Year 1 Flashcards
WHO definition of health
“A state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity.”
What are the types of questions used in a consultation
Open ended Direct Closed Leading Reflected
What is an open question
Is not seeking a particular answer but simply signals the patient to tell his story
What is a direct question
Ask about a specific item
What is a closed question
Can only be answered with yes or no
What is a leading question
Presumes the answer
Is best avoided
What is a reflected question
Allows the doctor to avoid answering a question
Example of open question
Tell me about the pain
Example of direct question
Where is the pain
Example of closed question
Is the pain severe
Example of leading question
The pain is severe?
Example of reflected question
You want to know the cause of the pai
Which 3 styles of doctor patient relationships has Szasz and Hollender describes
Authoritarian or Paternalistic
Guidance/co-operation
Mutual Participation
How long does an average GP consultation take
10 mins
What 3 separate activities does a consultation typically involve
- Talking together (always)
- Doctor examining patient (often)
- Performing Procedures (sometimes)
Culturally what is described as normal
What is defined as normal will depend on expectations and standards of the society
Thus on political, economic and social factors
Criteria may differ between societies, over time within the same society, and between groups within the same society
Which factors can determine expectations and standards of normal culturally
Political
Economic
Social factors
Describe a mutual participation relationship
Active involvement of patients as more equal partners
What is the lay age belief about health
Older people concentrates on functional ability in their daily lives
Younger people tend to speak of health in terms of physical strength and fitness
What is the lay social class belief about health
People living in difficult economic and social circumstances regard health as functional – the ability to be productive, to cope and take care of others
Women of a higher social class or educational qualifications have a more multidimensional view of health
What is the gender lay belief about heath
Men and women appear to think about health differently
Women may find the concept of health more interesting
More likely to attend their GP
Women include a social aspect to health
Men tend to leave their health to get worse for longer
What is the training path to becoming a GP
5yrs med school FY1 and 2 GP 3yrs training path - 2yrs hospital training - 1yr GP training
Who is the first point of contact for patients needing to see a doctor
GP
Which wide range of skills do GPs need to have
Problem solving Managing risk and uncertainty Evidence based medicine Wide range clinical skills Holistic approach aimed at managing risk and dealing with uncertainty and complexity
Who can GP practices be owned by
GP themselves
Or Local NHS organisations
What is the trend in types of practices
Tend to be large primary health care centres now
Which aspected of lifestyle may be covered in a GP consultation
Diet Exercise Alcohol Smoking Illicit Drug Use Sexual Health
What are the used of computers in GP practices
Online transactions Appointment booking Repeat prescriptions Support prescribing Assist in consultations Allow GPs to manage hospital letters Allow GPs to manage blood results Keeping records (digital record keeping)
Do GPs own and run businesses by themselves or in partnership with others
Can be either
What is a GP running the business responsible for
Providing:
Adequate premises and infrastructure
To provide safe patient services and employ/train practice staff
Advantages of using technology in GP practices
Patient data can be easily accessed by any approved member of staff at any time and sometimes any place when working remotely
Patient data can be listed, graphed and searched easily (enabling GPs to convey and track information)
How often do GPs need to revalidate their qualifications
Every 5yrs
How do GPs prepare for appraisal
Reading literature
Attending courses
Performing audits
Who composes the practice team
Manager IT/Admin Staff Secretarial Staff Reception Staff Nurses- Junior/Senior Advanced Nurse Practitioners/Physicians Assistants Phlebotomists/Health Care Assistants
What is a major key attraction of GP
Ability to be flexible and make own decisions about the balance of their team to address the needs of their own practice
What are options within GP
Partner Special interest (e.g Obs & Gynae, Diabetes, Minor Surgery) Salaried GP Part time (3 days rather than 5) Medical education Sports doctors
Are GPs now required to work out of hours
No
No longer required
What is meant by longitudinal care
Possibility to work with someone from birth right through to adult life
What does effective communication improve?
Patient satisfaction Patient recall Patient understanding Patient concordance And outcomes of care
Which 3 broad types of skills are needed for successful medical interviewing
Content skills
Perceptual skills
Process skills
What can body language include
Gaze behaviour
Posture
Specific gestures
Which factors influence the consultation
Physical factors
Personal factors
- doctor
- patient
What are Roger Neighbours tasks in a consultation
Connect with the patient
Summarise and verbally check that reasons for their attendance are clear
Hand over and bring the consultation to a close i.e hand over to the patient a the end to ensure all issues have been covered
Ensure safety net exists in that no serious possibilities have been missed
To deal with housekeeping of recovery and reflection
What are the 3 aspects of safety netting
Advise the patient of expected course of the illness/recovery
Advise of symptoms indicating deterioration
- Highlight things to look out for
Advise who to contact if patient deteriorates
Double check the patient has understood all of this
What is a risk
Chance of (or of bad) consequences Implies chance
Definition of uncertain
Not able to be relied on, not known or definite
Definition uncertainty
state of being not completely confident or sure of something
What is resilience
Positive capacity of people to cope with change and stress
What are the protective factors for resilience
Positive early upbringing
Self confidence
Social support
Good problem solving skills
Give an example of Hypothetico-Deductive Reasoning
Maybe 4 or 5 diagnostic hypotheses
Rare but not immediately concerning diagnoses excluded at this stage
Strengthen case for diagnoses through brief history and examination
Extend the search thereafter if no diagnoses identified
Not about common diagnoses, rather about likely diagnoses
What is a hazard
Something with the potential to cause harm
What is a risk
Likelihood of harm occurring
What is a risk factor I
Increases the risk of harm
What is a protective factor
Decreases the risk of harm
What is susceptibility
Influences the likelihood that something will cause harm
Give the types of hazards
Physical Chemical Mechanical Biological Psychological
Routes of exposure of hazards
Skin
Blood/sexual
Inhalation
Ingestion
Which factors influence the degree of risk
How much a person is exposed
How the person is exposed
Conditions of exposure
What does risk combine
The probability that a particular outcome will occur and the severity of the harm involved
Which 3 principles govern the perception of risk
Feeling in control
Seize of the possible harm
Familiarity with the risk
What are involuntary risks
Involuntary risks are situations where we are believed to have little control
Perceived as having greater risk
E.g plane trip
What are voluntary risks
Voluntary risks are situations we believe we have some control over
Perceived as less risk
E.g Car Trip
Are risks involving greater or lesser harm perceived as having more risk
Greater possible harm
Even if the less harmful events are more likely
Are risks that are more of less familiar perceived as having greater risk
Less familiar
What does risk perception depend on
Peoples beliefs Previous experience Attitudes towards risk Judgements Feelings Beliefs Personality Wider social values Wider cultural values Demographic factors Socio-economic factors
Examples of environmental chemical risks
Pesticides
VOCS
Examples of environmental physical risks
Ionising and non-ionising radiation
Noise and vibration
Examples of environmental biological risks
Infectious agents
Allergic substances
Examples of hazardous diet
Fat Salt Bacteria Pesticides Acrylamide Phthalates
Examples of hazardous inhalation
Environmental tobacco smoke Smog Asbestos Legionella Pesticides
Examples of hazardous dermal risks
UV-A/UV-B
Bacteria
Cosmetics
Pesticides
What are the 3 main components of NHS structure
Primary Care
Secondary Care
Tertiary Care
Describe primary care
Illness first presents Most illness managed Gatekeeper function Prevention Accounts for 90% of all patient contact
Describe secondary care
Hospital consulting role
Describe Tertiary care
Regional centre
Name 2 out of hours services
G-Med
NHS 24
Describe a typical GP day
Morning and afternoon surgeries Paperwork (results, letters, ect) and telephone calls interspersed throughout day House calls Extended hours Duty doctor/emergencies Practice business/staff issues
What % of people are referred to secondary care
1%
Who is is easier to change behaviours in
Women and elderly
What factors motivate people to change their behaviours (use alcohol in pregnancy as an example)
The advantages of not drinking (healthy baby) outweigh the disadvantages
You anticipate a positive response from others to your behaviour change (e.g your partner also wants the unborn child to be healthy)
There is social pressure for you to change (very socially unacceptable to drink when obviously pregnant)
You perceive the new behaviour to be consistent with your self-image (earth mother)
You believe you are able to carry out the new behaviour in a range of circumstances
What does self-efficacy underpin
Goal setting
Effort investment
Persistence in face of barrier
And recovery from setbacks
What actions can the government to decrease obesity
Health education – diet and exercise Tax on unhealthy foods Legislation-proper labelling, lists of ingredients/food content Enforcement of legislation Ban on advertising unhealthy food Improve exercise/sport facilities Subsidise healthy food Transport policy e.g cycling lanes Funding NHS treatment for obesity e.g specialist clinics, bariatric surgery
Qualifications of a practice nurse
Fully registered nurse often with additional training
What is the role of a practice nurse
Works in the practice premises alongside the doctors
Does a variety of diagnostic and treatment procedures, health clinics
What is the role of a district nurse
Has his or her own independent work but is also ‘attached; to practice(s) and liaises with them
What is the role of a health visitor
Works mainly in the fields of prevention, health promotion, and public health, with responsibility for children aged 0-5yrs
What is the role of a midwife
Entirely responsible for their own caseload of pregnant women, but liaise with general practice
What is the role of the receptionist?
Reception and administrative responsibilities (e.g filing). Should not undertake any medical tasks as they are not trained for this
What is the role of a pharmacist
Local (‘community’) pharmacists are variably involved with general practice. Some health centres house their own pharmacy. At another level health boards employ pharmacists to provide general advice to groups of practices.
What is the role of a dietician
Interpret and communicate the science of nutrition to enable people to make informed and practical choices about food and lifestyle. In both health and disease
What is the role of an OT
Help people overcome the effects of disability caused by physical or psychological illness, ageing or accident and promote independent function in all aspects of daily life
What is the role of a physio
Concerned with human function and movement and maximising potential. It uses physical approached to promote, maintain and restore physical, psychological and social well-being, taking account of variations in health status
What is the role of a social worker
Concerned with human function and movement and maximising potential. It uses physical approached to promote, maintain and restore physical, psychological and social well-being, taking account of variations in health status
What is morality
Our attitudes, behaviour and relations to one another
What is consequentialism
the moral worth of an action is determined by its outcome
What is deontology
Duties ‘right and wrong’ actions absolute values
What is utilitarianism
Look at benefits and harms to individual and society; look at the consequences
Type of consequentialism
Give examples of duties of doctors laid out by the GMC
Make the care of your patient your 1st concern
Treat every patient politely and considerately
Respect patients dignity and privacy
Listen to patients and respect their views
Give patients information in a way they can understand
Respect the rights of patient to be fully involved in decisions about their care
Keep your professional knowledge and skills up to date
Recognise the limits of your professional competence
Be honest and trustworthy
Respect and protect confidential information
Make sure that your personal beliefs do not prejudice your patients care
Act quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practice
Avoid abusing your position as a doctor and
Work with colleagues in the ways that best serve the patients’ interests
What are the 4 principles of ethics
Autonomy
Non-malfeasance
Beneficence
Justice
What is autonomy
Promote the right to self determination
Confidentiality, informed consent, promote capacity
What is beneficence
to do good
What is justice
Fairness/equity (non-discrimination, equal treatment for equal need)
Describe a non-judgemental approach
you must not discriminate on grounds of age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status.
Describe fitness to practice
Specific duty to take appropriate action to protect patients, not just by your own action but also to protect patients if your or others are unfit to practice
Which ethical principles are particularly relevant to GPs
Non-judgemental approach Not imposing personal views Respecting patients views Confidentiality Not exceeding competency Fitness to practice
What is duty of candour
Must be open and honest with patients when something goes wrong with a patient’s treatment or care which causes or has the potential to cause harm or distress
What should you do if something goes wrong with a patients care
Be open and honest with the Patient (duty of candour)
If unsure of consequences immediately seek advice of appropriate senior colleague
Apologise to the patient and offer appropriate remedy or support
Put matters risk and explain fully the short and longer term consequences fo what has happened
To influence action/behaviour what must information given be?
Relevant to current goals
Easily understood and remembered
Readily available in the moment of decision or action
