Doctor-patient relationship

Question 1

An indigenous healer

Answer 1

Shaman

Question 2

Who was the god of healing?

Answer 2

Apollo

Question 3

Who was associated with health and disease?

Answer 3

Asklepios

Question 4

Who was the first person to believe that diseases were caused naturally and not because of superstition?

Answer 4

Hippocrates

Question 5

What did Hippocrates promote?

Answer 5

Natural theories of health and sickness and natural modes of healing

Question 6

Evolution of medical theories

Answer 6

1. Preternaturalistic: divine punishment
2. Hippocratic revolution
3. Naturalistic: ontological/functional concepts
4. 1940s, 1960s socio-cultural

Question 7

What do Hippocratic doctors pledge?

Answer 7

To do no harm: demonstrates the physician’s devotion to his art rather than fortune

Question 8

What is the physician excellent at in the modern age?

Answer 8

1. Anamnesis [complete clinical history of a patient]
2. Differential diagnosis

Question 9

3 reasons why the doctor-patient relationship is important

Answer 9

1. Bioethical reason
2. (Neuro)ethical reason
3. Legal reason

Question 10

What were the 2 trigger events that led to human research subject protection?

Answer 10

1. Nurember war tribunal (1947)
2. Syphilis study in Tuskegee GA, USA 1932-1972

Question 11

Describe the Syphilis study in Tuskegee GA, USA 1932-1972

Answer 11

• 600 low-income AA males, 400 of whom were infected with syphilis were monitored for 40 years
• free examinations given, but the patients were not told about their disease
• even though there was a treatment for syphilis in the 50s, the participants were denied treatment unit 1972

Question 12

Who created the Belmont report?

Answer 12

the National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research was created after the National Research act of 1974

Question 13

What are the 3 basic ethical principles?

Answer 13

1. Autonomy
2. Beneficence
3. Justice

Question 14

What is autonomy?

Answer 14

Individuals should be treated as autonomous agents: need to be informed about treatments and all risks and benefits

Question 15

What is beneficence?

Answer 15

Do no harm, maximum possible benefits and minimize potential harm

Question 16

What is justice?

Answer 16

Fair distribution of burdens and benefits of research

Question 17

What is the placebo effect?

Answer 17

The positive physiological or psychological changes associated with the use of inert medications, sham procedures or therapeutic symbols within a healthcare encounter

Question 18

What are placebos?

Answer 18

Inactive substances used to compare results with active substances

Question 19

What are sham treatments?

Answer 19

Doctor goes through the motions without performing the treatment

Question 20

What did sham surgeries prove in a review in 2014?

Answer 20

The sham surgeries provided some benefit in 74% of the trials

Question 21

What is an open injection?

Answer 21

Injection carried out by a doctor at the bedside who told the patient that the injection was a powerful analgesic

Question 22

What is a hidden injection?

Answer 22

The same analgesic dose was performed by an automated infusion machine which started without the doctor/nurse

Question 23

What was seen about hidden/open injections?

Answer 23

The analgesic dose to reduce the pain by 50% was much higher for hidden infusions that for open ones

Question 24

Which 4 painkillers were studied in the open/hidden injection study?

Answer 24

1. Metamizole
2. Ketorolac
3. Tramadol
4. Buprenorphine

Question 25

What does an open injection activate?

Answer 25

The endogenous opioid systems through expectation pathways

Question 26

What are dopamine pathways?

Answer 26

Expected reward for a behaviour performed

Question 27

What is stressed-induced analgesia?

Answer 27

It is a well-known phenomenon when soldiers are wounded in battlefield but feel no pain until the battle is over

Question 28

What is anxiety- induced hyperplasia?

Answer 28

The modulation of pain by emotion and context is widely recognised. Fear and pain can exacerbate pain

Question 29

What is nocebo hyperplasia?

Answer 29

How anxiety is turned into pain: attention is focused on pain and cholecystokinin

Question 30

What factors mediate the placebo effect?

Answer 30

1. associative learning/ conditioning processes 2. Cognitive factors such as the patient's expectation of a benefit from a treatment 3. quality of doctor-patient communication

Question 31

What promotes enhanced health and well-being?

Answer 31

Social contact

Question 32

Where is dopamine produced?

Answer 32

In the ventral tegmental area (VTA)

Question 33

Where is dopamine sent?

Answer 33

to the amygdala, nucleus accumbens, prefrontal cortex and hippocampus

Question 34

What is serotonin responsible for?

Answer 34

Feelings of satiation

Question 35

What are part of the mesolimbic pathways?

Answer 35

1. Nucleus accumbens 2. Amygdala 3. Hippocampus

Question 36

What does the amygdala mediate?

Answer 36

Decisions about reliability of people and situations in 1/10th of a second the brain judges the reliability of a face

Question 37

What increases confidence and trust?

Answer 37

Oxytocin

Question 38

What is a mirror neuron?

Answer 38

A neuron that fires both when an animal acts and when the animal observes the same action performed by another

Question 39

Neurotransmitters involved in the placebo response

Answer 39

endogenous opioids endocannabinoids dopamine cholecystokinin CKK

Question 40

Instead of administering drugs, what is something equally good that a physician can do?

Answer 40

Empathy and motivating them positively

Question 41

What is medical malpractice?

Answer 41

A legal cause of action that occurs when a medical or health care professional deviates from standards in hi/her profession, thereby causing injury to a patient

Question 42

What is defensive medicine?

Answer 42

Refers to the practive of recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient, but an option that mainly serves the function to protect the physician against a patient as a potential plaintiff

Question 43

What forms can defensive medicine take?

Answer 43

1. Assurance-bureaucratic behaviour 2. Avoidance behaviour

Question 44

What is defensive medicine a burden on?

Answer 44

health care costs

Question 45

What is assurance-bureaucratic behaviour?

Answer 45

involves the charging of additional services

Question 46

What is avoidance behavior?

Answer 46

Occurs when providers refuse to participate in high risk procedures or circumstances

Question 47

What increases the risk of non-adherence in patients?

Answer 47

poor physician communication

Question 48

Which routine visits tend to be longer?

Answer 48

With no-claims primary care physicians were longer than claims primary care physicians

Question 49

What is the range of consultation time?

Answer 49

22s in Bangladesh 22.5 min in Sweden

Question 50

What is the average consultation time?

Answer 50

5 min or less

Question 51

What can medical literacy do?

Answer 51

Improve doctor-patient communication and therefore the patient's health