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1. Foundations of Medicine > BSS > Flashcards

BSS Flashcards

1
Q

Lay Definitions of Health

A

Absence of disease

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2
Q

What is health behaviour?

A

‘behaviour patterns, actions, & habits that relate to health maintenance, health restoration and to health improvement’

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3
Q

What are the types of Health Behaviour?

A
  1. Preventative
  2. Illness / ‘sick-role’
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4
Q

What is preventative behaviour?

A

To prevent or detect disease

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5
Q

What kinds of preventative behaviour?

A

SELF-DIRECTED (e.g. drinking water, exercise, healthy diet)

PREVENTATIVE MEDICINE (e.g. getting vaccinated, screening attendance, using condoms)

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6
Q

What is ‘sick-role’ behaviour?

A

Defining ill health, finding remedies and getting well

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7
Q

What types of ‘sick-role behaviour’ are there?

A

SELF CARE (e.g. OTC medicines, self-help, coping strategies)

HELP/TREATMENT SEEKING & COMPLIANCE (e.g. talking to friends/family, seeking medical advice, therapy)

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8
Q

Why do we examine health behaviour?

A

significant proportion of morbidity and mortality can be attributed to health behaviours

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9
Q

How do we modify health behaviour?

A

Understanding behaviour - what influences, how we can change it

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10
Q

How can we begin to understand the causes of behaviour?

A

psychological approaches - e.g. social cognition models

(help understand, predict, and change health behaviour)

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11
Q

What is the primary determinant of behaviour?

A

COGNITIVE VARIABLES/COGNITIONS (attitudes & beliefs)

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12
Q

What are cognitive variables?

A

primarily focused on motivational factors

  • perception of RISK of developing health condition
  • perceived EFFECTIVENESS of behaviour achieving health goal

behaviour is viewed as rational & product of subjective cost-benefit analysis

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13
Q

What is the ‘Health Belief Model’?

A

Aimed to establish a systematic method to explain and predict preventative health behaviour

Adapted to many cultures & health behaviour, evidence based - explains variance in health behaviours

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14
Q

What is perceived severity?

A

How bad is this health outcome for me?

(how treatable is it, knowing people who have survived/died)

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15
Q

What is perceived susceptibility?

A

How am I at risk of this health outcome or issue?

Family history, friends w cancer, leading a healthy life

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16
Q

What is perceived threat?

A

Joining together perceived susceptibility and perceived severity?

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17
Q

What are perceived benefits?

A

physical health, psychological health, social benefits

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18
Q

What are perceived barriers?

A

cost, social impact, practical barriers

(e.g. difficulty getting screenings, fear of having x condition)

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19
Q

What is the belief in effectiveness of health behaviour?

A

perceived benefits + perceived barriers

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20
Q

What is self-efficacy?

A

Individuals need to believe they are capable of and have control over performing the behaviour that will reduce the threat to their health?

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21
Q

What are the limitations of the Health Belief Model?

A

emphasis on individualism and rational decision making ignores influence of other factors (social, economic, emotional)

does NOT take into account habitual/non-health related reasons for behaviour (social acceptability)

constructs are unobservable - hard to measure

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22
Q

What is Illness Behaviour?

A

‘the manner in which individuals MONITOR their bodies, DEFINE & INTERPRET their symptoms, take remedial action, utilise sources of help as well as the formal health care system’

going to see a doctor is process

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23
Q

What are the stages of illness behaviour?

A
  1. Symptom Interpretation (interpretation/denial)
  2. Coping (accommodation/self-management)
  3. Help-seeking decision-making (procrastination/’shopping’ between help sources)

(cycle)

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24
Q

What is a lay diagnosis of symptom experience?

A

‘The act of bringing meaning to a bodily change through a process of interpretation and evaluation?’

Thinking about if symptoms are normal or not, an illness or not, or serious enough for treatment

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25
Q

How do we normalise/rationalise symptom experience?

A

Seeking alternative innocuous/benign explanations, often linked to lifestyle factors or age.

May accept something is WRONG, but will offer a logical ‘non-threatening’ explanation

Help-seeking does NOT occur

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26
Q

How do we accommodate cancer symptoms?

A

Coping, denial

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27
Q

What are structural explanations for not help-seeking?

A

ACCESS barriers: time, cost, cultural sensitivity, lower classes, social structure

Competing social roles

Social Values: e.g. stoicism, ‘traditional masculinity’

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28
Q

What are cultural knowledge explanations?

A

Social Construct of Illness

Nature of Symptoms (visibility, recognisability, frequency)

Lay theories

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29
Q

What are lay theories?

A

What is ‘real’ illness?

Ideas about cause, course and prognosis

Stereotypes about ‘at risk’ groups

Beliefs about treatment

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30
Q

What is lay epidemiology?

A

‘The processes through which health risks are understood and interpreted by lay (non-professional) people’

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31
Q

What are key aspects of lay epidemiology?

A

Lived-experience, family history

Media, celebrities

Empirical evidence/health promotion messages

Modification by social norms and values

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32
Q

What are social barriers to the ‘meaning’ of being ill?

A

The social meanings of being ill, seeking help and becoming a patient

  • illness is a moral category
  • some diagnoses carry social meaning
  • becoming a patient can impact on our identity
  • help seeking is negotiated as an act of identity management
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33
Q

What is stigma?

A

‘A physical/social attribute or form of behaviour that results in a person not being fully accepted as a member of some social groups, being marked out and treated differently.’

34
Q

What is discredited stigma?

A

e.g. wheelchair user, facial disfigurement

35
Q

What is discreditable stigma?

A

e.g. infertility, epilepsy, HIV

(to tell or not to tell; to lie to not to lie)

36
Q

What is passing?

A

Art of concealing a discreditable stigma to control their self image

BY avoiding social contact & stigma signs

37
Q

What is the traditional model of doctor-patient relationship?

A

Paternalism

Patients = ‘sick-role’
Doctors = ‘professional role’

38
Q

What are the different models of doctor-patient relationship?

A

Paternalistic
Shared (‘mutual’)
Consumerist (‘informed’)
Default (low levels of engagement)

39
Q

What are the stages in consultations?

A
  1. INFORMATION EXCHANGE (symptoms, physical examination)
  2. DELIBERATION & DIAGNOSIS (deciding on diagnosis)
  3. DECIDING ON TREATMENT (assessing risk)
40
Q

When can we use paternalistic medicine?

A

Acute/emergencies

41
Q

When can we use shared (mutual) medicine?

A

Long-term conditions (e.g. asthma, arthritis) when patient has expert knowledge

42
Q

When can we use informed (consumerist) medicine?

A

Participation in clinical research

43
Q

What model to patients want?

A

Depends - must understand patients’ preferences for STYLE and TREATMENTS

CAN CHANGE

44
Q

Do socio-demographics influence preference for styles?

A

Do older people prefer paternalism?
Do middle class people prefer shared decision-making?
Should children be treated paternalistically?

45
Q

What is shared decision making?

A

Patient Centred Care and shared decision-making interconnected

46
Q

What is shared decision making in the NHS?

A

Patients asking what their options are, pros/cons, how to get support

47
Q

How can we question shared decision making?

A

Does shared decision-making…
- put pressure on doctors?
- take more time?
- sometimes increase patient anxiety?
- sometimes unsuitable for all patients/conditions? how do doctors judge?

48
Q

What is compliance?

A

When patients follow advice from a doctor
(e.g. taking medication as prescribed, following lifestyle advice)

Different types
- ‘intentional’ / ‘voluntary’ non-compliance
- ‘non-intentional’/ ‘involuntary’ non-compliance

49
Q

Are patients compliant with medication?

A

MAX of 50% of patients take medication as prescribed

-> problem on non-adherence

50
Q

What are the problems of non-adherence?

A

large costs
causes many hospital admissions (10-25%)
increases length of hospital stay

51
Q

What are reasons for non-compliance?

A

concerns about side effects

views about appropriateness of treatment

practical barriers

misunderstandings between patients & doctors

52
Q

What is patient ‘adherence’?

A

respecting patients’ involvement and choice about what they do

respecting that patients make rational decisions about whether to follow advice

53
Q

What is concordance?

A

agreement about treatment

concordance = patients more likely to adhere

54
Q

How can a doctor facilitate concordance

A
  1. find out/respond to patients’ ideas, concerns, expectations
  2. identify treatment choices & evaluate research
  3. address treatment feasibility & discuss w patient
  4. develop therapeutic doctor-patient alliance
  5. encourage agreement on treatment action plan
55
Q

What is the ‘placebo’ response/effect?

A

positive response of a person to entirely inert substance/intervention OR to active intervention where response is above & beyond expectations

can be deliberate or unintended

56
Q

What is the nocebo response?

A

harm rather then benefit is caused

more likely to occur if person has previous experience of adverse effects

57
Q

What are treatment effects?

A

‘respectful focus on entirety of a person’s life situation’

  • meaning of treatment influences placebo response
  • emotional & cognitive care increases placebo response
    (role of compassion in healthcare)
58
Q

What is a Health System?

A

consists of all organisations, people and actions whose primary intent is to promote, restore or maintain health

59
Q

What are the 5 main systems for funding health systems?

A

General taxation
National Health Insurance
Privatised Health Insurance
Out of Pocket Payments
Charitable Donations

60
Q

What type of system is the NHS?

A

A social solidarity system

61
Q

What is a social solidarity system?

A

UNIVERSAL coverage

FREE at point of delivery

Access based on CLINICAL NEED, not ability to pay

62
Q

What does the NHS include?

A

Hospital, GP, Ambulance, Community Health Services

63
Q

What are the challenged ahead for the NHS?

A
  • Covid-19 & service backlog
  • financial control
  • behavioural medicine & preventative care
  • inequalities in health & health outcomes
  • Brexit (staffing, supply chains, R&D, PH response0
64
Q

What are the challenged ahead for the NHS?

A
  • Covid-19 & service backlog
  • financial control
  • behavioural medicine & preventative care
  • inequalities in health & health outcomes
  • Brexit (staffing, supply chains, R&D, PH response0
65
Q

What is a Profession?

A

discrete body of knowledge; members control access to
- monopoly over market

autonomy over work conditions and from state & capital

altruism is core motive - performance MORE important than financial reward

66
Q

What are the professional roles of a doctor?

A
  • politics
  • rationing
  • research
  • legal advice
67
Q

ACCORDING TO GMC, what are the duties of a doctor?

A
  • knowledge, skills, & performance
  • safety & quality
  • communication, partnership & teamwork
  • maintaining trust
68
Q

What is knowledge, skills, & performance?

A

Care of patient comes FIRST

Good standards of practise and care

69
Q

What is safety & quality?

A

ACT if patient safety/dignity is compromise

protect & promote health of patients & public

70
Q

Why do Health Inequities exist?

A

Lifestyle/Behavioural
Material/Structural
Psychosocial

71
Q

How does ‘lifestyle’/behaviour influence health?

A

certain groups are MORE likely to engage in health-harming behaviours and LESS likely to engage in health promoting behaviours

-> smoking, alcohol,

72
Q

How are there inequities in help-seeking behaviour?

A

Men are less likely to consult a GP than women

73
Q

How are there inequities in screening opportunities?

A

South Asian and lower SES women are less likely to attend breast screening

74
Q

Why do some people have ‘healthy lifestyles’ whilst others don’t?

A

Materialist/Structuralist Explanations

75
Q

Does poverty affect health?

A

Poverty is the number one cause of ill-health

76
Q

How does poverty affect health?

A
  • Direct Impact
  • Affects people’s choices
  • Access/Quality of Services
77
Q

How does poverty DIRECTLY IMPACT health?

A

1m unfit homes in UK. Leads to

-> respiratory infections
-> asthma
-> nausea & vomiting
-> fever
-> excess winter deaths

costs NHS £1.4bn/year

78
Q

How does poverty AFFECT CHOICE?

A

-> Healthy Diet - more expensive & less available
-> Physical Activity - less outdoor space, crime & anti-social behaviour

79
Q

How does poverty affect ACCESS TO SERVICES?

A

Inverse Care Law - ‘those most in need of medical care are least likely to receive it’

80
Q

What are some psychosocial explanations that can harm your health?

A

Experiences of anxiety, grief, anger, hopelessness, insecurity, stress, loneliness, fear, lack of control, shame

81
Q

How can psychosocial stress lead to ill-health?

A
  • impact on mental health
  • directly via impact on physiological mechanisms
  • indirectly via impact on behaviour (e.g. smoking)
82
Q

How do psychosocial explains cause inequality?

A

Certain groups are more likely to experience negative psychosocial states than others
- racism
- poverty
- gendered experiences

1. Foundations of Medicine (4 decks)

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