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The WHO defines "health" as

a state of completely physical, social, and mental well-being


Summarize the extension of the modern health care model and thus, the broadened role of physicians

Not just treatment of dz
Also prevention of disease, injury, sickness and illness and the promotion of health


Describe how primary prevention differs from secondary prevention

Primary prevention - protect, promote and maintain health i.e. sanitation, exercise, healthy diet

Secondary prevention - enhances resistance or buffers the impact of risk factors i.e immunizations, health screening


Why is the biomedical model too specific?

Healthcare requires a comprehensive multidisciplinary approach and should account for psychosocial-spiritual approaches


Describe the BPSS model

Multiple determinants are involved in development of disease and the resultant illness
Biological, Psychological, Social, Spiritual


Describe the Integrated Sciences Model

Psychosocial phenomena functionally connected to biological with common universal principles (homeostasis, stress adaptation, learning, development)
5 critical domains: bio, behavioral, cognitive, sociocultural, environmental

All psychosocial and biological phenomena are interdependent and interactive
Individuals are complex integrated system of interacting variables (stress in one domain affects all others)


Describe the importance of integrated assessment

Exploration of differential and interactive contributions of bio, behavioral, cognitive, cultural and enviro risk factors
- More informative of all mechanisms and processes that contribute to a disorder (i.e. targets for tx)


Describe the importance of multimodal treatment

Addresses as many contributing factors as possible, i.e. bio, behavioral, cognitive, sociocultural, enviro
- More effective especially with complexly determined health behaviors (such as smoking)


Describe the biomedical model

firmly grounded in basic biologic sciences and scientific methodology


Summarize the responsibilities of physicians

- inform to the best of their ability
- use authority in best interest of patient
- avoid abuse
- elicit, listen to, and address pt concerns
- respect pt decisions


Summarize rights of physicians

- refse to perform any act that conflicts with personal or ethical principles (i.e. abortion ) but still make referrals


Summarize the rights and responsibilities of patients

- receive complete information
- refuse treatment (certain exceptions)
- know about hospital's conflicts of interest


Define informed consent

Patient's right to know all tx options and to decide which care is appropriate for them


Describe the limits of confidentiality when working with patients

- situations where there is concern that the patient will harm themselves
- situations that involve mandatory reporting (i.e. child abuse)
- between professionals involved in pt care
- members of a teaching group


Describe transference

Beliefs, expectations, and perceptions from previous relationships that influence current life experience (i.e. physician lectures diabetic about not following regimen; pt has very strict and critical parent and responds negatively to MD as if parent)


Describe countertransference

Inappropriate reactions the physician has to a patient (i.e. MD views pt as "nice old lady" and is unable to ask intrusive questions)


Summarize factors that influence patient adherence to treatment recommendations

- complexity of regimen
- persistence of symptoms
- frequency and quality of contact with physician
- patient beliefs


What type of patient beliefs influence adherence to treatments?

illness warrants tx, tx is effective, cost is reasonable for benefits, tx is feasible


Define rapport

State of mutual confidence and respect between two people


How is rapport maximized between physician and patient (6 ways)?

- sensitivity to emotions
- cultural appropriateness
- establishing limits of confidentiality
- attentive listening
- observation
- touching


Describe how a physician should respond to sadness

show respect, be considerate and caring, be patient


Describe how a physician should respond to anger

acknowledge anger, remain calm, listen reflectively, do not take personal, encourage patient to discuss


Describe the types of questions that should be avoided (2)

Compound questions - several questions asked together
Leading questions - prompt patient to give a specific response


Describe potential sources of error in clinical decision making (8(

a) theoretical and personal bias
b) diagnosis by formula (fitting its into preconceived categories)
c) optimism/pessimism
d) too many hypotheses
e) oversimplification
f) reorganizing the abnormal
g) provider-patient interactions (bad attitudes, labels)
h) mistaking correlation for causation