Theme C Flashcards
(178 cards)
1
Q
Describe the professional attitude expected of medical staff and students?
A
- Make care of your patient your first concern.
- Protect and promote the health of your patients and the public.
- Provide a good standard of practice and care and keep up to date.
- Treat patients as individuals and respect their dignity.
- Work in partnership with patients.
- Be honest and open and act with integrity.
- Maintain confidentiality.
2
Q
Definition of medical professionalism
A
• Set of values, behaviours and relationships that underpins the trust that the public has in doctors
3
Q
Describe the regulatory role of the GMC?
A
• To protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.
4
Q
Outline the role of medical schools and the GMC in ensuring students and doctors fitness to practice?
A
- GMC sets its guidance for what medical graduates need to accomplish in Tomorrow’s Doctors.
- This is taught by the medical schools.
- This is examined formally in various exams taken throughout the course, reflective essays, learning to give feedback and self-reflection, attendance and punctuality, plagiarism.
5
Q
Benefits of good and consequences of bad communication?
• More accurate diagnosis
• More accurate data gathering
• Increased adherence with treatment regime
• More effective patient-doctor relationship
• Increased patient-doctor satisfaction
A
Benefits of good communication
• More accurate diagnosis
• More accurate data gathering
• Increased adherence with treatment regime
• More effective patient-doctor relationship
• Increased patient-doctor satisfaction
Consequences of poor communication • Inaccurate diagnosis • Less recognition of ICE • Non-adherence to treatment • Decreased satisfaction with doctor • More complaints
6
Q
Can communication skills be taught? How?
A
- Skilled training leads to improvement in communication
- Self reflection
- Feedback should be specific, descriptive, and non-judgemental
7
Q
Why is Calgary-Cambridge important?
A
- Every patient has their own problem and explains it within their own framework
- Understanding the CC model can help you treat them better and you can communicate with them from within their own framework
8
Q
What models explain difference in people?
A
- Biomedical explanations of difference rely on biology
- Social models explain difference by social interactions
- Faith system
- Epigenetics (combines biological and social)
9
Q
What makes science social?
A
- Decisions about research funding
- Pharmaceutical industry - profits
- Ethical issues
- Nature of scientific work - communication
10
Q
What is eugenics?
A
- Improving a population by controlled breeding
* Encourages good genetics, discourages bad genetics
11
Q
What is positive and negative eugenics?
A
POS= Encourages good genetics
NEG = Discourages bad genetics
12
Q
Issues with eugenics?
A
- Thinking about the future based on genetics
- Designer babies
- Genetic screening - health insurance, employment, and civil liberties
- Many conditions are polygenic
13
Q
What is patient centred care?
A
• Care that is responsive to the wants, needs, and preferences of the patient
14
Q
6 criteria of patient centred care?
A
- Shared decision making
- Understanding of the patient’s needs, wants and preferences
- Enhances prevention and health promotion(early detection and complication prevention)
- Enhances the doctor-patient relationship(caring, feelings, trust and power)
- Realistic(resource and time based)
15
Q
What is the sick role?
A
• TheSickRoledefines the obligations and privileges of the doctor-patient relationship.
16
Q
What is the patient expected to do in the sick role?
A
• Want to get better
• Seek medical advice
• Shed some normal activities
Regarded as being in need of care and unable to get better on their own
17
Q
What must the doctor do to uphold the sick role?
A
- Apply a high degree of skill and knowledge
- Act for welfare of patient (patients best interest), not self interest
- Be non-judgemental and emotionally detached
- Be guided by rules of professional practice
18
Q
What right does the doctor have? (as part of the sick role)
A
- Right to examine patients
- Granted autonomy in professional practice
- Occupies position of authority in regard to the patient
19
Q
Criticisms of the sick role?
A
- Symptom iceberg - Patients do not necessarily act on symptoms and go see the doctor
- Chronic illness and MUS - If cause unknown, patients can’t enter sick role due to uncertainty
- People try to label themselves as sick
- Conflict between best interests for the patient and cost to society in allocation of resources
• tension/strain on doctor to be non-judgemental and ignore their own beliefs
20
Q
What is evidence?
A
• Body of facts/information indicating whether a belief or proposition is true or valid
21
Q
What 4 sources are used when making a clinical decision?
A
- Patient preferences
- Available resources
- Research evidence
- Clinical expertise
22
Q
Why is evidence-based decision making important?
A
- Deals with uncertainty
- Medical knowledge is incomplete/shifting
- Patients will receive most appropriate treatment
- Constant need for innovation and improvement
- Improving efficiency of healthcare services
- Reduces practice variation
23
Q
Give 4 ways in which EBDM may be implemented?
A
- Evidence based clinical guidelines
- Summaries of evidence provided to practitioners
- Access to reviews of research evidence
- Practitioners evaluating research for themselves
24
Q
What is economics?
A
• Economics is about how people allocate scarce resources amongst competing activities
25
Define opportunity cost?
The cost of passing up the next best choice when making a decision
26
Give 3 aspects of opportunity cost decisions?
* Time is an important cost - spending time on one person denies another
* Overspending your budget cuts another elsewhere
* Good medical practice means you must be aware of the cost of the care you deliver to patients, be aware of the treatments you give to ensure they work
27
What are the sources of NHS funding?
* Tax finance
| * Some user charges e.g. prescriptions
28
How is the NHS organised?
* 210 CCGs - Buyers
| * Public hospitals and GPs - Sellers
29
What is flat of the curve medicine?
The phenomenon where health care consumption (costs) continues to rise while health outcomes (usually defined by life expectancy), remain the same
30
Criteria for choosing the best treatment
Must be cost effective and clinically effective
31
What are meta-ethics?
• Study of moral concepts, eg right and wrong
32
What is normative ethics (moral theory)?
• Study of the means of deciding what is right and wrong
Seeks to tell us how we can find out what things have what moral properties, to provide a framework for ethics
33
What is applied ethics?
It seeks to apply normative ethical theories to specific issues, telling what it is right and wrong for us to do- APPLICATION OF MORAL THEORY
34
What are the 3 main types of moral theory?
• Consequentialism - Moral based on the consequence of the action (Whether an act is right or wrong depends only on the results of that act.
The more good consequences an act produces, the better or more right that act)
* Deontoloty (duty based) - Moral based on actions adherence to the rules (focuses on the rightness or wrongness of actions themselves)
* Virtue ethics - Right act is one a virtuous person would do (emphasizes an individual's character as the key element of morality)
35
What are the 4 ethical principles?
* Autonomy - Respect the patient as an individual to make choices
* Non-maleficence - Not permitted to harm patients
* Beneficence - Act in a way that positively benefits patient (act in patients best interests)
* Justice - Treat people fairly and equitably
36
What are the 2 agenda's and what's the difference between them
* Disease - What is wrong with the body (physically)
| * Illness - Look at the way that the patient experiences the disease
37
Why should you treat both the disease and the illness (2 agendas)
* Disease - Means you treat the correct condition, improves biomedical health
* Illness - Can discover how illness is impacting patients life, patient more satisfied, enhances doctor-patient relationship
38
What is autonomy?
* Fully informing patients with capacity to allow them to make their own decisions
* Respecting wishes regarding patients treatment
39
What ethical principles should you think about when assessing patients best interests?
* Beneficence - Act to positively benefit patient
| * Non-maleficence - Act in a way as not to harm the patient
40
What potential difficulties that might occur when assessing best interest?
* Difficulties in predicting future outcome
* Conflict between benefits of treatment and patients own views
* Conflict between patient and doctor view of best interest
* Emotional attachment may distort doctors views
* Patient may be unable to communicate relevant information
41
What is paternalism?
• The intentional overriding of a persons known preferences or actions by another person (this can be by coercion or misinformation).
42
What is coercion?
• Persuading patient to do something by force of threats (eg forcing to eat)
43
What is misinformation?
• Lying to save from distress
44
What is the Bolam test? (negligence)
* Test of negligence, determines standard of care
* A doctor isn’t guilty of negligence if he has acted in accordance with a practice accepted by a responsible body of doctors.
45
What is the Bolitho amendment? (negligence)
BOLITHO - you cannot defend a case on the basis of a current practice that is not reasonable or logical
ie doctor's behaviour should have been logical
46
Where can you look at disease distribution?
Globally, regionally, locally
47
Why do we need to study populations?
* To find out about risk (diseases, drugs, etc)
| * Need to use evidence of what has previously happened to a population to work out how drugs act etc
48
What is epidemiology?
• Study of incidence, distribution and control of diseases in populations
49
What are the 3 types of epidemiology?
* Descriptive - Tell us how things are distributed
* Analytical - How we can exploit those distributions to ask questions
* Experimental - Change the distributions ourselves to see what happens
50
What is incidence?
New cases of disease within a period / Number initially free of disease
51
What is prevalence
Number of people with a disease at a particular point in time / Total population
52
How can epidemiology be useful in smoking research?
* Identify cause of disease
* Guides preventative action - Identifies targets for intervention
* Surveillance of populations and smoking can measure effects of intervention
53
What is illness behaviour?
• The way in which symptoms may be differently perceived, evaluated and acted upon by different kinds of persons
54
What is the symptom iceberg?
• Patients only report 5-15% of symptoms
The symptom iceberg describes the phenomenon that most symptoms are managed in the community without people seeking professional health care.
Only 10% of symptoms make patients see the doctor. The rest is undertaken by lay people and the community.
55
What is the lay referral system?
• People talk to other people (lay people) before seeking help
Friends, relatives, pharmacist
56
What demographic/social factors influence help seeking and illness behaviour?
* Gender
* Age
* Social class
* Race
* Culture
57
What are Zolas triggers to help seeking behaviour?
* Interference with work or physical activity
* Interference with social relations
* Interpersonal crisis e.g. death in family
* Putting a time limit on symptoms
* Sanctioning - relative/friends tell them to seek help
58
What influences health seeking behaviour?
* Perception and evaluation of symptoms
* Perceived risk
* Previous experience
* Psychological factors - Fear of what it might be
* Denial
* Concern about using NHS resources
59
What barriers are there to help seeking?
* Provision and availability of services
* Car ownership, transport cost, availability
* Disruption to work
* Attitudes of staff - Previous bad experience
* Inverse care law - Better off areas get better health provision that poorer areas
* Geographical distance
* Time, effort
* Long waiting times
60
What is health promotion?
• The process of enabling people to increase control over, and to improve, their health
61
What are WHOs 5 aspects of health promotion?
* H - Healthy public policy
* A - Action in the community
* R - Re-orientating health services
* P - Personal skills
* S - Supportive environment
62
What are the four different approaches to health promotion
* Medical - Focuses on disease and prevention
* Behavioural - Focuses on attitudes and lifestyles
* Client-centred - Focuses on empowering individuals
* Societal - Focuses on political and social action
* Educational - focus on teaching and education
63
What is primary/secondary/tertiary health prevention?
Primary prevention: Prevent onset of disease (e.g. screening risk factors, health protection and health education)
Secondary prevention: Catching the disease early (e.g. cancer screening)
Tertiary prevention: Stopping the disease progressing any further (e.g. treatment to stop HIV – AIDS)
64
What is beatties's typology of health promotion?
Health Persuasion | Legislative action
Personal counselling | Community development
________________________
Authoritative vs negotiated intervention
and
Individual focus vs. collective focus
65
What is health persuasion?
* Includes mass media campaigns, such as sexual health and health eating
* For example, 5-a-day TV campaign, Screening adverts (smear test campaign)
66
What is legislative action?
* Passing a law to promote health
| * For example, laws that subsidise the price of healthy food or sugar tax or smoking ban
67
What is personal counselling?
* Opportunistic prevention in consultations
| * For example, GP advice on smoking/drinking
68
What is community development?
* Locally based initiatives
| * For example, communities producing and distributing food themselves/ Sure start and health action zones
69
Medical ethics applied to health promotion
Example: MMR immunisation (concerns regarding association with autism)
• Autonomy = respecting parents views (however parents aren't the patient)
• Beneficence = protecting the individual child
• Non-maleficence = all interventions carry risk
Justice= protect community
70
What is health education?
* Learning experiences designed to facilitate voluntary actions conductive to health
* Happens through mass media campaigns and through advice from health professionals
71
What is health protection?
* Legislation to protect public health
| * Includes seat belts, smoking ban
72
What is prevention paradox?
• A preventative measure which brings much benefits to the population but much to each individual
73
What is advocacy for health?
• A combination of individual and social actions designed to gain political commitment, policy support, social acceptance for a particular health goal or programme
74
What is empowerment for health?
Empowerment is a process through which people gain greater control over decisions and actions affecting their health
75
What is enabling?
• In health promotion, enabling means taking action in partnership with individuals or groups to empower them to promote and protect their health
76
What is health literacy?
• Health literacy represents the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health
77
What are social inequalities in health?
• Differences in people's health linked to social inequalities in their lives
78
Are new diseases inversely related to social class?
• No, but as disease progresses the social gradient tends to re-emerge
79
What is the gini coefficient?
* Measure of inequality
| * Area between Lorenz curve and perfect distribution
80
Give some examples of social inequalities in health?
* Routine manual workers have higher chance of infant mortality
* Teenage pregnancy more common in lower social groups
81
What did the black report show?
* Social health inequalities are involved in mortality
| * Shows health inequalities were widening
82
Measures of health inequality
Household income, educational level, occupational status, housing tenure, area deprivation.
83
When was the black report published?
• 1980
84
What are the 4 explanations of socioeconomic inequalities in the black report?
* A statistical artefact
* Natural selection - People's health drives their social class, healthy people are more likely to get promoted, while unhealthy people are more likely to lose their jobs
* Result of differences in health behaviour
* Poverty causes poor health
85
How do childhood circumstances influence inequalities?
* Childhood is a period of rapid development and heightened sensitivity to environmental influences
* Father's occupation at birth is a strong indicator of life expectancy
86
Name some government initiatives to help reduce child poverty?
* National minimum wage
* Increase child benefit
* Increase income support
* Teenage pregnancy strategy
87
Why has child poverty increased?
```
• Unemployment/part-time work
• Lower pay
• More single parent families
• Freezing or abolition of some benefits
More indirect taxation
```
88
What is the marmot report 2010? Name the 6 policies
```
Children having the best start in life
All children given chances to maximise potential
Create fair employment
Ensure healthy living standards
Strengthen communities
Strengthen health promotion
```
89
What is culture?
• System of knowledge, experience, belief, attitudes, meanings, signs, and symbols shared by a group of people
90
What is enculturation?
• Process of learning your own groups culture
91
What is acculturation?
• Process of taking on another groups culture
92
Why do people self care?
* Many people will self treat before seeing a doctor
| * Many cultures have strong non-western medical traditions
93
Why are CAMs used? (Complementary and alternative medicine)
* Easily accessible
* Control over treatment
* Dissatisfaction with health care
* Poor doctor-patient relationship
* Desperation
* Perceived effectiveness and safety
94
What is diagnosis?
• Determining the nature of a disorder by considering the patient's signs and symptoms, medical background, and test results
95
What is prognosis?
• Assessment of future course of patients disease and management
96
Why is prognosis important?
* It can help diagnostic and treatment decisions
| * It is important for patients to know the likely course of their disease
97
What are the types of theory that decision making focuses on?
* Descriptive - What are you doing?
* Normative - What should you be doing?
* Prescriptive - How can we improve what you are doing?
98
What is the hypothetico-deductive model? (decision making) and who uses it?
* Cue acquisition (initial encounter with the patient- collating information)
* Hypothesis formation (forming a tentative hypothesis from the info collected)
* Cue interpretation (interpreting cues initially given- accepting or rejecting cues depending on how they contribute to the hypothesis)
* Hypothesis evaluation (evaluate whether evidence collected confirms or rejects hypothesis)
* Inexperienced clinicians
* Experiences clinicians with a problem they don't recognise
99
What is broad and narrow evidence
Broad evidence - Any factor that can and should influence clinical decision making
Narrow Evidence - Results from rigorous clinical trials and observational studies
100
What is the hierarchy of evidence?
• Lists the types of study design ranked in order of their perceived ability to provide evidence for use in practice
Metaanalysis -> Systematic review -> RCTs -> Cohort studies -> Case control studies -> Cross sectional studies -> Animal studies and in-vitro studies -> Case reports
101
Where can good evidence be found?
Cochrane database, Evidence based journals, Medline
102
What is consent and what are the 3 requirements for valid consent?
Voluntary agreement given by a competent patient that has been fully informed
1. Informed 2. Voluntary 3. with capacity
103
What are the 4 forms of consent?
* Oral
* Written
* Implied
* Expressed
104
What information does the patient require as part of the consent process?
* Potential benefits
* Potential risks
* Alternative treatment options
105
When is consent required?
* Before examination
* Before treatment or care
* Disclosure of confidential information
* Screening
* Teaching
* Research
106
Why is consent needed?
* Improves trust between patient and doctor
* Legal requirement
* Respects autonomy
* Professional duty
107
What is the Bolam principle?
• Practitioners are not negligent if they act in accordance with the practice accepted by a responsible body of medical opinion
108
What is battery?
• If a person touches another person without consent
109
What is negligence?
The concept of failure to exercise care
110
What is capacity?
Determined by a physician, refers to an assessment of the individual's ability to understand, appreciate, and manipulate information to form rational decisions.
111
Which act focuses on who has capacity?
• Mental capacity act 2005
112
Who does the mental capacity act apply to?
• People who are 16 and over
113
Which act says a 16 year old has full capacity?
• The family law reform act 1969
114
What is Gillick competency?
• Child (under 16) can consent to medical treatment if deemed competent by medical professional, without need for parental permission or knowledge
115
What is a POM?
• Prescription only medicine
116
What is a P drug?
• You can get it from a pharmacy under the supervision of a pharmacist
117
What are OTC drugs?
• Over the counter, can be purchased without prescription
118
Why are P drugs used?
* Pharmacists can ask customers questions about who it is for, symptoms, etc
* Ensures no 'red flags' about how long the patient can use it for
* Duration of a symptom may mean it is not safe to self treat
119
Who are the MHRA?
• Medicines and healthcare regulatory authority
120
When can a POM change to a P?
• No danger when used correctly without the supervision of a doctor
121
When can a P change to OTC?
• Safe to sell without the supervision of a pharmacist
122
Name 3 community pharmacy teams?
* Minor ailment schemes
* Emergency contraception
* Smoking cessation
* Health education
123
Self medication scale of analgesics say that the belief of patients can fit into 3 categories?
* People who prefer to let pain 'run its course'
* People reluctant to take mild analgesics
* People who 'don't think twice' about taking mild analgesics
124
Outline Frasier Guidelines
· The young person understands the advice being given. -> make sure they know how to take it/when to take it/ safety precautions
· The young person cannot be convinced to involve parents/carers or allow the medical practitioner to do so on their behalf.
· It is likely that the young person will begin or continue having intercourse with or without treatment/contraception.
· Unless he or she receives treatment/contraception their physical and/or mental health is likely to suffer.
The young person's best interests require contraceptive advice, treatment or supplies to be given without parental consent.
125
What is quantitative data?
* Discrete - Only certain values possible
| * Continuous - Any value is possible
126
What is qualitative data?
* Multinomial - Categories aren't ordered
* Ordered - Categories exhibit logical order
* Dichotomous - Two categories that oppose
127
What are descriptive statistics?
• Data is collected and summarised and described in terms of means, SDs etc
128
What is ecological fallacy?
• Inferences about nature of individuals are deduced from inference for the group to which they belong
129
What are inferential statistics?
• Using statistical tests to make generalisations about a population
130
What is nominal/ordinal and interval data
Nominal - categorical eg sex
Ordinal - ordered in value eg. degree of pain
Interval - continuous data with equal intervals eg. height, age, weight
131
What are measures of location?
• Mean - Average of all observations
• Median - Midpoint of the data set
Mode - Most frequent observation
132
What are measures of dispersion?
* Standard deviation
* Interquartile range
* Range
133
What is a hypothesis?
An idea expressed in such a way that it can be tested and refuted
134
What is a null hypothesis?
• The hypothesis that there is no difference between two groups
135
What is a P value?
• The probability that the difference between groups would be as big or bigger than that observed if the null hypothesis is true
136
At what point is statistical significance generally accepted?
* P=0.05
* Strong evidence against the null hypothesis, can reject the nulll hypothesis
* Statistically significant
137
What is standard error?
* Describes how good a given estimate is
* Tells you how good your sample statistic is
* Looks at how accurate your estimation of the mean is
138
What is a confidence interval?
• Range of values that we think contain the mean
139
What are confidence limits?
• The actual upper and lower boundaries that state the boundaries of the confidence interval
140
What is the difference between race and ethnicity?
* Race is genetic
| * Ethnicity is socially determined
141
How is ethnicity important in medicine?
* Disease prevalence varies with ethnicity
* Approaches to best treatment may vary with ethnicity
* Affects behaviour towards others
* Can look at the patient according to their own values
142
What is ethnocentricity?
• Judging one culture based on the values of another
143
Which anaemias are genetic?
* Sickle cell disease
| * Thalassaemia
144
What are the primary, secondary, and tertiary management principles associated with sickle cell?
* Primary - Carrier screening
* Secondary - Postnatal screening
* Tertiary - Treatment, preventatives, therapeutics
145
Should we screen everyone?
• Cost - It would cost a lot of money
• Could be seen as racist
if screening certain ethnic groups, impression of ethnic minorities being sicker/bringing in disease
• How do we determine ethnicity so know who to screen?
146
What is risk?
* Probability that an event will occur during a specified time
* Only works if a time period is fixed
147
Relative vs absolute risk?
* Relative - The ratio of the probability of developing an outcome in those exposed compared to those not exposed (risk ratio)
* Absolute - Risk of developing the disease over a time period
148
How to calculate risk ratio?
Risk in exposed divided by risk in non exposed
A RR of 1 - No difference in risk between the two groups
A RR of <1 - The event is less likely to occur in the experimental group than is the control group
149
What is absolute risk reduction?
• Difference in risk between study and control populations
150
Why is it important to maintain confidentiality
* Improves trust between patient and doctor
* Respects autonomy
* Prevents patient harm
* Virtuous
* Human rights act
* GMC requirement
151
When can confidentiality be breached?
* Statute (law)
* Consent by patient
* Public best interest
152
Name some statutes (laws) that oblige doctors to disclose information?
* Public Health Act 1984
* Road Traffic Act 1988
* Prevention of terrorism act 1989
153
What is a cross-sectional survey?
* Descriptive study, observational
| * Analyses data from a population at one specific point in time
154
What is the medical model of disability?
Criticism of medical/individual model of disability?
* Emphasis on what is wrong with the person
* Exclusion from society
* Views disability as a tragedy
* Puts disability between the patient and the doctor
Criticisms..
• Looks at disability as a tragedy
• Doesn't look at the person as normal in society
• Sees disability as a medical problem that doctors have to fix
155
Historical factors which led to the development of the 'medical model of disability'?
* Industrial revolution
* Advances in technology
* Social darwinism
156
Outline the social model of disability?
Criticisms...
* Discrimination arises because of the organisation of society
* Society fails to make activities accessible
criticisms
• Looks at disability as though impairment can never cause an individual problem but society can
• Doesn't fully appreciate the complexity of different disabled peoples liver
157
What is the interaction mode of disability?
* Looks at interactions between people's impairments and the environments they live in
* Sees disabled people as individuals
* It is person-centred
158
What is social contructions?
• There is no such thing as a disabled individual but that society makes people individual
159
What are the measures for assessment of disability?
* Barthel Index
* SF36
* Functional assessment measure
160
What are the unmet needs of carers?
* Information and advice
* Practical and emotional support
* Training in caring activities
* Respite care and short breaks
161
What is the Libertarian argument?
• Some people are poor because they don't work hard enough, or cause their own needs (eg by smoking)
162
Arguments for lifestyle-based assessment
* People who contribute to ill health are less deserving of resources for treatment than those who don't
* Deterrence - It is more likely to deter people from damaging their health
* You are also more likely to get more benefits from a treatment in people who don't
163
What are instrumental theories?
* The purpose of rights is to promote a certain state of affairs which is seen as good
* If we have a system that recognises rights, it will lead to a much happier society
164
What is risk?
• Probability that an event will occur during a specific time
165
What is the precautionary principle?
• Action shouldn't be taken if the consequences are uncertain and potentially dangerous
166
What factors did McKeown argue improved health?
* Environment - Nutrition and hygiene
* Behavioural - Reproduction
* Medical - Immunisation
* Public health
167
What is social iatrogenesis?
Damage resulting from the medicalisation of life
168
What is social constrictionism in relation to stigma?
• The enactment of stigma is about social interaction - It is about people's responses to behaviour or physical appearance
169
What is disease?
• Discrete pathological processes within the body with clinical signs
170
What does the patient with MUS want?
* Alliance with the doctor over problems
* Wants the doctor to recognise they are suffering and it's not their fault
* A convincing explanation that is plausible and credible
171
What is exculpation?
• Recognise reality of suffering and tell patient to not feel guilty about their symptoms and that they are not the patients responsibility
172
What is a collusion response?
• ex. Using explanations about blood pressure and serotonin to push antidepressants (deceiving someone)
173
What is clinical significance?
clinical significance is the practical importance of a treatment effect - whether it has a real genuine, palpable, noticeable effect on daily life.
174
Name the Bradford-Hill criteria?
* Strength of association
* Specificity - Does A always only cause B?
* Temporal association - effect has to come after cause
* Theoretical plausibility
* Consistency - Do you always find the same relationship?
* Coherence - Does the data fit in with what we know now?
* Dose-response relationship - Does greater exposure lead to greater effect?
* Experimental evidence - Can we test this experimentally?
* Analogy - If A causes B, does something similar to A cause something similar to B?
175
What are the typical grief reactions?
* Affective - Depression, distress, guilt
* Cognitive - Denial, lowered self-esteem
* Behavioural - Fatigue, agitation, social withdrawal
* Psychological - Loss of appetite, weight loss
* Immunological - Disease, illness
176
Describe stages of grief
1) Denial/Isolation
2) Anger
3) Bargaining
4) Depression
5) Acceptance
177
Name the theories of predicting and changing health behaviours?
* Transtheororetical model
* Health belief model
* Theory of planned behaviour
178
What is heterogeneity of studies?
• Similarity of studies
