e health and ethics and law Flashcards
(142 cards)
1
Q
definition of e health
A
collective use of information systems and electronic communication for supporting and facilitating the efficient provision of health care and health research
2
Q
definition of precision medicine
A
treatment that considers individual variability in genes, environment and lifestyle for each person
3
Q
definition of m health
A
mobile health
4
Q
what are the three levels of calculation
A
practitioner level
higher level
population level
5
Q
what is practitioner level
A
calculating risk for a certain patient based on the information they give you, important for deciding between drastic and gentle treatment options
6
Q
what is higher level
A
analyse data to improve overall service- e,g calculate standard mortality ratios SMR for different hospitals- patient experience is data you analyse in health informatics
7
Q
what is population level
A
analysis of large groups on data that already exists ‘the general practice research data base which has 590 primary care practices and 5 million patients
8
Q
ethics and law in medicine
case c- was schizophrenic and has gangrene but wanted to prevent amuptation
turns out he was competent to reject treatment
what are the three points to assess capacity according to the old criteria
A
understand information
weigh information and make a decision
able to retain information and believe it
9
Q
what is the 2005 mental capacity act altered criteria
A
understand information
retain information
adults are assumed to have capacity
weigh it up and make a decision
communicate decision
10
Q
what are the three features of criminal law
A
punishment
jury decides
beyond reasonable doubt
11
Q
what are three features of civil law
A
compensation
judge decides
balance of probabilities
12
Q
duty meaning
A
must do it, enforced by gmc professionals or law legal but rarely absolute
13
Q
what does right mean
A
your choice to do something
14
Q
what does defence mean
A
may go against normal guidelines but there is adequate reasoning
15
Q
what is the legal duty of care
A
obligation to care to prevent harm being suffered by another person
no good samaritan law in the uk
16
Q
in emergency what is the legal and professional duty
A
legal duty- none
professional duty- by gmc
17
Q
when is there a legal duty to help in an emergency
A
gp- anyone registered in its list and in the boundaries of the practice
nhs trusts- vicarious liability- liability for employee negligence
all doctors- offer help and if the help is accepted legal duty of care established R vs bateman 1925
18
Q
what is a successful negligence claim
A
barnett vs chelsea- can be negligent but unless it leads directly to harm claim fails
1) duty of care is established
2) duty of care is breached (negligence)
3) breach leads to direct harm
19
Q
what is the bolam vs friern test 1957
A
not negligent if:
-ordinary level of skill
~accordance with a body of medical opinion- opinion can be in minority
20
Q
what is the bolitho test
bolitho vs city 1997
A
just having a medical opinion is not enough
actions need to be logical
21
Q
the standards for an inexperienced doctor?
A
not lower for an inexperienced doctor
should seek help
if adequate help not provided hospital is liable
22
Q
according to the law is there a legal right to break confidentiality after death
A
no legal right to confidentiality after death
23
Q
what does the gmc say on confidentiality after death
A
factual right to confidentiality after death
24
Q
duty- ordered by judge/court
parliamentary statutes
what are notifiable diseases public health control of diseases act 1984- not HIV
A
malaria rabies TB shigella, invasive strep a, campylobacter, c botulinium, brucella, plague, acute meningitis, cholera, diptheria
25
if someone has TB, in the hospital how is this dealt with
they can be detained and examined without consent but cannot be treated without consent
26
what incidents are reported to the police
road traffic incidents, stabbings, gun injuries, terrorism
27
what are the three points to remember when engaging with police
duty of care to patient comes first- make police wait until patient is well enough
patient can refuse to see the police
minimum information revealed unless public interest or its defensible
28
in what instance was there a defence to breaking confidentiality
w vs edgell 1990- defence of breaking confidentiality in public interest
gmc requirements
serious immediate risk
try to seek consent
warn patient
only to necessary people
minimum amount of information (police only that there is a stab wound, no past medical history unless its in public interest then potential defence for it)
anonymise as far as possible
29
what are the gmc requirements
serious immediate risk
try to seek consent
warn the patient
only to necessary people
minimum amount of information to police e.g there was a stab wound, no past medical history unless in public interest
anonymise as much as possible
30
do you inform dvla of an epileptic patient
yes
31
do you inform a partner of venereal disease
yes if defence is met and there is a risk to the partner
32
what do the gmc suggest on how doctors deal with family and friends
doctors should be considerate
dont refuse to speak to them based on confidentiality
establish what the patient would like to disclose before they become more ill and lose capacity
after losing capacity reasonable to share relevant information to family and friends unless strong reason to believe the patient would not want this
33
what is the data protection act 1998
patients have a right to access health records
but need to submit a request
information that could cause serious harm isnt given
34
what are the three conditions for consent
capacity
non coercion
well enough informed
35
what is the grey area in the 'well enough informed' requirement of consent
can withold consent if its dentrimental to patients health
sideway case- enough information but should not overwhelm the patient -no need to give minute risks
36
what is battery
touching in a harmful or offensive manner without consent doesnt need to be with hostile intent
37
what is mill harm principle
only stop people if what they are doing is harming other people
38
what is life preservation
if doubt about competence or insufficient time for further exploration
39
how does psychology relate to medicine
the severity of a disease in medical terms does not determine the difficulty in adjusting to it
40
how can psychology be studied as an aetiology
measure external psychological factor (e.g stress) then measure physiological factor e.g endocrine change or wound healing
41
what is emotional loneliness
not having anyone to confide in or that you feel close to
42
what is social loneliness
lack of broader social group where they belong
43
what is a 'lethal combination'
male social loneliness severe depression
44
how do patients misinterpret statistics
think in high/low risk, not numbers
hard to make logical connection between risk and problem - patients disregard it
women reduce smoking in relation to lung cancer but not in response to the risk of cervical cancer
45
what is freud and psychoanalysis
interpretative, find insight into patient to achieve change
46
what is behaviourism
behaviour and learning systems often by reward systems
47
what is cognitivism
information and beliefs
48
what is cbt
behaviourism and cognitivism
49
what is humanist and existential psychology
personal growth therapies- encourage potential
50
what is mindfulness and third wave
calm planned stance, not problem thoughts feelings
51
doctor patient relationship
patient satisfaction is not what is clearly related to better outcomes
disadvantaged people engage less worse relationships and consultations
52
what is representative heuristics
as a doctor you match the case infront of you to stereotypes, its quicker but inaccurate
53
what is availability heuristics
when what comes to mind easily is believed to be far more common and more accurate reflections of real world
54
what are the 6 types of mental health issues
psychosis
affective
behaviour
organic
developmental/genetic
neurosis
55
what is psychosis
loss of contact with reality delusions associated with schizophrenia
56
what is affective (in terms of mental health)
dramatic mood changes depression
57
what is behaviour (in terms of mental illness)
antisocial behaviour such as alcoholism
58
explain organic mental illness
structural brain pattern (alzheimers)
59
explain developmental genetic mental illness
autism dyslexia adhd
60
explain neurosis mental illness
distress without hallucinations and delusions such as anxiety and ocd
61
what does DALY stand for
disability adjusted life years
62
whats the equation for DALY
years lived with disability= yearsx disability weightingx years of life lost
63
what does DALY show to be the most popular contributor to burden of disease in high income countries
depression
64
what does DALY compare
compare the conditions that reduce quality of life with the conditions that cause morbidity
65
what contributes to adolescent risk taking behaviour
reward system temporary imbalances
66
what is infancy
take moments to gain voluntary control of reflexes
blurry vision but can distinguish patterns
can distinguish taste and hear sounds
67
what percentage of patients dont take treatment as directed
50%
68
is non adherence intentional or non intentional
both
69
what are the stages of non adherence
initiation- collecting and starting treatments
implementation- timing diet dose behaviour
persistence- taking full course of medication
70
what is adherence related to
doctor patient relationship, believing treatment is important, social support
not strongly to- severity of illness, age, socioeconomic status, information about illness- even simplifying treatment doesnt necessarily improve adherence
71
how is non adherence measured
asking- reporting bias/ hidden in non adherence
blood tests- non adherence
72
what are causes of non adherence
information-action gap- knowledge is necessary to change intention but not sufficient to change behaviour
73
what is an example of interactions between psychological processes and the nervous immune system
anxiety before surgery is increased
anxiety during recovery is lower
74
how do you assess the interaction between psychological processes and the nervous system
exposure to virus- how many symptoms has the person developed
cut- speed of wound healing
75
what are psychological factors in developing cardiovascular disease
personality
mood disorder- e,g depression
stress
76
what are the effects of depression and stress that can effect the risk of developing cardiovascular disease
physical activity
adherence to treatment
increase in catecholamines and increase in cortisol
damages immune system regulation
increases blood pressure
increases inflammatory cytokines
IL6 increases endothelial activation more plaque formation
enzymes that break down protective surfaces of plaque
tumour necrosis factor and fibrinogen increase
77
what does ncd stand for
non communicable disease
78
what is ammendable mortality
deaths occuring before the age of 75 from causes that are considered amendable to medical intervention
79
what is avoidable mortality
deaths considered preventable through public health policies
80
what is health equity
absence of unfair and avoidable or remediable differences in health among social groups
81
what are the factors that make up disease burden
morbidity
mortality
financial cost
82
what does DALY stand for
disability adjusted life year
83
what is the disability weighting of death
0
84
what is the disability weighting of perfect health
1
85
how to calculate disability adjusted life years
years lived with disability= yearsx disability weighting x years of life lost
86
what are most DALYS caused by globally
ischaemic heart disease
cardiovascular disease
diarrhoea
hiv/aids
lrti lower respiratory tract infection
87
what is omran
as a country develops
1) pestillence and famine (high death rates due to infection)
2) living conditions begin to improve (receding pandemics-reduced infections)
3) the age of non communicable diseases cancer diabetes
age of delayed degenerative diseases alzheimers
88
what is the definition of epidemiology
study of distribution and determinants of diseases who gets the disease and why
89
what are drivers of social change
1848 public health act
the great stink- smell from untreated human waste made sewage system
concerns about productivity of working class
religious ideals
90
what are the origins of the germ theory
miasmatic theory
zymotic theory
germ theory
91
who invented handwashing
ignaz semelweis
92
who invented contamination
louis pasteur
93
who discovered causative organisms
robert koch
94
who pioneered antiseptic surgery
joseph lister
95
what report did chadwick make
report on sanitary conditions for working class and hygiene education
96
what reports did Farr and snow make
reports on cholera and mortality how to classify disease and contributed to zymotic theory
snow mapped cases of cholera to water pump
97
what did nightingale and farr achieve
link between conditions and mortality in army hospitals
98
other than treatment what can be put in place to prevent health inequalities
preventative measures
99
what can funding do to help health inequalities
health budget- government ring fenced
social care budget- local authorities from their own budget
barker report- reccomended single ring fenced budget for nhs and social care
100
what are the carer assessment legislations
1990-taken into account when assessing a disabled person
1995-assessed with patients by law
2000-separate assessment for carer and disabled person
101
what does medicalisation mean
when non medical problems become defined as medical problems
102
what are the 3 levels of medicalisation by conrad and schneider
conceptually-problem is defined with medical terminology
institutionally-organisations take medical approaches to the problem
interactionally- doctors and patients define and treat the problem as medical
103
things which are medicalised often begin as what
deviances
104
what is rose 2007 deproffessionalism
doctors are no longer the only ones deciding what is medicalised
decrease in lay professional distinction
doctors are constrained by law and bioethics
105
what is the black report
there has been a reduced poverty gap but inequalities are increasing
106
how can lower income impact health
the main factors are housing and employment according to (marmott review, acheson report and black report)
acheson social policy causes health gap- fixed by targeting families and education and job control
107
what are the six policy objectives of the marmott review
1- give children the best start to life
2- enable all children to maximise their capabilities
3- fair employment
4- minimum income standard- having sufficient resources to participate in society, consuming goods and services considered essential in britain
5- healthy and sustainable places
6-ill health prevention
108
what are the SMART goals
specific
measurable
achievable
relevant
time based
109
what are overt and covert negotiation techniques in a consultation
subtle
indirect
inferred would be covert
explicit and direct would be overt
110
what are the handwashing steps
rub palm to palm
with one hand interlock back of fingers of the other hand
interlock front facing fingers
back of fingers with opposite hand
thumbs
nails in each palm circular motion
wrists
111
women have lower mortality than men but have similar or possibly higher morbidity, the exception is which type of countries
countries where women are fundamentally subordinated
112
what is the factor in lower mortality in women
help seeking behaviour
113
elderly only have slightly more acute illnesses than young people but have alot more chronic conditions than young people why
mental decline
114
what percentage of 65+ exhibit psychological morbidity
20%
115
what is the role theory (parsons)
loss of work/role in society is demoralising decreases self esteem- pessimistic about leisure time
116
what is the cumming and henry disengagement theory
voluntary withdrawal from society instead they pre occupy themselves
benefits both society and elderly
117
structured dependency theory what is the townsend theory
old age defined by retirement age- government power over pensions and poverty
economic burden, excluded from society
118
what is the third age theory by laslett
compression of morbidity- enjoy freedom from family/work
119
what is cultures of ageing gilleard and higgs theory
role of elderly different in each generation
120
what are moodys four scenarios
propagation of morbidity
compression of morbidity
lifespan expansion
voluntary acceptance of limits
121
what is moodys scenario about propagation of morbidity
increases life expectancy but also longer end morbidity
122
what is moodys scenario compression of morbidity
less change in life expectancy but shorter end morbidity
123
what is moodys scenario lifepsan of expansion
increase life expectancy and shorter morbidity
124
what is the moodys scenario voluntary acceptance of limits
life span extension rejected after certain age
125
what is race
genetic- can only have one race
126
what is ethnicity
how you view yourself- ethnic group has circumstances, ethnic group has circumstances e.g history differentiating it from rest of population
127
what is culture
set of shared experiences, beliefs values
128
what is class
class is a much more important factor than ethnicity in explaining social inequalities people of chinese origin living in the uk- same life expectancy and general health indigenous population
129
how do you define a profession
specialist skill
monopoly over formal training and usage of skills
autonomy
strict code of ethics
status, shared identity and solidarity
130
what is the 1858 medical act
forced registration with the GMC and title of Dr
131
what is the power approach
- medical profession has autonomy and ultimately dominates and outranks other professions
132
what are the challenges of the power approach
poletarianisation thesis- managerialism- are managers and targets underminding medicine as a profession
deskilling- tasks are increasingly specialised and the use of technology is increasing
133
what is deprofessionalism
ICT
consumers encouraged to take a greater role
paramedics pharmacists
134
what is embodied trust
when you prove or gain trust rather than it being instrinsic
enforceable trust
135
what are the three types of medicine by jewson 1976
bedside medicine- power lay with patient- diagnosis is based on what patient says
hospital medicine-shifted to hospital so doctors have power and can examine
laboratory medicine - patient becomes depersonalised cant influence diagnosis
136
what is the 1995- surveillance medicine
assessing risk and illness prevention
137
what is 2003 escaped medicine
imaging techniques- patient vanished alienated and doctors have less voice
138
how is health defined positively negatively and functionally
positively- fitness and wellbeing
functionally- ability to cope with every day activities
negatively- absence of illness
139
what is the clinical iceberg
professional services treat just the tip of total ill health
140
why do people see a doctor
mechanic- 1978 behaviour in consultation depends on how others respond to symptoms
friedson- lay referral system- discuss with family/friends before going to doctor
tudor hart-inverse care law- need help most see doctor least
zolas five triggers
141
what are zolas five triggers that prevent people from going to doctors
interpersonal crises
interference with social personal relationship
interference with vocational physical activity
sanctioning pressure from others
temporalising- if i dont feel better in a week
142
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