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Flashcards in Theme C Deck (27):

What are the 6 elements to Patient-Centred Care?

1. Explores the patients’ main reason for the visit concerns and need for information

2. Seek an integrated understanding of the patients’ world – their whole person, emotional needs, and life issues.

3. Finds common ground on what the problem is and mutually agrees on management

4. Enhances prevention and health promotion

5. Enhances the continuing relationship between the patient and the doctor

6. Is realistic


What is the conventional medical model of disease?

Looks at biomedical perspective only (no social, psychological and behavioural factors).

Biomedical explanation for disease - deviations from the norm. Over-simplifies problems of illness. Enables paternalistic medicine.


What is disease?

What is wrong with the body, as identified by signs and symptoms and abnormal tests.


What is illness?

Feelings about being ill (feelings, ideas, function, expectations).


What are the problems that arise from failure to recognise the duality of agendas (disease & illness)?

- Patient dis-satisfaction
- Complaints


How is disease and illness interrelated?

To be patient-centred, must weave between disease and illness to find common ground and mutual understanding with patient.


How might the patient's agenda be explored in consultation?

The Calgary-Cambridge model seeks both disease info by history and examination and illness info by ICEF.


Define epidemiology.

Study of distribution and determinants of health-related states and events in population and the application of this study to the control of health problems.


Define incidence.

Number of new cases in a period/number initially free of disease
Number changes due to new diagnosis and immigration of ill people.


Define prevalence.

Number of people with disease at a particular point in time/ total population
Number changes due to recovery, death, emigration of ill people.


Describe patterns of smoking across time.

Smoking prevalence has decreased over time in males and females.
- highest male -> Bangladesh
- lowest male -> Indian
- highest female -> Irish
- lowest female -> Bangladesh


Describe smoking prevalence between girls vs. boys.

Ages 11-15, higher girls prevalence
Above 18, higher male prevalence
Decreasing prevalence after age 25.


What is descriptive epidemiology?

Tells us how things are distributed.


How does descriptive epidemiology help in medicine?

Knowledge of distribution of smoking in the population guides prevention action.
e.g. Need to help people stop smoking before age 40 as health risks will reduce to that of non-smokers then.


What is symptom iceberg?

Most symptoms are managed in the community without people seeking professional healthcare.
Tip of the iceberg - small amount of people present to healthcare.
Submerged majority - self care.


What are the factors that influence people's decision to seek help from healthcare professionals?

- Interference with work or physical activity.
- Interference with social relations
- Interpersonal crisis
- Putting time limit on symptoms
- Sanctioning by friends and relatives.


What are the barriers to people seeking help?

- Provision and availability of health services.
- Attitudes of staff (receptionists, doctors)
- Social/cultural distance
- Geographical distance
- Time, effort, childcare, loss of earnings
- Car ownership and transport costs
- Bad experiences and waiting times.


What is the old world model of doctor-patient relationship?

Patients don't have easy access to knowledge base of doctors.
Doctor is smartest.


What is the new world model of doctor-patient relationship?

Patients have as much access to the evidence base of medicine as doctors.
Patients are smarter.


What is medical pluralism?

Co-existence with a society of differentially designed and conceived medical traditions and systems (herbalism, acupuncture, homeopathy).


What is the lay-referral system?

Before attending appointments, 70% consult at least 3 lay people e.g. relatives and friends, pharmacists, internet.


How does illness behaviour vary?

With age, ethnicity, religion, sexual orientation and disability.


How does illness behaviour vary with gender?

Men find cold symptoms more difficult to handle than women.


How does illness behaviour vary with ethnicity?

BAME more likely to delay help seeking.


How does illness behaviour vary with socio-economic conditions?

Working class -> symptoms part of everyday life e.g. cough and back pains.
Middle class -> seek help quicker than working class.


Why are symptoms differentially perceived by different people?

Depends on our life experiences.
Socially and culturally learnt response -> multi-faceted.


Outline the complexity of lay ideas on health and illness.

Heart attack:
- Perception and evaluation of symptoms -> similar to indigestion and angina.
- Perceived risk of MI -> no longer feel at risk due to recent changes in lifestyle.
- Previous experience -> symptoms vary than last time.
- Use of NHS -> concerned about wasting NHS time and resources.