Year 2 Tutorial 2 Long Term Conditions Flashcards
Why have chronic illnesses become increasingly prevalent
Due to ageing population resulting in a huge burden on the health care systems
Examples of chronic illness
Osteoarthritis, ischaemic heart disease, respiratory disease
Effects of chronic illness
Constraints of family life
Failure to re-establish functional capacity to work
Unremitting physical discomfort
Incidence
Number of new cases per year
Prevalence
Number of existing cases
Pathophysiology
pathological basis of underlying disease process. May incl. causation if known and pathological course e.g. atherosclerosis – sub-intimal deposition of atheroma in arteries -> blood vessel narrowing. Occurs prior to clinical events so present in absence of clinically detectable disease
Clinical disease
Pathophysiological process resulting in a specific clinical consequence
Illness episode
Time between illness onset and offset
Response
Pattern of decrease in symptoms and or signs indiciting decrease in the severity of the underlying pathological process
Recovery
sustained period of health following illness episode when clinical features no longer present or insufficient to warrant further investigation or change in treatment
Remission
period following episode of illness to warrant use of “recovery”; signs and symptoms have lessened in insufficiency and remain insufficient to warrant further investigation or treatment
Relapse
reinstatement in clinical features following episode of illness. Not necessary to have entered remission to relapse (can occur during response period)
Recurrence
• reinstatement of new episode of illness following abatement of clinical features of sufficient duration to warrant term “recovery”
Body and structure impairment
Disturbance to body structures, organ or system function which presents at birth or arises from disease or injury; equates to presence of clinical disease
Activity limitation
restriction or lack of ability to perform activity in a manner or within range considered normal e.g. atherosclerosis pt paralysis down one side due to stroke has activity limitation due to impairment
Participation restriction
social construct depending on meanings and values; social disadvantage for individual resulting from activity limitation or impairment that limits or prevents role normal for that individual eg pt who has stroke who used to do manual labor
WHO definition of health
Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity
Aetiology of Chronic Disease
- Long term complex interaction of factors
* May be genetic and/or environmental factors or may be neither
Vulnerability
individual’s capacity to resist disease, repair damage and restore physiological homeostasis. This is important in the extremes of age
Individual impact of chronic disease
Denial, self-pity, apathy, isolation
Family impact of chronic disease
o Financial
o Social
o Other family members may become ill as a result
Treatment of chronic disease
- Aimed at disease or effect of disease. Need to recognize chronic nature of disease and come to terms with it.
- Often difficult as both pt and dr must admit failure in diagnosis or cure w/ payoff of better management
Stress
o Real or perceived demands of situation outweigh actual or perceived physical, psychological and social factors
o Signs may be cognitive, social, emotional or physical. Usually anxiety and depression when illness related
Different coping mechanisms
♣ Problem-solving – direct action, decision-making or planning
♣ Support seeking – social support, comfort and help seeking
♣ Escape avoidance – disengagement, denial and wishful thinking
♣ Distraction – finding alternative activities to do
♣ Cognitive restructuring – positive thinking and accommodation
Emotion-focused coping strategy
modifying response to problem (palliative, avoidant or defensive coping). Less constructive e.g. being ill
Problem-focused coping strategy
action to change or address stressor (problem solving or approach coping). More constructive e.g. help seeking, taking action
Personality
o Fundamental behavioral and social characteristics of a person.
o Innate but interacts w/ environmental factors and genetic factors may predispose an individual to interact with or respond to his or her environment in a certain way.
Resilience
o Positive capacity to cope with change, stress and adversity.
o Adapt successfully to challenges. – bounce back to previous normal state or use exposure to adversity to grow stronger.
Requires positive childhood experience -> self-confidence
Illness behaviour
o Positive e.g. attending rehabilitation classes or negative e.g. addiction to analgesia
o Based on social learning in childhood via reinforcement (adopt sick role as a child) or modelling (parents had high levels of illness behavior)
Stress in relation to health
Prevents people from making rational health care decisions. Stress hormone release can exacerbate physical symptoms.
Symptom Perception
o xisting conditions – may think psychological symptoms physical (e.g. hyperventilation from anxiety in asthma pt -> inhaler overuse)
o Need to recognize psychological factors
o Pain – unpleasant sensory or emotional experience associated with actual or potential tissue damage or described in terms of such damage
o Emotions can modulate sensory signals coming from site of pain
Psychological impact of disease
Chronic illness can cause anxiety and depression
Illness
o What pt experiences when unwell; how interpret and define symptoms and response to actions they take to them.
o Can vary between cultures e.g. in Western world pain during Labour is symptom whereas expected and accepted in other cultures.
o Often people only seek help when symptoms interfere with work or daily life
Disease
o More objective – what dr sees and interprets and what actions they suggest
Medical model of disability
• Disability intrinsic to individual and direct consequence of underlying disease
• Reduction can only be achieved via amelioration of underlying pathology
Medical intervention means to restore “normality”
Social Model of disability
• Socio-cultural focus, disability placed outside individual
• People not per se limited by medical condition but by behavior of others towards them and environmental conditions
• Underpins legislation to remove barriers
Reduces limitations e.g. wheelchair access, hearing aid loop systems etc
GMC good medical practice on disability
doctors must not unfairly discriminate against patients by allowing their personal views to adversely affect their professional relationship with patients or the treatment they provide or arrange. This includes disability as well as many other factors. You should challenge colleagues who do not comply with this guidance and be aware of own attitudes and prejudices of disability and address this by finding out about common disabilities
Disability discrimination Act
person with disabilities is one with physical, sensory or mental impairment which has a substantial, adverse and long term (>12 months) effect on ‘normal’ day to day activities. Updated in 2010 when equality act became law.
Equality Act 2010
disability is one of the characteristics protected under this legislation as well as age, race and sexual orientation. A person has a disability if they have a mental or physical impairment that has a continuing effect on their ability to perform day to day activities.
Psychological Model of Disability
• Describes how activities performed by someone with a health condition underpinned by same psychological processes of nondisabled person.
• Includes motivation, mood disorders and self-efficacy. Also upbringing, resilience, coping and self-motivation
Also lived experience of disability including self image, social and economic marginalization, uncertainty about wellbeing and feelings
Pattern Recognition
• car bumper damaged in car park, on return can probably work out what has happened
Hypothetico-deductive Reasoning
o Initial hypothesizes – 4 or 5 – determine preliminary level of Hx taking, examination and investigation – must correlate with potential seriousness of diagnosis: DECIDE IF MINOR AND SELF LIMITING or LIKELY TO REQUIRE ACTIVE THERAPY. E.g. not pt’s or NHS best interest to determine exact aetiology of simple viral sore throat
Inductive Reasoning
- How we learn medicine and what we fall back on
- Takes quite a lot to use hypothetico-deductive model safely and effectively. To begin with in most cases have no idea what’s wrong so must use comprehensive inductive model
- Best way of learning about clinical method as gives lots of practice of various skills involved
Problem solving method most commonly used by GP’s
- Humans are more variable than cars, have a mind of our own and can’t be disassembled or repaired therefore GPs use hypothetico-deductive reasoning more than other specialties, although makes use of all three problem solving methods
- Due to large nos of people whose PCs are undifferentiated demands so need way of short-cutting intricacies of inductive method by cutting out lines of enquiry and examination that are most likely unproductive
