Aspects of a healthy lifestyle to discuss with patients
● illicit drug use
● sexual health
Aspects of health likely to be worse for children in the most deprived area
● lower birth weight
● less likely to benefit from breastfeeding in infancy
● poorer dental health
● higher rates of obesity
● more likely to take up smoking
Risks to foetal well-being
● illicit drugs
● prescription drugs
● OTC medication / internet sourced remedies / herbal medication
● diet (poor nutrition / lack of dietary folic acid / soft cheese / pate)
● infectious diseases (Toxoplasma, Rubella, Cytomegalovirus, Herpes)
● maternal disease (diabetes, epilepsy)
Factors to make pregnant women more likely to change lifestyle behaviour
● advantages of [not drinking] (e.g a healthy baby) outweigh the disadvantages
● ( Hannah) anticipates a positive response from others to her behaviour change (e.g Hannah’s boyfriend / family want the unborn baby to be healthy)
● there is social pressure to change (e.g very socially unacceptable to drink when obviously pregnant)
● Hannah perceives the new behaviour to be consistent with her self-image (e.g perceives herself as an earth mother)
● Hannah believes she is able to carry out the behaviour in a range of circumstances (e.g at home / parties)
WHO definition of health
- A state of completely physical
- and social
- well-being and not merely the absence of disease or infirmity
Factors thast affect our beliefs about health and example
● age = older people concentrate on functional ability whilst younger people tend to speak of health in terms of physical strength and fitness
● social class = people living in difficult economic and social circumstances regard health as being able to to provide and take care of others
● gender = men and women appear to think about health differently (women include a social aspect to health)
● culture = different perceptions of illness / disease, differences in concordance with treatment
Different routes to exposure to hazardous substances
● sexual contact
Categories of hazards and examples
● physical = heat / noise / radiation from equipment
● chemical e.g pesticide
● mechanical = trips / slips
● biological = spread of infection amongst colleagues (respiratory / GI)
● psychological / stress = anxiety regarding job security / relationships with colleagues / deadlines / busy
Common reasons for children to visit GP
● feeding problems (newborns)
● URTIs e.g colds & coughs
● sore throat
● vomiting + / - diarrhoea
● abdominal pain
● behavioural problems
● developmental delay
Social influences on health
● employment/financial security
● social class
● health system
Health and social care team members when to assist in the care of a COPD patient
● physiotherapist = help to clear chest secretions
● pharmacist = advice on medication / interactions / timing of antibiotic medication / encouragement regarding concordance
● dietician = assessment of nutrition and advice on improving appetite to gain weight
● counsellor = assessment and management of low mood
● practise nurse = assessment and advice regarding inhaler use / chronic disease (long term condition) monitoring clinics / flu and pneumococcal immunisation
● occupational therapist = assess for aids to assist daily living e.g stair lift / shower rail)
Ethical, psychological and social issues to consider in abortion
- Beliefs regarding termination
- Any religious beliefs
- Thoughts regarding bringing a child into the world that you do not feel able to care for
- Anxiety about being a parent
- Anxiety about going through with a termination
- Stress/anxiety about level of support she may have from family and friends
- Support network- does Lisa feel her friends would be supportive
- Her social life will dramatically change after having a baby
- Ability to find a job/ work will be affected in the short or longer term
Factors to increase the chance of someone changing their behaviour
- You think the advantages of change outweigh the disadvantages
- You anticipate a positive response from others to your behaviour change
- There is social pressure for you to change
- You perceive the new behaviour to be consistent with your self-image
- You believe you are able to carry out the new behaviour in a range of circumstances
Benefits of mutual participation style
- Greater participation by the patient means they have a feeling of relatively greater personal autonomy
- The patient adopts greater responsibility for their own health through sharing of information and decision making
- Patients are generally more satisfied with consultations where they have been fully informed and are therefore less likely to complain about their care
- May increase compliance with advice/concordance with treatment
- The physician uses all of the authority inherent in his/her status and the patient has no autonomy.
- The patient tries hard to please the doctor and has does not actively participate in their own treatment.
Content, perceptual and process skills
- Content skills: what doctors communicate-the substance of their questions and responses, the information they gather and give; the treatments.
Perceptual skills: what they are thinking and feeling-their internal decision making, clinical reasoning; their awareness of their own biases, attitudes and distractions.
Process skills: how they do it-the way doctors communicate with patients; how they go about discovering the history or providing information; the verbal and non-verbal skills they use; the way they structure and organise communication.
Govenment strategies to promote population health
- Legislation/policies on smoking/alcohol (e.g. minimum age to buy products, licensing laws, taxation)
- Improvements in housing
- Provision of health education
- Health and safety laws
Why people may feel smoking is normal
- Might be normal for her peer or social group, but would be abnormal perhaps for the wider population and/or a different population group
- Might watch TV programmes where smoking is normal behaviour.
Different health professionals in the health care of a new mother and baby
GP-postnatal examination of Lisa, 8 week baby check, medical problems?
Midwife-follow up of Lisa and Kayleigh for first 10 days after birth, advice on feeding
Health Visitor-advice on early child care from 10 days to school age, immunisations
Pharmacist-advice OTC medication, smoking cessation advice
Example of hypothetico-deductive reasoning
- The patient history leads to making several diagnostic hypotheses, based on your past experience e.g. simple infective diarrhoea, infection elsewhere such as a respiratory infection, malabsorption syndrome or acute appendicitis.
- Rare, but not immediately concerning diagnoses can be excluded at this stage e.g. malabsorption syndrome, as although important, it is not immediately life threatening.
- Acute appendicitis is also rare, but is life threatening, so needs to be actively excluded.
- Strengthen the case for diagnoses/diagnosis through more detailed history and examination and possibly some initial investigations. This may help provide evidence for your initial hypotheses, but if not…
- Extend the search if no diagnosis identified.
- Hypothetico-deductive reasoning is not necessarily about common diagnoses, but about likely diagnoses.
- If the patient does not follow the expected pattern of illness/recovery from the postulated diagnosis, revision of the diagnosis is required e.g. persistent diarrhoea may then make a diagnosis of malabsorption more likely and this will need to be investigated
Safety netting advice
· Advise the patient of the expected course of the illness/recovery
· Advise of symptoms indicating deterioration
· Advise who to contact if patient deteriorates
Examples of the use of computers in patient care
- Store and book appointments
- Patient records
- Support prescribing
- Electronic management of hospital letters or blood results
- Chronic disease management and recall
- Patient leaflets/resources
- Public health information
- Identify patients for screening programmes
Hazard and risk definition
Hazard: something with potential to cause harm
Risk: the likelihood of harm occurring
Questions to ask patient to determine if symptoms are work-related
- Does it happen at work?
- Does it happen during holidays?
- Did it ever occur before she started working there?
- Is anyone else at work similarly affected?
Why are GPs the most appropriate professional to guide patients
- Aware of Hannah’s current and past medical history
- Aware of Hannah’s social circumstances e.g. family support
- GP has knowledge of a broad range of illnesses and health conditions
Trusted health professional who is likely to have been known by the patient/family for some time, perhaps lifelong
- GP has role in prevention as well as diagnosing/treating illness/disease i.e. GP is responsible for holistic patient care
- GP likely to be local to Hannah’s home and therefore accessible
- the ongoing capacity of healthcare systems, organizations and professionals to provide for diverse patient populations high quality care that is safe, patient- and family- centred, evidence-based, and equitable.
Ways risk can be minimised
• Safety netting
• Summarise and verbally check that reasons for attendance are clear
• Hand over and bring the consultation to a close i.e. hand over to the patient at the end to ensure all issues have been covered
• Deal with the housekeeping of recovery and reflection e.g. record keeping, referral if necessary, pausing to reflect before next patient
List the five core concepts associated with the Social Cognitive Theory
•Outcome expectations (positive)
Environmental factors which may influence an individual’s behaviour.
What are the effects on a person's partner if they have lost their job?
- Exhaustion due to working extra hours
- Worry and stress about family's future
Anger that their partner has been fired
- Change of family dynamics due to partner being home all the time
- Enjoyment due to extra time being able to spent with partner
What are the effects in a person if they lose their job?
- Feeling of worthlessness --> Depression
Guilt that they are no longer supporting their family
Anxiety about finding a new job or retiring
Anger at their employers
- May resort to substance misuse as a coping mechanism
- Positive outlook for new future employment