Year one and two Flashcards
What are the three types of skills needed for successful medical interviewing?
Content, perceptual and process skills
Szasz and Hollender describe three different types of Doctor-Patient Realationships. What are they?
- Authoritarian or Paternalistic, Guidance, Mutual Participation
Name the 5 question types which can be asked during a consultation?
Open ended, closed, direct, leading or reflected
Body language during consultations is highly important. What four points should be considered throughout the consultation?
Gesture Clusters, Congruence, Culture and Context
Name the members of a primary care team?
GP, NHS 24 staff, Midwives, Phramacists, Dieticians, Nurses, PA’s, Physiotherapists, Counsellors, Reception staff
What are the top risk factors for health in Scotland?
Excessive drinking, smoking, unhealthy diet, sedentary lifestyle, obesity
- Albert Bandura proposed the Social Cognitive Theory in 1993. What are the 5 core concepts of SCT?
Self Efficacy, Goal Setting, Outcome Expectations, Self-Regulation, Observational Learning
- According to SCT, an individuals behaviour can be influenced by what factors?
- Personal Factors (how confident the individual feels about changing etc.), Enviromental/Social factors, Behavioural Factors
What does NICE recommend for GP’s to do to change patients behaviours?
- Take account of patients circumstances, Aim to develop and build on the individuals skills, tailor interventions to tackle the individuals beliefs and attitudes associated with target behaviours
- What is the WHO’s definition of health?
- A state of complete physical, mental and social well-being and not just the mere absence of disease or infirmity
Statistical normality corresponds to what ?
A bell curve
- What is cultural normality?
- The norm which is based on the expectations and standards of a particular group of individuals
- Health can be perceived as being holistic. Seedhouse (2001) identifies 5 major characteristics or qualities which define positive ideas about health. List all 5.
- Health as an ideal state, health as physical and mental fitness, health as a commodity, health as a personal strength or ability health as the basis for personal potential
- Blaxter(1995) questioned 9000 individuals about their health. Lay people categorised their health into what categories?
- Functional ability, absence of disease and physical fitness
- Name 6 duties of a doctor registered with the GMC.
- Make the care of your patient your first concern, treat every patient politely and considerately, respect patients dignity and privacy, listen to patients and respect their views, give patients info in a way that they can understand, keep your professional knowledge up to date, make sure that your personal beliefs do not prejudice your patients care, be honest and trustworthy, respect and protect confidential information, act quickly to protect patients from risk, avoid abusing your position as a doctor, work with colleagues in ways that best serve the patients interests, recognise the limits of your professional competence
- Give Examples of the four pillars of medical ethics?
- Respect for autonomy (informed consent, confidentiality, promote capacity), Non-Maleficence (avoid harm – avoid unnecessary surgerys, procedures etc.), Beneficence (to do good – do the best for your patients), Justice (fairness, equity, triage, individual vs population)
- According to the GMC Guide 2006, name 6 things you cannot discriminate against?
- Colour, age, culture, disability, ethnicity, gender, lifestyle, race, religion, sex, sexual orientation, social or economic status
- Concerning ethics, what are the four principles of medicine?
Beneficence, non-maleficence, autonomy and justice
- The Duty of Candor states that you must inform patients if something has gone wrong with their treatment. What other two things does it state you must do in this instance
- You must apologise to the patient and offer an appropriate remedy or support to put matters right and explain the short term and long term effects of what has happened.
- Access to healthcare means the opportunity to use healthcare regardless of whether you come to use it. What are the 3 A’s of Access to Healthcare?
- Affordability, Accessibility, Acceptability
- Name factors which influence the degree of risk?
- How much the person is exposed, how the person is exposed and the conditions of exposure
- Name the three principles which govern the perception of risk?
- Feeling in control, Familiarity with the risk, Size of the possible harm
- What are the individual variables in risk perception?
- Previous experience, attitude towards risk, values, beliefs, socio-economic factors, personality, demographic factors
- List four aspects of lifestyle you MAY cover in a consultation with ANY patient when giving advice to promote a healthier lifestyle.
- Diet, Exercise, Sexual Health, Drug Use, Alcohol Intake, Smoking
- Which factors enable you, as a GP, to be the most appropriate professional to guide a patient about their current worries.
- You are aware of patients PMH, You are aware of patients social circumstances, GP has a knowledge of a broad range of illnesses and health conditions, GP is likely to have known patients for some time, GP has a role in prevention as well as diagnosing/treating illness/disease i.e. GP is responsible for holistic patient care, GP is likely to be local and therefore accessible
- List three examples of environmental factors which may influence an individual’s behaviour
- Culture, Social Support, Location, Income, Time
- Give five factors which influence lay beliefs about health. Include examples.
- Age-older people concentrate on functional ability, younger people tend to speak of health in terms of physical strength and fitness
Social class- people living in difficult economic and social circumstances regard health as functional (ability to be productive, take care of others), women of higher social class or educational qualifications have a more multidimensional view of health
Gender-men and women appear to think about health differently (women may find the concept of health more interesting, women include a social aspect to health)
Culture-different perceptions of illness/disease, differences in concordance with treatment
- List the factors in which the government can curb the rise in obesity?
29. Health education-diet and exercise Tax on unhealthy foods, “fat tax” 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. cycle lanes
- Define Cultural Competence
- Cultural competence is the understanding of diverse attitudes, beliefs, behaviours, practices, and communication patterns attributable to a variety of factors (such as race, ethnicity, religion, SES, historical and social context, physical or mental ability, age, gender, sexual orientation, or generational and acculturation status).
- List four potential difficulties which may arise from consulting with a patient from a different culture.
- Language barrier, examination taboos, third party present, fear and distrust, lack of knowledge about the NHS, racism, stereotypes, bias, religious beliefs. Patient may not be entitled to NHS care
- Discuss the three steps of safety netting.
- Advise the patient of the expected course of the illness/recovery
Advise of symptoms indicating deterioration
Advise who to contact if patient deteriorates
- Neighbour suggests that there are other ways to minimise risk whilst consulting. Give three examples of how you can do this?
- Summarise and verbally check that reasons for attendance are clear
Hand over and bring the consultation to a close i.e. hand over to the patient at the end to ensure all issues have been covered
Deal with the housekeeping of recovery and reflection e.g. record keeping, referral if necessary, pausing to reflect before next patient
- Name 6 advantages of GP’s as gatekeepers.
- Identify those patients who are in need of 2° care assessment
Personal advocacy
Patient does not necessarily know which specialty to go to
Increases likelihood of referral to appropriate department
Increases likelihood of appropriate referral/use of resources
Limits exposure to certain investigations e.g. MRI scan, X-rays
GP acts as co-ordinator of care
Puts GP in position to provide patient education
- What are the skills of a GP?
- Ability to relate to the public, seek help, self-reflect, recognise ones limitations, problem solve, good com skills, clinically competent
- The consultation between the patient and doctor requires good communication skills for it to be successful. What are the three broad types of skills required for successful medical interviewing?
36. Content Skills (what doctor communicates) Perceptual Skills (picking up on how patient thinks or feels) Process Skills (how doctor communicates information)
When is a patient more likely to change their lifestyle
- Benefits outweigh disadvantages
Patient anticipates a positive response from peers
Social pressure is forcing them to change
If they believe that a new lifestyle will be consistent with their new self-image
If they believe that they can carry out the new behaviour in a number of different situations
- Define Hazard, Risk, Risk Factor, Protective Factor, Susceptibility
- Hazard – something that has the potential to cause harm
Risk – The likelihood of harm occurring
Risk Factor – something which increases the risk of harm
Protective Factor – something which decreases the risk of harm
What kind of reasoning is used in GP Consultations
- HYPOTHETICO-DEDUCTIVE REASONING
Discuss the principles behind patient centred care
Person-centered care is the provision of care that places the patient at the centre ensuring that the healthcare system is designed to meet the needs and preferences of patients as defined by patients themselves.
What are the five principles of patient centred care?
Respect Choice and Empowerment Patient involvement in health policy Access and support Information
In which group are long term conditions more prevalent?
Older people and more deprived groups
What percentage of GP appointments are accounted for by long term illnesses?
50%
Define incidence
The number of new cases in a population in a specified period of time
Define prevalence
Number of people in a population with a specific disease at a single point in time or in a defined period of time
What is the aetiology behind long term conditions?
Genetic factors
Environmental Facots
Define vulnerability
An individuals capacity to resist disease, repair damage and restore physiological homeostasis can be deemed vulnerability.
What are the pressures that patients and carers are put under by the healthcare systems?
Changing behaviour or policing the behaviour of others to adhere to lifestyle modificatios
Monitoring and managing their symptoms at home
Complex treatment regimens and polypharmacy
Complex administrative systems
Bury describes the concept of biographical disruption. What is the basis behind this term?
Long term conditions lead to loss of confidence in body which leads to a loss of confidence in social interaction or self identity
What are the impact of long term conditions on the individual?
can be negative or positive and may include denial, self pity and apathy
What are the impact of long term conditions on the family?
Financial, emotional and physical
What are the impact of long term conditions on the community?
Isolation of an individual if the community are not accepting of the individuals infirmity
How does WHO define disability?
Body and Structure Impairment -
Abnormalities of structure, organ or system function (organ level)
Activity Limitation -
Changed fuctional performance and activity by the individual (personal level)
Participation Restrictions -
Disadvantage experienced by the individual as a result of impairments and disabilities (interaction at a social and environmental level)
What are some medical models of disability?
Individual/personal cause, underlying pathology, individual level intervention, individual change/adjustment
What are some social models of disability?
Societal cause, conditions referring to housing, social/political action needing, societal attitude change
Name two forms of disability legislation?
Disability Discrimination Acts 1995 and 2005
Equality act 2010
What might contribute to a persons reaction to disability?
The nature of the disability
The information base of the individual, ie education, intelligence and access to information
The personality of the individual
The coping strategies of the individual
The role of the individual – loss of role, change of role
The mood and emotional reaction of the individual
The reaction of others around them
The support network of the individual
Additional resources available to the individual e.g. good local self-help group, socio-economic resources
Time to adapt i.e. how long they have had the disability
What is Wilsons criteria for screening?
Knowledge of disease, knowledge of test, treatment for disease
Define disease
Symptoms,signs and diagnosis - biomedical perspective
Define illness
Ideas, concerns and expectations. Patients perspective
What affects the uptake of care?
Lay referral, sources of info such as the internet etc, medical factors (new symptoms, visible symptoms, increasing severity and duration), non medical factors (peer pressure, crisis, beliefs, ethnicity,culture)
What are the three main aims of epidemiology?
Description - describe distrabution of disease in human populatio
Explanation - Elucidate natural history and identify aetiological factors of disease
Disease Control - provide basis on which preventative measures, public health practices and therapeutic strategies can be developed
Define relative risk
Relative risk
This is the measure of the strength of an association between a suspected risk factor and the disease under study.
Define the concept of health literacy
Health literacy is about people having the knowledge, skills, understanding and confidence to use health information, to be active partners in their care, and to navigate health and social care systems.
What is a descriptive study?
Descriptive studies attempt to describe the amount and distribution of a disease in a given population
What are cross-sectional studies?
In cross-sectional studies, observations are made at a single point in time
What are case control studies?
In case control studies, two groups of people are compared:
a group of individuals who have the disease of interest are identified (cases),
a group of individuals who do not have the disease (controls).
What are cohort studies?
baseline data on exposure are collected from a group of people who do not have the disease under study.
The group is then followed through time until a sufficient number have developed the disease to allow analysis.
What are trials?
Experiments used to test ideas about aetiology or to evaluate interventions
What trial is the definitive method of assessing any new treatment in medicine?
Randomised Control
What are the three factors to consider when interpreting results?
Standardisation, Standardised Mortality Ratio, Quality of Data, Case Definition, Coding and Classification, Ascertainment
What is bias?
Any trend in the collection, analysis, interpretation or review of data that can lead to conclusions that are systematically different from the truth
Give four examples of bias?
Selection bias, information bias, follow up bias, systematic error
What is a confounding factor?
A factor associated independently with both disease and with the exposure under investigation and so distorts the relationship between the exposure and the disease
What are the criteria for causality?
Strength of association, consistency, specificity, temporality, biological gradient, biological plausibility, coherence, analysis and experiment
What are the implications of having an increase in the aged population?
Health - Increased number of geriatricians will be required, an increase in elderly health care facilities will be required, there will be more focus on long term conditions and palliative care
Social - Increased dependence on family/carers, increased demand for care homes/carers
Economic - Increase in pension/retirement age
Define multimorbidity
Co-existence of two or more long term condition in an individual
Name some options for elderly care
Sheltered housing, residential home, nursing home care
What are anticipatory care plans?
When individuals, their care providers and those close to them make decisions in respect to their future health or personal and practical aspects of care
What are some legal examples of ACP?
Welfare power of attorney, financial power of attorney, guardianship
What are some personal examples of ACP?
Next of kin, advance directive, consent to pass on relevant info to others, preferred place of death, religious and cultural beliefs about death, treatment preferences
What are some medical examples of ACP?
DNACPR, Electronic care summary, home care package
What is the role of the district nurse ?
Visiting people in their own homes or in care homes
What is the role of a midwife ?
Provide care during all stages of pregnancy, labour and the early post natal period
What is the role of a health visitor?
Lead and deliver child and family health services
Provide ongoing additional services for vulnerable children and families
Contribute to multidisciplinary services in safeguarding and protecting children
What is the role of a Macmillan Nurse?
Nurses who specialise in cancer and palliative care, providing info to people with cancer and their families from the point of diagnosis onwards via :
- Specialised pain and symptom control
- Emotional support for both the patient and their family or carer
- Care in a variety of settings
- info about cancer treatment
- Advice to other members of the caring, for example district nurses and Marie Curie nurses
- Co-ordinated care between hospital and patient’s home
- Advice on other forms of support, including financial help
What are the impacts of developing a long term health condition?
On the individual - can be negative or positive. Include denial, self pity and apathy
On family - financial emotional
Community/Society - isolation of the individual may occur
What are the three classifications of disability according to the WHO?
Body and Structure impairment
Activity Limitation
Participation Restriction
What are the methods of communicating risk
Via actual risk and relative risk
Verbally, using fractions
How do you structure an audit according to the RCGP guidelines?
Title using Reasons for Audit, Criteria to be Measured, Standards Set, Preparation and Planning, Results, Reflections
A patient presents to the GP after a diagnosis with arthritis and claims that he is not fit for work? What might you do?
Alter analgesia to help symptoms
Provide a Med 3 Fit note
Refer to physio
Sick Role
Exempts an individual from normal social roles
The sick patient is not respionsible for their illness and should try to get well
They should seek competent help and co-operate with doctor and health professionals
By how much is the elderly population bound to increase by 2050?
4x
What is health literacy?
Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decision
Expert Patient
Patient has an in-depth knowledge of condition, sometimes exceeding that of health professional
Utilising knowledge could improve patient care and quality of life
Knowledge held by patient is an under-recognised resource
What is the aim of SIGN guidlines?
To help social care professionals and patients understand and use medical advice
Reduce unwanted variations in health practice
Improve healthcare across Scotland by focusing on patient important outcomes
What are 6 sources of epidemiological data?
Mortality data, hospital activity stats, cancer stats, accident stats, GP morbidity stats, Drug Misuse Database
What are examples of confounding factors?
AGE, SEX, SOCIAL CLASS
What are 6 reasons for the current population trends?
Decrease in birth rate Improvement in housing Improved sanitation Improved nutrition Improved safety Migration
What are the social implications of an elderly population?
Increased demands on care home spaces, increased dependence on families, increased emphasis on social activities for the elderly, change in the role of a grandparent, decreased employment rates in young as more elderly folk remain in work for longer
Financial implications of being a carer for parent?
Drop in income since working less to look after parent, cut back on household basics, missing out on financial support, stress
What is the CHADS@ score?
Clinical prediction which estimates incidence of stroke in patients with rheumatic AF. Score determines treatment
Relationship between chronic disease/minor illness and incidence & prevalence?
Chronic Disease - Low incidence, High Prevalence
Minor Illness - High incidence, Low Prevalence
