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Year One Flashcards

1
Q

Typical GP day

A 
Morning and afternoon surgeries
Paperwork (letters, results etc.) and phone calls interspersed throughout the day
House calls
Extended hours
Duty doctor/ emergencies
Practice business/ staff issues
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2
Q

Main features of general practice

A

Caring for the whole person as well as their illness
The promotion of healthy lifestyles
The first point of contact

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3
Q

What is a GP practice

A

Most GPs are independent NHS contractors, owning and running the business alone or in partnership with others.

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4
Q

Responsibilities of a GP practice

A

Running the business affairs of the practice
Providing adequate premises and infrastructure to provide safe patient services
Employing and training practice staff.

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5
Q

Ongoing learning as a GP

A

Each 5 years GPs prepare for appraisal by reading literature, attending courses and performing audits.
Appraisal work is assessed so the GP can be re-validated and allowed to continue working

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6
Q

Effective communication improves…

A 
Patient satisfaction
Recall
Understanding
Concordance
Outcomes of care
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7
Q

five core concepts associated with the SCT framework

A 
Observational learning/ modelling
Outcome expectations
Self-efficacy
Goal setting
Self regulation
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8
Q

Personal factors affecting behaviour (SCT)

A

Self-efficacy
Perceived outcomes/ consequences
Importance of outcomes/ consequences
Perceived risk to the individual

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9
Q

To influence behaviour, information must be

A

Relevant to current goals
Easily understood and remembered
Readily available in the moment of decision/ action

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10
Q

Self-efficacy underpins….

A

Goal setting
effort investment
persistence in face of barriers
recovery from set-backs

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11
Q

Choice architecture

A

The environment in which the individual makes choices

*Changes in choice architecture can influence individual decisions

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12
Q

Nudges

A

Prompt choices without getting people to consider their options consciously

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13
Q

Bio-medical/ scientific view of health

A

Health as the absence of disease

Health as the absence of illness

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14
Q

Reasons for verbally checking and safety netting

A

To check you’ve understood the real reason the patient was there.
To chech nothing was missed
To minimise the chance of future problems
To ensure you are ready for the next consultation

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15
Q

5 core concepts of social cognitive theory

A 
Observational learning/ modelling
Outcome expectations
Self-efficacy
Goal setting
Self regulation
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16
Q

Uncertainty definition

A

State of not being completely confident or sure of something

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17
Q

Safety netting

A

If uncertainty remains, this must be communicated to the patient

They must know what to look out for, how to seek help and what to expect about the time course
It may be important to arrange follow up.

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18
Q

Method used as a full systematic enquiry is not possible

A

Hypothetico-deductive reasoning

  1. consider diagnoses that are likely or immediately concerning.
  2. eliminate other diagnoses at this stage
  3. strengthen the case for diagnoses through brief history + examination
  4. extend the search if no diagnosis identified
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19
Q

Childhood experiences that influence adult health

A 
Nutrition 
Trauma
Nurture
Optimism
Education
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20
Q

Factors that influence the degree of risk

A

How much a person is exposed
How the person is exposed
Conditions of exposure

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21
Q

Where do ethical principles come from?

A
  1. duties

2. considering the benefits and harms to individual and society (4 principles)

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22
Q

Duty of Candour

A

Must be open and honest with patients when something goes wrong.
Must apologise and offer to put matters right.
Must raise concerns where appropriate.

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23
Q

Ethical practices

A 
Non-judgemental approach
Not imposing personal views and respecting patients' views
Confidentiality
Not exceeding your competency
Fitness to practice
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24
Q

Focuses of cultural competence in health care

A
  1. eliminate misunderstandings that may arise from differences in language or culture
  2. Improve patient adherence
  3. Eliminate health care disparities
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25
Q

Role of the physician in eliciting the patient’s explanatory model of illness

A
  1. asking questions to elicit the patient’s understanding of their illness
  2. Having strategies for identifying and bridging the different communication styles
  3. Having skills for assessing decision-making preferences and the role of family
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26
Q

BELIEF model of cross-cultural communication

A 
B-eliefs about health (what caused the illness) 
E-xplanation (why did it happen)
L-earn (about belief)
I-mpact (on life)
E-mpathy
F-eelings
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27
Q

A culturally competent doctor

A

Has an awareness and acceptance of difference whereby diversity is valued

Understands how their own culture influences them

Understands the dynamics of difference present when cultures interact

Is familiar with the cultures in their area

Adapts to the cultural context of the patient/client

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28
Q

Role of primary care

A

Where illness first presents,
Most illness managed,
“Gatekeeper” function,
Prevention

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29
Q

Secondary care

A

Hospitals

Consulting

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30
Q

Tertiary care

A

Regional centres

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31
Q

Bridging Primary and Secondary Care

A 
Public health specialists,
Occupational medicine,
Some hospital specialties (e.g. mental health, palliative care),
Management of long term conditions,
Community Hospitals
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32
Q

General practice team members

A 
Manager, 
IT/Admin Staff,
Secretarial Staff,
Reception Staff,
Nurses – Junior/Senior,
Advanced Nurse Practitioners/Physicians Assistants,
Phlebotomists/Health Care Assistants,
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33
Q

Other roles of GPs

A

Out-of-hours responsibility,
GPs with special interests,
Portfolio careers,
Events coverage e.g. concerts, car rallies,
BASICS (British Association for Immediate Care - pre-hospital care)

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34
Q

Primary Care specialties

A 
General Practice (GP), 
Occupational and Environmental Medicine (OEM),
Public Health (PH)
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35
Q

Personal qualities of a good GP

A 
Clinical competence, 
Organisational ability, 
Ability to work with others, 
Maintaining good practice, 
Relating to the public,
Ability to deal with uncertainty

Ability to manage oneself,
Ability to care about patients and their relatives,
A commitment to providing high quality care,
An awareness of one’s own limitations,
An ability to seek help when appropriate,
Commitment to keeping up to date and improving quality of one’s own performance,
Appreciation of the value of team work,
Good interpersonal and communication skills,

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36
Q

Uses of GP IT systems

A

Book appointments,
Chronic disease management and recall,
Patient leaflets/resources,
Public health information,
Identify patients for screening programmes,
Electronic management of hospital letters,
Electronic management of blood/other results,

Assist in consultations (patient records),
Support prescribing,
Use in audit,
E-consultations,
Store appointments,
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37
Q

The four essential components of clinical competence

A

Knowledge,
Communication skills,
Physical examination,
Problem solving

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38
Q

Skills needed for successful medical interviewing

A

Content skills - What doctors communicate

Perceptual skills - What they are thinking and feeling

Process skills - How they do it

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39
Q

Types of factors Influencing the Consultation

A

Physical factors

```
Personal factors
of the doctor and patient
~~~

40
Q

Physical Factors Influencing the Consultation

A

Site and environment.
Adequacy of medical records.
Time constraints.
Patient status (new/known)

41
Q

Personal Factors Influencing the Consultation

A 
Age, 
Sex,
Backgrounds and origins, (e.g. social class/ ethnicity)
Knowledge and Skills
Beliefs,
The Illness,
42
Q

Types of doctor-patient relationships

A

Authoritarian or paternalistic relationship,
Guidance/co-operation,
Mutual participation relationship.

43
Q

Parts of the medical consultation

A

Talking together- always
Doctor examining the patient - often
Performing procedures - sometimes

44
Q

Interviewing techniques in taking the history

A

The open-ended question,
Listening and Silence,
Facilitation - manner that encourages communication

45
Q

Types of questions

A 
Open-ended question, 
Direct question - specific,
Closed question - yes or no,
Leading question - best avoided,
Reflected question (allows the doctor to avoid answering a direct question, e.g. "you want to know the cause of the pain?)
46
Q

Types of non-verbal communication

A

Instinctive, e.g crying. laughter, expressions of pain

Learned - From life experiences (depends on culture) or from training

Clinical - e.g. abnormal movement in response to pain

47
Q

Factors to consider when reading body language

A

Culture,
Context,
Gesture Clusters (a cluster of gestures reinforces the message)
Congruence (if body language agrees with what is being said)

48
Q

Aspects of body language

A

Gaze behaviour,
Posture,
Specific gestures

49
Q

Main Risk factors for chronic disease

A 
Smoking, 
Obesity,
Poor diet, 
Lack of physical activity,
Excessive alcohol consumption,
50
Q

types of factors influencing behaviour according to social cognitive theory

A

Personal factors - beliefs, knowledge, attitudes, self efficacy

The behaviour itself - habit, pattern

The environment - culture, location, income

51
Q

WHO definition of health

A

”A state of complete physical, mental, and social well-being

and not merely the absence of disease or infirmity.”

52
Q

Types of normality

A

Statistical,

Cultural - depends on the expectations and standards of the society

53
Q

Lay definitions of health

A

Absence of disease,
Physical fitness,
Functional ability,

54
Q

Aims of a GP Consultation

Calgary Cambridge Model

A 
Initiating the Session, 
Gathering Information,
Providing Structure,
Building Relationship,
Explanation and Planning,
Closing the Session,
55
Q

Roger Neighbour’s tasks of a consultation

A

To Connect with the patient,

To summarise and verbally check that the reasons for attendance are clear*

To hand over and bring the consultation to a close*

To ensure that a safety net exists in that no serious possibilities have been missed*

To deal with the housekeeping of recovery and reflection*

.
.

*Ways in which risk can be minimised

56
Q

Sources of guidance to deal with risk and uncertainty

A 
National (e.g. SIGN)
Local 
Immediate guidance/ protocool
Colleagues
Peer group
Reflection
57
Q

Strategies for managing risk and uncertainty

A 
Use external evidence,
Respect the internal evidence,
Good organisation, 
Be aware of your feelings,
Apply reflective practice,
Developing a good doctor-patient relationship, 
Consider each patient as an individual,
Consider the use of a checklist for diagnosis,
Peer group discussions
58
Q

Reasons for the social and economic gradient of health

A

Access to health care,
Environmental exposures (physical and social)
Health behaviours,
Life course factors,

59
Q

Factors affecting access to healthcare

A

Affordability
Accessibility
Acceptability

60
Q

Physiological response to psychological distress

A

Increased blood pressure
Impaired glucose tolerance
Immune dysregulation
Oxidative cellular stress with accelerated aging

61
Q

Health is determined by…

A 
Where you are born, 
Where you live,
How you are brought up,
Your life chances,
Your political voice,
Your family support,
62
Q

The roles of government in reducing exposure to health risks

A

Legislation
Regulation
Taxation

63
Q

Hazard

A

Something with the potential to cause harm

64
Q

Risk

A

The likelihood of harm occurring and the severity of the harm involved

65
Q

Risk factor

A

Something that increases the risk of harm

66
Q

Protective factor

A

decreases the risk of harm

67
Q

Susceptibility

A

influences the likelihood that something will cause harm

68
Q

Types of hazard

A 
Physical,
Chemical, 
Mechanical,
Biological,
Psychosocial
69
Q

Routes of exposure for hazards

A

Skin
Blood/ sexual
Inhalation
Ingestion

70
Q

Principles governing the perception of risk

A

Feeling in control,
Size of the possible harm,
Familiarity with the risk

71
Q

Individual variables in risk perception

A 
Previous experience,
Attitudes towards risk, 
Values,
Belief,
Socio economic factors,
Personality,
Demographic factors
72
Q

Direct pathological effects of the environment

A

Physical - e.g. radiation

Chemical - e.g. pesticides

Biological - e.g. infectious agents

73
Q

Indirect pathological effects of the environment

A

Housing,
Transport (encourage walking?),
Town planning (access),
Income/ wealth distribution

74
Q

Ethics definition

A

The body of moral principles or values governing a particular culture or group

75
Q

Ethics comprise of…

A

Principles
Values
Honesty
Standards

76
Q

Morality definition

A

Our attitudes, behaviours and relations to one another

77
Q

4 principles of ethics

A

Respect for autonomy
Non-malfeasance
Beneficence
Justice

78
Q

Culture definition

A

The learned and shared values of a particular group that guides:

  • thinking
  • actions
  • behaviours
  • emotional reactions to daily living

The sum of beliefs, practices, habits, likes and dislikes

Norms and customs that are learned

79
Q

Cultural sensitivity

A

The ability to be open to learning about and accepting of different cultural groups

80
Q

Multiculturalism

A

The recognition and acknowledgement that society is pluralistic; there exists many other cultures

81
Q

Influences of culture on health care

A

Misunderstandings arising from differences in language or culture

Poor patient adherence and poor outcomes

Health care disparities (differences in health care between different groups)

82
Q

Barriers to health care

A 
Lack of knowledge, 
Fear and distrust,
Bias and ethnocentrism,
Stereotyping,
Language barriers,
Differences in perceptions and expectations,
Situation
83
Q

Aspects of acquiring cultural competence

A

Knowledge,
Attitudes,
Skills (eliciting patient’s explanatory model of illness)

84
Q

Cultural competence

A

The understanding of diverse attitudes, beliefs, behaviours, practices, and communication patterns attributable to a variety of factors

85
Q

proportion of doctor patient consultations that occur within primary care

A

90%

86
Q

For 1000 people, how many report symptoms each month

A

750

87
Q

For 1000 people, how many see their GP per month

A

250

88
Q

For 1000 people, how many are admitted to hospital each month

A

9

3.5% of those seen in primary care

89
Q

For 1000 people, how many are referred to another doctor each month

A

6

90
Q

Factors that increase the chance of someone changing their behaviour

A

You think the advantages of change outweigh the disadvantages
You anticipate a positive response from others to your behaviour change
There is social pressure for you to change
You perceive the new behaviour to be consistent with your self-image
You believe you are able to carry out the new behaviour in a range of circumstances

91
Q

Governmental actions to promote health in the population

A 
Legislation/policies on smoking/alcohol 
Improvements in housing
Provision of health education
Health and safety laws
Traffic/transport legislation/policies
92
Q

Environmental factors which influence behaviour

A 
Culture 
Social support
Location
Income
Time
93
Q

Factors which influence lay beliefs about health and how

A

Age - older people focus on functional ability

Social class - lower class regard health as functional

Gender - women include a social aspect

Culture - different perceptions of disease

94
Q

Advantages of GPs as gatekeepers

A

GPs identify patients in need of secondary care
Patients may not know which speciality to go to
Limits exposure to certain investigations
GP acts as a coordinator of care
Puts GP in a position to provide patient education

95
Q

Advantages of GPs as gatekeepers

A

GPs identify patients in need of secondary care
Patients may not know which speciality to go to
Limits exposure to certain investigations
GP acts as a coordinator of care
Puts GP in a position to provide patient education

96
Q

Systems of behaviour

A

Reflective system

Automatic system

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