Theme C

Question 1

What are the 6 elements to Patient-Centred Care?

Answer 1

1. Explores the patients’ main reason for the visit concerns and need for information
2. Seek an integrated understanding of the patients’ world – their whole person, emotional needs, and life issues.
3. Finds common ground on what the problem is and mutually agrees on management
4. Enhances prevention and health promotion
5. Enhances the continuing relationship between the patient and the doctor
6. Is realistic

Question 2

What is the conventional medical model of disease?

Answer 2

Looks at biomedical perspective only (no social, psychological and behavioural factors).

Biomedical explanation for disease - deviations from the norm. Over-simplifies problems of illness. Enables paternalistic medicine.

Question 3

What is disease?

Answer 3

What is wrong with the body, as identified by signs and symptoms and abnormal tests.

Question 4

What is illness?

Answer 4

Feelings about being ill (feelings, ideas, function, expectations).

Question 5

What are the problems that arise from failure to recognise the duality of agendas (disease & illness)?

Answer 5

• Patient dis-satisfaction

- Complaints

Question 6

How is disease and illness interrelated?

Answer 6

To be patient-centred, must weave between disease and illness to find common ground and mutual understanding with patient.

Question 7

How might the patient’s agenda be explored in consultation?

Answer 7

The Calgary-Cambridge model seeks both disease info by history and examination and illness info by ICEF.

Question 8

Define epidemiology.

Answer 8

Study of distribution and determinants of health-related states and events in population and the application of this study to the control of health problems.

Question 9

Define incidence.

Answer 9

Number of new cases in a period/number initially free of disease
Number changes due to new diagnosis and immigration of ill people.
Rate

Question 10

Define prevalence.

Answer 10

Number of people with disease at a particular point in time/ total population
Number changes due to recovery, death, emigration of ill people.

Question 11

Describe patterns of smoking across time.

Answer 11

Smoking prevalence has decreased over time in males and females.
Ethnicity:
- highest male -> Bangladesh
- lowest male -> Indian
- highest female -> Irish
- lowest female -> Bangladesh

Question 12

Describe smoking prevalence between girls vs. boys.

Answer 12

Ages 11-15, higher girls prevalence
Above 18, higher male prevalence
Decreasing prevalence after age 25.

Question 13

What is descriptive epidemiology?

Answer 13

Tells us how things are distributed.

Question 14

How does descriptive epidemiology help in medicine?

Answer 14

Knowledge of distribution of smoking in the population guides prevention action.
e.g. Need to help people stop smoking before age 40 as health risks will reduce to that of non-smokers then.

Question 15

What is symptom iceberg?

Answer 15

Most symptoms are managed in the community without people seeking professional healthcare.
Tip of the iceberg - small amount of people present to healthcare.
Submerged majority - self care.

Question 16

What are the factors that influence people’s decision to seek help from healthcare professionals?

Answer 16

• Interference with work or physical activity.
• Interference with social relations
• Interpersonal crisis
• Putting time limit on symptoms
• Sanctioning by friends and relatives.

Question 17

What are the barriers to people seeking help?

Answer 17

• Provision and availability of health services.
• Attitudes of staff (receptionists, doctors)
• Social/cultural distance
• Geographical distance
• Time, effort, childcare, loss of earnings
• Car ownership and transport costs
• Bad experiences and waiting times.

Question 18

What is the old world model of doctor-patient relationship?

Answer 18

Patients don’t have easy access to knowledge base of doctors.
Doctor is smartest.

Question 19

What is the new world model of doctor-patient relationship?

Answer 19

Patients have as much access to the evidence base of medicine as doctors.
Patients are smarter.

Question 20

What is medical pluralism?

Answer 20

Co-existence with a society of differentially designed and conceived medical traditions and systems (herbalism, acupuncture, homeopathy).

Question 21

What is the lay-referral system?

Answer 21

Before attending appointments, 70% consult at least 3 lay people e.g. relatives and friends, pharmacists, internet.

Question 22

How does illness behaviour vary?

Answer 22

With age, ethnicity, religion, sexual orientation and disability.

Question 23

How does illness behaviour vary with gender?

Answer 23

Men find cold symptoms more difficult to handle than women.

Question 24

How does illness behaviour vary with ethnicity?

Answer 24

BAME more likely to delay help seeking.

Question 25

How does illness behaviour vary with socio-economic conditions?

Answer 25

Working class -> symptoms part of everyday life e.g. cough and back pains.
Middle class -> seek help quicker than working class.

Question 26

Why are symptoms differentially perceived by different people?

Answer 26

Depends on our life experiences.

Socially and culturally learnt response -> multi-faceted.

Question 27

Outline the complexity of lay ideas on health and illness.

Answer 27

Heart attack:

• Perception and evaluation of symptoms -> similar to indigestion and angina.
• Perceived risk of MI -> no longer feel at risk due to recent changes in lifestyle.
• Previous experience -> symptoms vary than last time.
• Use of NHS -> concerned about wasting NHS time and resources.