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Medicine year 2 semester 1 > Case 17- SAP > Flashcards

Case 17- SAP Flashcards

1
Q

The major social and cultural barriers to health

A 
• Stigma and discrimination
• Violence
• Marginalisation
• Law and policies
• Poverty and inequality
Effect of these barriers- negative psychological impact, social isolation, prevents the patient from coming in for diagnosis and treatment
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2
Q

Cultural attitudes to condom use

A

• People from Central and East Africa believe that if the condom breaks it can lead to infection, sterility and death
• Uganda- some women view condoms as bad for reproductive health
• South Africa- believe that condoms hold bodily fluid that may be used by sorcerers
• Cultural patterns of masculinity identity.
Cultural patterns leads to negative HIV/AIDS outcomes.

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3
Q

Stigma

A

When an adverse social judgement is made about a person or a group which leads to rejection, blame, social exclusion or devaluation

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4
Q

What is stigma about

A

An enduring feature of identiyt i.e. race, ethnicity and sexual preference

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5
Q

Health related stigma

A

Social judgement which is based on an enduring features of identity conferred by a health problem or health related condition i.e. HIV, epilepsy or mental health

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6
Q

Stigma and deviance

A

People are stigmatised if they follow deviant activity instead of the social norms, how stigma and deviance are defined varies across cultures. Stigma is not an innate attribute but arises through social interaction

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7
Q

Examples of stigmatised health issues

A

Schitzophrenia, bipolar, epilepsy, autism, diabetes, HIV

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8
Q

Labelling theory

A

Labels create social outsiders, labels are created for people outside the social norm

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9
Q

Euphemism treadmill

A

Whatever term is used is likely to develop stigma eventually

Even when we stop using an originally offensive term, the replacement term will also pick up negative connotations

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10
Q

The metaphors of AIDs

A

The metaphors and myths surrounding AIDs adds to the suffering
• AIDS as a plague
• AIDS as an invisible contagion
• AIDS as moral punishment
• AIDS as an invader
• AIDS as war
• AIDS as a primitive or pre-social force or entity

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11
Q

Modes of adaption to illness

A
  • The pragmatic type- downplay their illness
  • The secret type- use tactics to conceal their disease, which they regarded as stigmatizing
  • The ‘quasi-liberated type’ publicly proclaiming their disease in order to educate others
  • Unadjusted- overwhelmed by their condition
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12
Q

Types of enacted stigma

A

Overt discrimination due to their social unacceptability
• Subjected to degrading or insulting language
• Labels such as cheap, bad, greedy, shameless, dirty
• Spat on laughed at
• Harassment and abuse from the police

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13
Q

Types of felt stigma

A

Denotes both a sense of shame and a fear of encountering enacted stigma
• Exhibiting a degree of shame in their profession/illness
• Angry and hurt by negative community responses
• Fear of encountering enacted stigma
• Concealing activity from friends and family

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14
Q

Felt normative stigma

A

A subjective awareness of stigma which motivates individuals to take actions to avoid enacted stigma

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15
Q

What does internalised stigma result in

A

Results in prejudice and enacted stigma, subjects of stigma accept discredited status

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16
Q

Early generations of HIV patients

A
  • Many more side effects
  • Memories of friends and partners who had died
  • Coped by getting involved in HIV activism (some still are)
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17
Q

Later generations of HIV patients

A
  • Rejected activism- HIV should only claim a small part of their social identity
  • Praised the self-reliance and HIV anonymity made possible by ART
  • Distanced themselves from a public HIV identity
  • Because of stigma most concealed their HIV status
18
Q

Causes of stigma

A

1) Believing people with certain attributes are vectors of disease- especially HIV/AIDs
2) Believing people are deviant and dont fit in with social norms i.e. sex workers

19
Q

Stigma surrounding HIV

A
  • Believing only certain people can get HIV
  • Feeling like people deserve to get HIV due to their lifestyle choices
  • Refusing contact with someone who has HIV
  • Believing HIV is only transmitted through sex
20
Q

How can the stigma around HIV be reduced?

A
  • Talk about HIV and normalise it
  • Take actions to protect i.e. anti-discrimination laws
  • Educated people
  • Empower people to act on violations and understand rights
21
Q

Right

A

An entitlement or justifiable claim to have or obtain something or to act in a certain way. They are often provided by the state and enshrined in law

22
Q

When were human right established

A

The united nations was founded in 1945 and the WHO was founded in 1948. In 1958 the UN adopts the universal declaration of human rights. Enjoying the highest attainable standard of health is a human right. Many countries have incorporated the right to health in their national constitution

23
Q

Human rights and HIV

A
  • International laws and treaties give every person the right to health and to access HIV and other healthcare services
  • Human rights violations in the context of HIV include criminalisation, stigma, discrimination and denial of treatment
  • Countries that fail to meet human rights requirements for people living with HIV should be held legally accountable
24
Q

Critiques to the right to health

A
  • Where do we stop?
  • Where does the money come from?
  • Where do resources come from?
  • How do we know the extent of the public health impact?
  • Who is responsible?
  • Any individual responsibilities i.e. smoking and alcohol
25
Q

Human rights- HIV

A
  • Every person has the right to access HIV medication and healthcare
  • There should be no violence or discrimination against someone who has HIV
  • No denial of treatment
  • National AIDS trust stops reckless transmission of HIV and can prosecute anyone transmitting it on purpose
26
Q

Sensitive issues that may arise in a consultation

A

1) Grief
2) HIV
3) Doctors errors
4) Mental health
5) Sexual health
6) Criminal acts
7) Safeguarding

27
Q

Aims of sexual history taking

A
  • To gather information- patients presenting symptoms, patients risk of STI including routes of acquiring potential infections
  • To explore other significant risks to sexual health
  • To allow effective management of presenting problems and other risks to health
  • To promote health
28
Q

Non-clinical determinants of health

A

Education, Diet, Exercise, Alcohol and drugs, Living conditions, Poverty, Dependents, Access to green spaces, Access to transport, Gender, Age, Occupation, Sleep, Stress levels, Politics, Religion, Relationships

29
Q

Psychological context of risk

A
  • Scared of the consequences
  • Don’t want everyone else to have a good time - miss out
  • Scared of being judged
  • Grief
30
Q

Social context of risk

A
  • All of their friends are doing it
  • Never been told about the actual risks
  • Family ideas - if their parents don’t care then they will probably be more likely to take health risks
  • Cultural and national consensus on something influences attitudes
  • Lack of education around their health
  • Predisposition
  • Socioeconomic status
31
Q

GMC advice on working with a medical condition

A

If your judgment or performance could be affected by a condition, consult a suitably qualified colleague. You must follow their advice about any changes to your practice they consider necessary and must not rely on your own assessment of the risk to patients.
If you have any concerns that a colleague may not be fit to practice and may be putting patients at risk, ask for advice from a colleague, your defence body or the GMC. If you are still concerned, report this and make a record of the steps you have taken.

32
Q

GMC guidance on disclosing information about a serious communicable disease

A

You should follow guidance - raising and acting on concerns about patient safety - if you are concerned that a colleague who has a serious communicable disease is practicing or has practiced in a way that puts patients at risk of infection. You should inform your colleague before passing on the information as long as it is practicable and safe to do so.

33
Q

Public health act 1984- dealing with infectious patients

A

May act if:

  • Person is or may be infected or contaminated
  • The infection or contamination is one which presents or could present significant harm to human health
  • There is risk that patient may infect or contaminate others
  • It is necessary to make the order in order to remove or reduce that risk
34
Q

What might a doctor to do for an infectious patient

A

Submit medical examination, be removed to hospital or other suitable establishment, be detained in hospital, be kept in isolation or quarantine

35
Q

The law on notifiable disease

A

Registered doctors have the legal duty to notify suspected cases of certain infectious disease to the proper officer at their local council

36
Q

Ethical issues relating to patients with serious communicable disease

A

Confidentiality for the patient balanced against the benefit for the people who may have been in close contact with the infected patient

37
Q

Legal issues relating to patients with serious communicable diseases

A

Registered doctors have a legal duty to notify suspected cases of certain infectious diseases. Follow guidance on raising concerns published by the GMC

38
Q

Describe when its justifiable and when its mandatory to breach confidentiality?

A

Health Service Regulations 2002 provides the legal basis for sharing confidential health information without consent
• Reckless transmission of HIV
• Notifiable diseases
• Police requests for investigations e.g. driving offence / terrorism

39
Q

The social and political factors affecting health

A

1) Impact of the media
2) Gender, race, ethnicity
3) Acess to health service

40
Q

WHO key concepts of the social determinants of health

A 
Employment conditions
Social exclusion
Public health programmes and social determinants
Women and gender equity
Early child development
Globalisation
Health systems
Measurement and evidence
Urbanisation
41
Q

The Dahlgren and Whitehead model of health determinants

A

1) Personal characteristics include- sex, age, ethnicity and hereditary factors
2) Lifestyle factors- behaviours such as smoking, alcohol use and physical activity
3) Social and community- family and wider social circle
4) Living and working conditions- access and opportunities in relations to jobs, housing, education and welfare services
5) Socioeconomic, cultural and environmental factors- disposable income, taxation and available work

Medicine year 2 semester 1 (53 decks)

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