Year 3 FoPC Flashcards
What is the most common cause of death today?
Cancer
Ischemic Heart Disease
Accidents in young
Suicide in men aged 15-34yrs
What are some features of unexpected death?
Profound sense of shock
No chance to say goodbye or take back hasty words.
What is terminal care?
The last phase of care when a patient’s condition is deteriorating and death is close.
What are some features of Palliative care?
Emphasis the quality of life
Performed by a multi-disciplinary team.
Communication is essential
Most provided in primary care with support from specialist practitioners to palliative care units.
What are some stages of the Supportive and Palliative Care Indicators Tool?
Would it be a surprise if they died in next 6-12months.
2 or more general indicators:
-Progressive weight loss (>10%) over past 6 months.
-2 or more unplanned admission in the last 6months.
-Performance status poor or deteriorating.
-a new diagnosis of a progressive life limiting illness.
-2 or more advanced or complex conditions
-Nursing home or NHS continuing care unit, or needs more at home care.
Then look for disease related indicators.
Assess patient and family for supportive/palliative care needs. Review treatment, Plan care. Consider for GP practice palliative care register.
What can be used to measure the need for palliative care?
Palliative performance scale.
What are some features of palliative care in primary care?
Practices have a register of patients
Meet regularly to discuss cases
Enhances communication between team members
Out of Hours service also notified of palliative patients.
What is the WHO definition of Palliative care?
Provides relief from pain and other distressing symptoms.
Affirms life and regards dying as a normal process.
Intends neither to hasten nor postpone death.
Integrates the psychological and spiritual aspects of patient care.
Offers a support system to help patients live as actively as possible until death.
Offers a support system to help family cope during illness/bereavement.
Uses a team approach to address needs.
Who are some of the members of the palliative care team?
GP Specialist practitioners Specialist palliative units Macmillan Nurses CLAN Marie Curie nurses Religious or cultural groups Support networks
What is meant by a good death?
- Pain free
- Open acknowledgement of imminence of death
- Death at home surrounded by friends and family
- Death as personal growth
- An aware death in which personal conflicts and unfinished business are resolved.
- Death according to personal preference and in a manner that resonates with the person’s individuality.
What is the role of the Gold Standards Framework?
Offers tools to enable primary care to provide palliative care at home.
Includes setting up cancer register, reviewing patients and reflective practice.
What are some stages of receiving bad news?
Stability Immobilisation Denial Anger Bargaining Depression Testing Acceptance
What are some features of grief?
Individual experience
Process may take months/years
May need to be reassured it is normal
Abnormal or distorted reactions may need more help.
Bereavement is associated with morbidity and mortality.
What is euthanasia?
Deliberate ending of a person’s life with or without their request.
Voluntary
Non Voluntary
Physician Assisted suicide.
What are some reasons for requesting euthanasia?
Want to end suffering
Unrelieved symptoms
Don’t want to be a burden
What should be our response to a patient requesting euthanasia?
Listen Acknowledge issue Explore reasons for request Explore ways of giving more control to patient Look for treatable problems Remember spiritual issues Admit powerlessness
What is sociology?
The study of development, structure and functioning of human society.
What is the sociology of medicine?
Systematic theory Authority recognised by clientele Broader community sanction Code of ethics Professional culture sustained by formal professional sanctions.
What is the function of National Statistics Socio-economic Classification (NS-SEC)?
Measure the employment relations and conditions of occupations.
Good predictor of health, education etc.
What is social influence on our health?
Collective set of conditions in which people are born, grow up, live and work.
What are some examples of Social influences on health?
Gender Ethnicity Physical environment/housing Education Employment Income Social status Financial security Health system Social environment
What are some characteristics of gender in healthcare?
Men have higher mortality at every age.
Women have higher morbidity
Women consult more frequently in GP settings
What are some characteristics about ethnicity in health?
Type 2 diabetes higher in South Asian pops
Greater prevalence of sickle cell disease in African origin groups.
Minority ethnic groups have better general health than majority of white pop.
Mortality in Scotland is higher in white pop than black and minority ethnic pop.
What are some potential barriers to the use of health services?
Patient level - language barriers, understanding system, beliefs
Provider level - provider skills and attitudes, understanding differences due to ethnicity
System level - organisation of appointments/referrals.
What is meant by culturally competent care?
Combination of attitudes, skills and knowledge that allows an understanding and therefore better care of patients with a different backgrounds to our own.
Why are those with higher levels of education tend to be healthier than those with similar income but less educated?
- better understanding of health
- more effective engagement with health care services e.g screening programmes
- better engagement with health related advice
- better able to navigate health services
What is the WHO definition of health inequalities?
The differences in health status or in the distribution of health determinants between different population groups
What are some barriers that stop people with learning difficulties from getting healthcare?
Lack of accessible transport Staff have little understanding Failure to recognise they are unwell Anxiety or lack of confidence Not involvement allowed form carers Inadequate follow-up or aftercare.
What is the inverse care law?
This described that those who most need medical care are least likely to receive it and conversely, those with least need of health care tend to use health services more, and more effectively.
1971 - Dr Julian Tudor Hart
What factors can reduce health inequalities?
- Effective partnership across sectors.
- Refine integration of health and social care
- investing in more vulnerable patient groups
- reduction in poverty
- improve access
- social inclusion polices
- improved employment
- equal access to education
- improved housing
What is the role of voluntary sector organisations?
Provide a means to engaging effectively with communities and individuals
Deliver a range of services which may help to reduce health inequalities e.g. health promotion, supporting access to relevant services.
What are some benefits of volunteering?
Gain confidence Make a difference Meet people Be part of a community Learn new skills Take on a challenge Fun
What is the role of Citizens Advice?
Help people directly with negotiating difficult problems e.g. debt, finances, benefits, consumer rights
Support witnesses in courts
Advocacy work - help improve how big organisations work.
What is the role of Alcohol and Drugs Action?
7 day access to support, advice and targeted interventions for anyone affected by substance misuse and related issues
Telephone helpline, drop in service, needle exchange, ongoing support
Harm reduction service, support for families, services for women and girls including those at risk of sexual exploitation or those engaged in prostitution.
What is the role of CLAN?
Local charity providing emotional and practical support to people affected by cancer across NE Scotland, Orkney and Shetland.
What is the role of Somebody Cares?
Providing free food, furniture, clothing and much more to the poor, the vulnerable and the marginalised people of the area
What is the role of Penumbra?
Mental Health charity
Wide range of services which offer hope and practical steps towards recovery including schools work, young peoples services, self harm services, supported living and wellbeing workshops.
What is Resilience?
The capacity to recover quickly from difficulties, a person’s ability to resist adversity without resulting in physical or psychological disability.
What are the personal strengths underpinning resilience?
High frustration tolerance Self acceptance Self belief Humour Perspective Curiosity Adaptability Meaning
What are some behaviours that support resilience?
Positive relationships Reflective ability Assertiveness Avoid procrastination Developing goals Time management Work-life balance
What are some sources of burnout?
Perfectionism, denial, avoidance, micromanaging, unwilling to seek help, conscientious. Culture of invulnerability Culture of presenteeism Blame culture Overwork Shift work Lack of oversight Chaotic work environment Lack of teamwork Fractured training
What is an occupational history?
Chronological list of all the patient’s employment with the intention of determining whether work has caused ill health, exacerbated an existing health problem or has ill health had an impact on the patient’s capacity to work.
What is a fit note?
Items of consideration for employers when signing a patient’s return to work.
Can only be completed by a doctor.
It is not binding on the employer.
Required if patient has been off for more than 7 consecutive days (including on working days).
What is the role of Occupational Health?
Ensuring the health and well being of the working population by preventing work-related ill health and providing specialist rehabilitation advice.
They provide independent, impartial advice to employers and employees on the effects of work on health and the effects of health on work.
What are the fit note options?
Phased return to work - start with reduced hours and build up.
Altered hours - work at different times of day
Amended duties - change in work practice or content
Workplace adaptation - e.g. changes to seating to support back better.
What is sustainability?
Ability to continue over a period of time.
What are some features of Low carbon clinical care and NHS sustainability?
Prioritise environmental health.
Substitue harmful chemical with safer alternatives
Reduce and safely dispose of waste
Use energy efficiently and renewable where possible.
Purchase and serve sustainably grown food.
Safely manage and dispose of pharmaceuticals
Adopt greener building design and construction.
What is health promotion?
Any planned activity designed to enhance health or prevent disease.
Legislation, immunisation, development of activities etc. are all involved.
What is the educational theory of health promotion in action?
Provides knowledge and education to enable necessary skills to rate informed choices re health
e.g. smoking, diet, diabetes
What is the Socioeconomic theory of health promotion action?
‘Makes healthy choice the easy choice.
National policies e.g. unemployment, redistribute income.
What is the Psychological theory of health promotion action?
Complex relationship between behaviour, knowledge, attitudes and beliefs. Activities start from an individual attitude to health and readiness to change. Emphasis on whether individual is ready to change. (e.g. smoking, alcohol).
What is the health education?
an activity involving communication with individuals or groups aimed at changing knowledge, beliefs, attitudes and behaviour in a direction which is conducive to improvements in health.
What is health protection?
Involves collective activities directed at factors which are beyond the control of the individual. Health protection activities tend to be regulations or policies, or voluntary codes of practice aimed at the prevention of ill health or the positive enhancement of well-being.
What is empowerment?
The generation of power in those individuals/groups which previously considered themselves to be unable to control situations nor act on the basis of their choices.
What are some benefits if empowerment?
An ability to resist social pressure.
An ability to utilise effective coping strategies when faced by an unhealthy environment.
A heightened consciousness of action.
What are the steps within the cycle of change?
Precontemplation Contemplation Ready for action - making definitive plans Action Maintenance Regression
What are some examples of health promotion?
Posters Clinics Vaccinations Screening Legislation - age limits, smoking ban etc. Tax on cigarettes Schooling Adverts
What is primary prevention?
Measure taken to prevent the onset of illness or injury
Reduce probability and/or severity of illness or Injury.
What is secondary prevention?
Detection of a disease at an early stage in order to cure, prevent or lessen symptomatology.
What is Wilson’s Criteria for Screening?
Knowledge of disease
knowledge of test
Treatment for disease
What is screened for in Scotland?
Cancers- breast, bowel, cervical.
Abdominal Aortic Aneurysm
Pregnancy screening
Newborn screening - cataracts, hearing, congenital heart disease, Guthrie test.
What is tertiary prevention?
Any intervention after the disease onset that limits the effect of the disease e.g. secondary prevention of stroke/MI.
What is the effect of establishing a healthy lifestyle early on in life?
Growth and development fuelled by food
Scotland has highest incidence of premature death due to heart disease.
High saturated fats and low fruit and veg are important factors in Scotlands health.
What is the role of parenting on establishing a healthy lifestyle early on in life?
Habits and lifestyles established in adolescence - learn from parents.
Smoking id more than twice as likely if your parents smoke.
Neglect and abuse can reoccur.
What are some common reasons children present fo primary care?
feeding problems Pyrexia URTI Coughs/colds rashes Otalgia Sore throat Diarrhoea Vomiting Behavioural problems
Why might a parent bring their child to surgery stating if they are unwell, even if clinically they aren’t?
Might be correct Someone else urging them to act. Anxiety Inexperience Lack of support Parent illness Social issues Abuse in home
What are some areas that can be covered in health promotion?
Diet Alcohol Smoking Exercise Sleep habits Screen time
How much exercise daily do NHS guideline suggest for teens?
At least 60minutes of moderate to vigorous exercise daily.
How much sleep do teens need per night?
8-10hours
What are the main objectives of realistic medicine?
- Build a personal approach to care.
- Change our style to shared decision making.
- Reduce unnecessary variation in practice and outcomes.
- Reduce harm and waste.
- Manage risk better.
- Become importers and innovators.
What is Assign score?
Cardiovascular risk score
What is a Citizen’s panel?
Large demographically representative group of citizens regularly used to assess public preferences and opinions.
What did the citizens advice panel say makes good doctors and the most important elements of a consultation?
Knowledge/qualifications
Good listener
Friendly/approachable
Felt listened too and not rushed
Clear communication
Resolution/diagnosis/outcome
What are some conditions that are commonly over diagnosed?
Prostate and thyroid cancers
Asthma
Chronic Kidney disease
Attention deficit hyperactivity disorder.
How may doctors become improvers and innovators?
Data analysis and audits
Self-reflection
What are the 5 choose wisely UK questions to help prompt better conversations between clinicians and patients?
Is the treatment or procedure really necessary?
What are the potential benefits and risks?
What are the possible side effects?
Are there any simpler, safer or alternative treatment options?
What would happen if I did nothing?
What are Wilson and Junger’s factors that need to be considered before setting up a screening programme?
Will the test detect the condition at an early pre-clinical stage?
Is the disease an important public health problem?
Is the natural history of the disease adequately understood?
Is a test available for the condition?
Is the test sensitive (low false negatives)?
Is the test specific (low false positives)?
Is the test safe?
Is the test acceptable to the public and professionals involved?
Is the cost of the test reasonable?
Does the overall cost-benefit analysis make it worthwhile e.g. number of tests required to save one life?
Is treatment for the condition being screened for of proven effectiveness?
Is treatment for the condition being screened for safe?
Is treatment for the condition being screened for acceptable to public and professionals?
Are facilities for diagnosis and treatment available?
What are some sources of epidemiological data?
Mortality data
Cancer Statistics
Hospital activity statistics
General Practice morbidity/disease registers
ISD information
NHS expenditure data
Social security information/benefits data
What are some questions you may ask someone to help decide whether they have occupational contact dermatitis?
Does he work with chemical irritants?
How much exposure does he have to these irritants (intensity/duration)?
Do his symptoms improve when not at work e.g. onshore, holiday?
Is personal protective equipment (PPE) used?
Does the patient comply with PPE use?
Does the company enforce PPE use?
Do other work colleagues have similar symptoms?
Has he any hobbies/pets/other activities which may be a likely cause?
Does he use hand cream or other topical agents he may be allergic to?
What are some common mild to moderate mental health conditions?
Depression Generalised anxiety disorder Panic disorder Social anxiety disorder Obsessive-compulsive disorder Post-traumatic stress disorder
What are some ways the government/local councils can try and reduce health inequalities?
Effective partnership across a range of sectors and organisations e.g. to promote health, improve patient education about health
Evaluate and refine integration of health and social care
Government policies and legislation e.g. smoking ban
Time to invest in the more vulnerable patient groups
Reduction in poverty
Social inclusion policies
Improved employment opportunities for all
Ensuring equal access to education in all areas
Improved housing in deprived areas
What are the benefits of patient empowerment?
Improved ability to make her own choice, going against the choices of those around her
Improved coping strategies when her colleagues are smoking to avoid smoking herself but still enable to her to socialise with them
An improved awareness of her own capacity to weigh up the benefits and risks of smoking to allow her to make a positive choice and act on that choice.
What are some reasons for people living longer?
Decrease in premature mortality/increased life expectancy
Decrease in birth/fertility rates
Migration
Greater availability of contraception
Improvements in housing
Improvements in sanitation
Baby boom-post war recovery years followed by greater sexual “freedom”
Health education programmes e.g. smoking, exercise, diet
Improved safety and reduction of injury
What are some social issues that occur as a result of people living longer?
- Increasing dependence on families and/or carers who are also ageing
- Demand for home carers and nursing home places likely to increase
- Increasing emphasis on social activities for elderly within communities
- Role of elderly as grandparents and carers of grandchildren likely to change
- Housing demands are likely to change as more elderly people live alone
What are some factors other than physical illness that may cause tiredness?
Poor diet Inadequate sleep Excess screen time Lack of exercise/too much exercise Academic difficulties Home/relationship difficulties Bullying Social isolation Mental illness
What are some benefits of regular exercise for children?
Builds confidence and social skills Develops coordination Improves concentration and learning Strengthens muscles and bones Improves health and fitness Improves sleep Aids weight loss/reduces risk excess weight gain Makes you feel good/improves feeling of general well-being
What is important to consider when breaking bad news?
Listen to the patient and their carers
Set the scene
Check whether patient wants to speak himself or with family present.
Find out what the patient already understands
Find out how much the patient wants to know
Share the information using a common language/avoid jargon
Review and summarise the information
Allow opportunities for questions
Agree follow up and support
What are some factors that contribute to resilience?
- Intellectual interest e.g. job satisfaction, career progression, variability (if wanted), capacity to develop special interest
- Self-awareness and self-reflection e.g. recognise and accept personal limits, establish boundaries in doctor-patient relationship, less self-critical, aided by mindfulness based stress reduction
- Time management and work life balance e.g. ensuring time for hobbies, leisure, relaxation, self-expression
- Continuing professional development
- Support including team working/supportive relationships within and out-with medicine
- Mentors (help trainees adapt to change and react to stress)
