FoPC Flashcards
(103 cards)
1
Q
What is holistic care?
A
Ability to understand and respect your patients’ values, culture, family beliefs and structure
Understand the ways in which these will affect the experience and management of illness and health
2
Q
What do holistic views acknowledge?
A
Scientific explanations of physiology but admits people have inner experience that are subjective, mystical and may affect their health and health beliefs
3
Q
What personal qualities do you need to be a GP?
A
Ability to care about patients and their relatives
Commitment to providing high quality care
Awareness of one’s own limitations
Ability to seek help when appropriate
Commitment to keeping up to day and improving the quality of one’s own performance
Team work
Clinical competence
Organisational ability
4
Q
How often is a GP revalidated?
A
Every 5 years
5
Q
How often is a does a GP have an appraisal?
A
Every yurrrrr
6
Q
What are the three broad types of skills needed for successful medical interviewing?
A
Content skills
Perceptual skills
Process skills
7
Q
What other factors influence the consultation?
A
Physical factors
Personal factors
8
Q
What are content skills?
A
What doctors communicate, substance of their questions and responses
9
Q
What are perceptual skills?
A
What they are thinking and feeling
Internal decision making: clinical reasoning, awareness of their own biases, attitudes and distractions
10
Q
What are process skills?
A
How they do it.
The ways doctors communicate with patients
How they go about discovering the history or providing information, the verbal and non-verbal skills they use
How they structure and organise communication
11
Q
What are physical factors?
A
- Site and environment -> where the consultation is
Adequacy of medical records -> not having to waste time
Time constraints
Patient status -> well known or new
12
Q
What are personal factors?
A
- Age. Young patients go for young doctors etc
- Sex. Same theory
- Background and origins. Social class and ethnic factors. May be considerable language difficulties
- Knowledge and skills. Important factor to the doctor
- Beliefs. Everyone has their own -> ideas about disease causes, weather affecting diseases, vitamins. Influenced by media, other people and past experiences
- Illness -> consultation about terminal illness can be harder than one about minor ailment
13
Q
Types of doctor patient relationship
A
Authoritarian
Guidance/co-operation
Mutual partnership relationship
14
Q
What is an authoritarian relationship?
A
Doctor uses their status. Patient has no autonomy
15
Q
What is a guidance relationship?
A
Doctor still has authority, patient is obedient and has some autonomy. Participates somewhat actively in relationship
16
Q
What is a mutual participation relationship?
A
Most desirable for more complex diagnostic interview
Patient feels some responsibility for successful outcome and feel more autonomy
Largest amount of diagnostic information tends to come out in this style, this leads to a more successful outcome
17
Q
What are different types of interviewing questions?
A
Direct questions
Closed questions
Leading questions
Reflected questions
18
Q
What is facilitation?
A
Body language, manner, gestures to encourage information
Not looking for specific information
Facilitation and silence go hand in hand
19
Q
What is an open ended question?
A
Not seeking a particular answer, just wanting to hear more of the history
20
Q
What is a direct question?
A
Asking about a specific item
21
Q
What is a closed question?
A
Can only be answered yes or no
22
Q
What is a leading question?
A
Presumes the answer
23
Q
What is a reflected question?
A
Allows doctor to avoid answering a direct question from the patient
24
Q
What are external factors that influence individual lifestyle factors?
A
Living and working conditions Agriculture and food production Education Work environment Unemployment Water and sanitation Healthcare services Housing
25
How are stress and coping related?
Mismatch between the person's perceptions of the demands on them and their ability to cope with those demands
26
What are some diseases cited as stress related?
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Bronchitis
Coronary heart disease
TB
Obesity
Diabetes
Skin disorders
Thyroid disorders
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27
What things is it possible to have a targeted intervention for?
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Eating
Physical activity
Sexual behaviour
Addictive behaviour
Stress management
Use of screening and other health services
```
28
What works best in intervention?
Targeting women and older people
Shorter interventions
Those which clearly map what they do to change processes
29
What are the NICE principles for population level policies to change specific health related behaviours?
Fiscal and legislative interventions
National and local advertising and mass media campaigns
Point of sale promotions and interventions
30
What are the NICE principles for investing in programmes to change specific health related behaviours?
Invest in programmes that identify and build on strength of individuals and communities and the relationships with communities
Support organisations and institutions that offer opportunities for local people to take part in
Support organisations and institutions that promote participation in leisure and voluntary activities
Promote resilience and build skills by promoting positive social network
31
What are the NICE principles for service providers and practictioners to facilitate specific health related behavriour changes?
Plan changes in terms of easy steps over time
| Plan explicit 'if-then' coping strategies to prevent relapse
32
What is the theory of planned behaviour?
Motivation for why people might change their behaviour
1. Attitude: positive or negative evaluation of behaviour
2. Subjective norm: what's normal for peer group
3. Perceptions of control of behaviours: belief that they can do it
33
What is meant by self efficacy?
Belief in ability to change
| Underpins: goal-setting, effort investment, persistence in face of barriers, recovery from setbacks
34
Determinants of behaviour
Information: has to be relevant to current goals, understood and easily remembered
Motivation: lead to behavioural skills, depends on seeing the value of change and having faith in your ability to manage change
Behaviour skills: knowledge and motivation are in place, check behavioural skills, role play/rehearsal often used
35
What is stress?
A condition
36
What is a stessor?
Stimulus causing the condition stress
37
What is coping?
Any action that alleviates stress
38
What are signs of stress?
Cognitive: anxious thoughts
Emotional: low mood
Physical: dissizness, chest pain etc
Behavioural: avoiding stressful situations
39
What are coping strategies?
```
Problem solving
Support seeking
Escape-avoidance
Distraction
Cognitive restructuring based on positive thinking
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40
What is the WHO definition of health?
A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
41
What can be interpreted from the WHO definition of health?
Health requires input from government, by health and other social and economic sectors, by non governmental and voluntary organisations, by local authorities, by industry and by the media
It's all about an individual's perception of quality of life
42
What would be an official or professsional definition of health?
Biomedical view of health
| Health as absence of disease or illness
43
What are the five major characteristics which define positive ideas about health?
Health as a:
- Physical and mental fitness
- Commodity
- Personal strength or ability
- Basis for personal potential
44
What would be a popular or lay definition of health?
- Absence of disease
- Physical fitness: younger people are more focussed on this
- Functional ability: older people are more concentrated on this
45
What do lay health beliefs depend on?
Social class
Gender
Cultural differences
46
How does social class affect lay health beliefs?
```
People living in poorer areas regard health as functional: the ability to be productive, to cope and take care of others
Women of higher social class or educational qualifications have a more multidimensional view of health
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47
How does gender affect lay health beliefs?
Men and women appear to think about health differently
Women may find the concept more interesting
Women include a social aspect to health
48
How do cultural differences affect lay health beliefs?
White and afro-caribbean patients attach different meanings to high blood pressure
Considered 'normal' to Afro-Caribbean patients
Don't associate it with risk of stroke/heart attack
Less likely to comply with treatment
49
What are some factors in gender inequality in healthcare?
Exposure, risk and vulnerability -> smoking, men = heart disease, women = infertility
Nature, severity or frequency of health problems -> men die younger than women, women report higher rates of illnes
Perception of symptoms -> myocardial symptoms different
Health-seeking behaviour -> men less likely to see GP
Long term social and health consequences -> male patients tend to show greater gains from cardiac rehab
50
What is statistical normality?
Bell curve, it it's within a distribution it's normal
51
What's cultural normality?
Depends on the expectations and standard of the society -> political and economic as well as social factors
Criteria used may differ between societies, over time within the same society and between groups within the same society
52
What do patients think about health and normality?
Might have a load of co-morbidities and consider themselves normal, healthy
It's about individual, social and cultural factors
53
How can you compare the health of nations?
WHO: infant mortality and life expectancy
| Spend on healthcare per capita per GDP
54
How are ill health and environment related?
Ill health can be considered in part the failure to adapt to an environment
55
What are the three examples of three direct pathological effects on environments?
Physical -> ionising and non-ionising radiation, noise and vibration
Chemical -> pesticides, VOCs
Biological -> infectious agents, allergic substances
56
What are three examples of three indirect pathological effects on environments?
Housing -> overcrowding
Transport -> does the environment encourage walking or car use?
Town planning -> access to amenities, social networks
Income/welfare/wealth distribution
57
What is a hazard?
Something with potential to cause harm
58
What is a risk?
Likelihood of harm occurring
59
What is a risk factor?
Increases the risk of harm
60
What is a protective factor?
Decreases the risk of harm
61
What is susceptibility?
Influences the likelihood that something will cause harm
62
What do people underestimate risk? What is an example?
Underestimating probability, benefit/pleasure, peer pressure
| e.g. consequences of smoking
63
What are the broad categories of hazards?
```
Physical
Chemical
Mechanical
Biological
Psychosocial
```
64
What are the different routes of exposure?
Skin
Blood/sexual
Inhalation
Ingestion
65
What is a mechanical hazard?
Something involving a machine. Cars, gas cannisters etc
66
What is a physical hazard?
Naturally occurring hazard e.g. natural disaster or U-V ray exposure
67
What factors influence the degree of risk?
How much a person is exposed
How the person is exposed
Conditions of exposure
68
What are the 3 principles that govern perceptions of risk?
Feeling in control
Size of the possible harm
Familiarity with the risk
69
How does feeling in control affect the perception of risk?
Involuntary risks are perceived as having a greater risk
| Voluntary risks are perceived as less risk
70
How does size of the possible harm affect the perception of risk?
Risks that involve greater possible harm are perceived as greater than those with less harm
Even if less harmful events are more likely -> dread
71
How does familiarity with the risk affect perception of risk?
Risks that are less familiar are perceived as being greater than more familiar risks -> complacency
72
What are some examples of individual variable in risk perception?
```
Previous experience
Attitudes towards risk
Values
Beliefs
Socioeconomic factors
Personality
Demographic factors
```
73
How does the way that people overestimate some risks and underestimate others affect their behaviour?
You'll be more motivated to avoid something if you think you're at risk of harm
People also minimise their risk though -> FH of lung ca, but smokes
So people can underestimate their chances of getting ill and overestimate their chances of dramatic hazards of low probability -> nuclear accidents
74
What is an example of the way that someone might underestimate risk?
So someone who is overweight might underestimate their chances of being overweight but underestimate their changes of stroke, CHD if both parents are well and in their 80s
75
What are ways that global health and sustainability are connected?
Inequalities in health within and between countries
Local problems may be generated or have consequences locally
Effective use of limited resources
Technology
Managing expectations and facilitating behavioural change -> people expect things to be super cheap
Politics/human rights/gender issues
76
What are the aims of a consultation?
```
Initiating the session
Gathering information
Providing structure
Building relationship
Explanation and planning
Closing the session
```
77
What do we want to do as doctors?
Connect with the patient
Summarise and verbally check that the reasons for attendance are clear
Hand over and bring consultation to a close
Ensure that a Safety Net exist in that no serious possibilities have been missed
Deal with the housekeeping of recovery and reflection
78
How does Neighbour's approach minimise risk?
Ensures both the doctor and patient are agreeing what the issue is today by summarising and verbally checking -> often a patient will add or correct information
Hand over to the patient at the end to check all issues have been addressed
Safety net -> does patient know who to contact if that happens? Do they know what symptoms would be concerning if they arise?
Housekeeping -> was that consultation well documented? Has the referral been done? Do I need to pause and allow myself to focus for the next consultation?
79
What is safety netting?
Have we understood and checked the real reason the patient was there?
Have we missed anything? How do we minimise the change of future problems?
Am I ready for the next consultation?
80
What's the difference between risk and uncertainty?
Risk - chance of bad consequences, loss. Can be quantified
| Uncertainty - not being completely confident or sure of something, maybe cannot be determined completely
81
What different groups have different ideas of risk and uncertainty?
Doctors
Patients
Government and regulatory bodies
Airline pilots
82
How do patients have different perceptions of risk and uncertainty?
Don't make decisions based on statistics, may have 20% chance of developing heart disease in next 10 years
4% of 20-24 yos developed a new STI in 2014 -> does that mean that contraceptive usage will be affected?
83
What is resilience and how might it be applied to medical careers?
Capacity to recover quickly from difficulties.
Uncertainty can wear you down in your job -> continual self doubt -> not just about patients but also interpersonal aspects
84
What are different strategies for managing uncertainty?
Algorithms
Pattern recognition
Pathways
Scenario/option planning
85
Why might you choose different strategies?
Speed of change vs. complexity
| If either of these factors are high or low, you use a different decision making strategy
86
When would you use algorithms?
Speed of change -> high
Complexity or ambiguity -> low
Example: childbirth, administering vitamin K to someone with a high INR
87
When would you use pattern recognition?
Speed of change -> high
Complexity or ambiguity -> high
Example: unstable patient in ITU, heart attack
88
When would you use pathways?
Speed of change -> low
Complexity or ambiguity -> high
Example: comorbidity or ambulant care, anticipatory care plan
89
Why is hypothetico-deductive reasoning used?
A full systematic enquiry is not possible
There are a few probable reasons and you deduce which ones it can't be based on the symptoms etc
You might be wrong because you don't have a diagnostic test and you've assumed there's no other cause
You base your diagnosis on the fact that some causes are more probable than other
Some pieces of information are more important than other
90
How does WHO rank health systems?
- Health (50%), disability adjusted life expectancy
- Responsiveness (25%), speed of service, protection, quality of amenities
- Fair financial contribution (25%)
91
Give an example of how the government might have an influence on a local level on health
In poorer areas there is increased morbidity and mortality from chronic diseases -> lung disease or heart disease
Barrier to good nutrition since healthy food is more expensive
92
How can policies have a direct bearing on health?
- Income security
- Employment
- Education
- Housing
- Business
- Agriculture
- Justice
- Technology
93
What is the concept of the health gradient?
```
Health hazards become harder to manage when certain aspects of health policy fail:
Environment health hazards
Lack of education
Inadequate food and nutrition
Unemployment
Poor housing
Poverty
Overall effect is it becomes more difficult to take individual preventative action
```
94
What is the effect of social inequality on more deprived areas?
```
Exclusive breastfeeding is lower
GP consultations for anxiety are higher
Higher percentage of smokers
More alcohol related hospital admissions
Life expectancy lower
Money thrown at these areas is very low
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95
How do we sort out social inequality?
Policy influences health
Strategic partnerships and advocacy -> decrease social inequalities and use institutional power -> improve living and working conditions -> decrease risk behaviours -> decrease injury and disease -> infant mortality goes down, life expectancy goes up
96
Influence of culture in health care
Misunderstandings in diagnosis or in treatment from language or culture
Poor patient adherence with treatments, poor outcomes
Health care disparities
97
Disease outcomes and culture
Death rates from lung cancer are higher in black men than white men
98
Disease prevalence and culture
Diabetes higher among Pakistani and Bangladeshi women
99
Transference
Physicians or patients transfer past emotions, beliefs or experience to the present situation
100
Barriers in transference
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Lack of knowledge
Fear and distrust
Bias and ethnocentrism
Stereotyping
Language barriers
Situation
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101
What is the focus of cultural competence?
Eliminate misunderstandings in diagnosis or in treatment planning that may arise from differences in language or culture
Improve patients adherence with treatments
Eliminate health care disparities
102
What is cultural competence?
Ongoing capacity of healthcare systems, organisations and professionals to provide for diverse patient populations high quality care that is safe, patient and family centred, evidence-based and equitable
103
What three basic skills do you need to acquire a high level of cultural competence?
Knowledge - understanding the meaning of culture
Attitudes - having respect for variations in cultural norms
Skills - eliciting patients' explanatory models of illness
