the profits of the practice.
How is IT used in primary care
GP practices are completely paperless.
Uses of IT systems:
- Store appointments
- Book appointments (now online systems for pts)
- Patient records
- Support prescribing
- Storing hospital letters
- Storing test results
- Use in audits
- E-consultations
- Chronic disease management – period followup
- Patient leaflets and resources
- Public health information
- Identify patients for screening
Discuss opportunities for flexible careers in GP, career paths and work/life balance.
GPs as independent contractors have the flexibility to decide the priorities of the practice and their own pattern of work. Many take on other roles such as hospital work and teaching.
GPs can choose how many sessions to work which provides flexibility. Out of hours is opt in.
Discuss postgraduate ongoing learning and reflection
5 year revalidation cycle. Annual appraisal preparation by reading literature, attending courses and performing audits. Ongoing reflection.
State seven occupations in primary care other than a GP.
Practice nurse District nurse Health visitor Midwife Receptionist Medical secretary Pharmacist
What is longtitudinal care
Cradle to grave care. Dealing with acute and chronic care of patients
Discuss aspects of communication in a consultation (communication skills needed, factors influencing the consultation, and consultation styles)
Communication Skills needed
• Content skills: What is communicated
• Perceptual skills: What is being thought and felt, awareness of own biases
• Process skills: How doctors communicate – verbal and nonverbal
Factors influencing the consultation
• Physical Factors o Site and Environment o Adequecy of records o Time constraints o Patient status
• Personal Factors o Age o Sex o Backgrounds and origins o Knowledge and skills o Beliefs
Doctor Patient Relationships
• Paternalistic: Doctor uses all authority and patient feels no autonomy
• Guidance/Cooperation: Doctor still exercises authority but patient has some feeling of autonomy
• Mutual participation: Moderation of use of authority. Patient involved in decision making.
Discuss stress and coping
Stress occurs when the demands of a situation (real or perceived) are greater than the individuals ability (real or perceived) to deal with it using their physical, psychological or social resources.
Signs of stress:
• Cognitive: Anxious thoughts, always seeing the worst
• Emotional (low mood, tension – anxiety and depression)
• Physical: Dizziness, Chest Pain, Ulcers
• Behavioural: Avoiding the stressful situation
Coping is any action taken to alleviated stress. Coping strategies include:
• Problem solving - involving direct action, decision making or planning
• Support seeking – Covering social support, comfort and seeking help
• Escape avoidance – disengagement, denial and wishful thinking
• Distraction – finding alternative activities to do
Discuss why people react differently to illness
Personality and early experience interact to contribute to illness, the course of the disease, and success or treatment. This can be described through two key phenomena:
• The Development of Resilience
• The Development of Attitudes Towards Health
Adult response to illness is a product of a process beginning in childhood.
Illness behaviour is based on social learning:
• Reinforcement: being encouraged to adopt the ‘sick role’
• Modelling: parents showed high illness behaviours
Discuss changing health related behaviour
• Have Information – Information must be:
o Relevant to current goals
o Easily understood and remembered
o Readily available in the moment of decision or action
• Be Motivated – Factors influencing motivation (example alcohol in pregnancy):
o The advantages outweigh the disadvantages (healthy baby)
o Positive response from others to the change in behaviour anticipated (partner wants a healthy baby)
o Social pressure to change (socially unacceptable to drink why pregnant)
o Perceive new behaviour to be consistent with self-image (good mother)
o Belief in ability to carry out the change in a range of circumstances (at home, parties)
• Behaviour Skills – example:
o Assertiveness in negotiating condom use with a sexual partner
What is self-efficacy?
The belief that you can perform a difficult task (eg changing a behaviour)
State the WHO definition of health
A state of complete physical, mental, and social well-being and not merely the absence of disease of infirmity.
Describe statistical normality
Bell curve
Describe cultural normality
Dependent on expectations and standard of society - these criteria vary widely between cultural groups
Discuss the different ways in which health and normality may be viewed by doctors compared with patients and appreciate the importance of understanding these differences.
Patients with chronic health problems may consider themselves healthy if it is controlled. Varies between age and gender. Younger people define as physical strength and fitness. Older people have a more functional definition. Gender: females more likely to include social aspect to health. Cultural differences: many Afro-Caribbeans consider hypertension normal and are less likely to be compliant with medication.
Discuss the removal or control of exposure to hazards in the workplace.
- Substitution: toluene instead of benzene (causes leukaemia), welding instead of riveting (vibrations)
- Engineering Controls: Enclosing dusty machines, fitting silences, improving ventilation
- Administrative Controls: Task rotation to reduce MSK problems, training, resticing access to hazardous areas
- Personal Protective Equipment: gloves, face masks, ear defenders (used as last line a defence as only effective when worn)
Define a hazard
Hazard: something with the potential to cause harm
Define risk
The likelihood of harm occuring
Define a risk factor
Something that increases the risk of harm
Define a protective factor
Something that decreases the risk of harm
What are the five broad categories of hazards
Physical Chemical Mechanical Biological Pyschosocial
Give two examples of physical hazards
Radiation
Noise/vibration
Give two examples of chemical hazards
Pesticides
VOCs
Give two examples of mechanical hazards
Trips and slips
Being injured by equipment
Give two examples of biological hazards
Infections agents
Allergens
Give two examples of psychosocial hazards
Stress
Bullying
State five routes of exposure
Skin Blood Sexual Inhalation Ingestion
What are the three principles that govern the perception of risk?
• There are three principles that govern the perception of risk:
o Feeling in Control
Involuntary risks (situations where we believe we have less control – eg aeroplane journey) are perceived as greater risk
Voluntary risks (situations where we believe we have more control – eg car journey) are perceived as less risk
o Size of the possible harm
Risks that involve the greater possible harm are perceived as greater than those involve less harm. Even if the less likely harmful events are more likely. (eg Tornado vs chip pan fire)
o Familiarity with the risk
Risks that are less familiar are perceived as being greater than more familiar risks (eg Nuclear accident vs food poisoning)
• Pulled together: we are more concerned with single catastrophic events with large consequences than chronic risks where the damage occurs over time.
What are the aims of a consultation?
Simple way to think is with Calgary-Cambridge Model
- Initiating the session
- Gathering information
- Providing structure
- Building relationship
- Explanation and Planning
- Closing the session
What are Neighbour’s Tasks of a Doctor?
• Connect with the patient
• Summarise and verbally check that the reasons for attendance are clear
• Hand over and bring the session to a close
o Give responsibility to the patient – give them the tools to manage
• Ensure a safety net exists and no serious possibilities have been missed
o Explain what to expect and when to seek further help.
• Housekeeping of recovery and reflection
Discuss strategies for managing uncertainty
Developing a good relationship with the patient is vital. Utilise external evidence to help consider risks.
Safety netting allows a margin for some uncertainty by handing over some of the responsibility to the patient. Patient should know what to expect with the course of the illness and when and how to seek further help.
Discuss hypotheticodeductive reasoning
Some causes are more probable than others. More efficient to consider these but also important to exclude rarer but serious causes.
State five political and economic influences on health (general)
National wealth Equality Political decision making on broader issues Economic spending and budgets Legislation
Discuss the effects of healthcare spending on the health of society
Spending and policies which address the basics of sanitation, housing, immunisation, education will have more impact on health than those targeted at individuals.
Discuss the four types of prevention and give examples
• Primary Prevention
o Prevention of onset of a disease in health individuals
o Examples: immunisations for all infants
• Secondary Prevention
o Interventions aimed at the early detection and treatment of a disease to prevent progression
o Examples: screening programmes
• Tertiary Prevention
o Reduce the consequences of a disease and disability (this is the most clinical level and does not really related to public health)
o Examples: hip replacements, stroke rehabilitation
• Primordial Prevention
o Addresses the broader social and environmental circumstances to pre-dispose to disease
o Examples:
Subsidies (basic foods)
Taxation (tobacco, alcohol)
Legislations (smoking in public places ban)
Free vitamins for mothers (reduced foetal growth due to poor maternal nutrition associated with a number chronic conditions later in life)
