1.01 Non Medical Sciences

What is illness behaviour?

-how people experience, define and interpret the symptoms of illness/disease/injury and how they interact with various social networks as they try to cope with or accommodate these symptoms

What are Zola's 5 triggers to consultation?

-Interpersonal crisis

-Perceived interference with vocational/ physical activity

-Perceived interference with social/ personal relations

-Sanctioning- pressure from others to consult

-Temporalizing of symptomology- setting a personal deadline for resolving the symptoms

List the social factors which can influence utilisation of medical services (6)

-gender (eg. women are more likely to consult than men), age (eg. children and elderly people are more likely to consult than young adults and middle aged people), social class, ethnic origin, marital status and family size

What is the biomedical model?

-this approach assumes that all disease can be explained in terms of physiological processes, therefore the treatment acts on the disease and not the person. The person as a whole is not considered

What is the biopsychosocial approach? (2)

-this approach takes into account biological, psychological and social factors. It was later expanded to also include factors such as ethnicity and culture

-responsibility for health and illness rests on the individual in the biopsychosocial model

Why is the biopsychosocial approach an improvement on the biomedical approach?

-links psychological and social factors to health explicitly opposed to assuming illness is caused purely by pathogens- holistic

What are some criticisms of the biomedical approach? (2)

-only attributes disease to biological factors e.g. viruses and genes. It is therefore REDUCTIONIST

-The biomedical model considers the patient to be a passive recipient of treatment and a victim of circumstance with no accountability for their disease.

What are some criticisms of the biopsychosocial approach?

-it has over reliance on subjective outcome measures

What are the challenges of acute illness? (3)

-uncertainty of illness/treatment

-unfamiliar people/environments and procedures

-disclosing weakness, anxiety or suffering to others

What do specific concerns of patients often reflect?

-previous experience or the experience of friends/family/what's shown on media

What is outcome anxiety?

-fears of what the results of illness and treatment will be

What is procedural anxiety and what does this normally stem from?

-fears about clinical procedures

-inaccurate beliefs or fears about what is going to happen

What are some of the effects of anxiety and how can this be related to a clinical scenario?

-there are changes to the way in which the patient thinks and processes information eg. increased vigilance for threatening stimuli and threatening interpretations of ambiguous information

-an anxious patient's view of a clinical procedure is very different from the clinician's

Why is being depressed a common reaction to illness? (2)

-illness restricts the opportunity for familiar and rewarding activities

-where complete recovery is not certain, it threatens expectations about future sources of reward and fulfilment

Why do patients often feel angry?

-due to the experience of disempowerment created by illness

How does anger often affect patients? (2)

-patients usually direct their anger to whoever is available - clinicians and lay carers are often in the line of fire

-many patients blame their illness on other people, including clinicians who they feel have failed to look after them-> this impairs the clinician-patient relationship

How does illness impact a person's close relationships? (2)

-people with illnesses may feel guilt about the effects of their illness on their carers

-they may also feel unable to meet the expectations of others, including family and friends

Explain how self-blame can be both detrimental and beneficial

-on the one hand it can lead to feelings of guilt or depression

-it has also been shown than those who felt some responsibility for causing their illness in a study of recovering spinal cord injury patients, were better adjusted

List Mechanic and Volkart's triggers to consultation (4)

-the frequency the illness occurs in given population

-familiarity of the symptoms

-predictability of the outcome of the illness

-amount of threat and loss that is likely to result from the illness

What is a population-based approach?

focuses largely on health promotion activities and actions

What is an individual approach?

focuses on high-risk or affected individuals through direct interventions

Give an example of an individual approach

Weight reduction and preventing/delaying disease

(individual approach) what is meant by a secondary approach?

Secondary approach is to decrease mortality and prevalence of chronic complications in those who have already been diagnosed. Aims to identify high risk patients.

Give examples of population-based approaches (5)

-Governments "strengthen capacity for surveillance"

-Prevent and control disease by training healthcare professionals and analyse policies

-Focus on women of reproductive age (as risks of chronic diseases begins in uterus)

-Screening facilities to identify at risk individuals

-Walkways and bicycle paths near public transport to encourage daily physical activity

What is the WHO definition of epidemiology?

the study of distribution and determinants of health-related status or events (including disease), and the application of the study to the control of diseases and other health problems

In simple terms, what is epidemiology?

'how much' there is of a disease in the population, 'why' and 'what can be done about it'

What are the objectives of epidemiology? (5)

-to identify the aetiology or cause of a disease, its relevant risk factors and transmission

-to reduce mortality and morbidity

-to determine the extent of a disease found in the community- critical for planning

-to evaluate both existing and newly developed preventative and therapeutic measures and models of healthcare delivery

-to provide the foundation for delivering public policy

What is a numerator? + what is it in relation to epidemiology (3)

-the upper part of a fraction

-the feature which has been counted

-no. of people who have developed the disease of interest

What is a denominator? + what is it in relation to epidemiology (3)

-the lower part of a fraction, used to calculate a rate or ratio

-the population from which the numerator was derived

-total no. of people in the population at risk

What are the determinants of disease?

-physical, biological, cultural & social behaviour that influences health/disease

What is the WHO definition of public health?

The art and science of preventing disease, prolonging life and promoting health through organised efforts of society

Give an example of a successful public health intervention (include some background)

-population of GB rapidly increased during the 1800s with cities like London seeing a sharp rise in the no. of people living there. This led to overcrowding, poor quality housing and associated medical issues

-in 1848 the first Public Health Act caused the setting up of a Board of Health and gave towns the right to appoint a Medical Officer of Health

-in 1853 vaccination against smallpox was made compulsory

-in 1854 improvements in health hygiene were introduced

-in 1875 a Public Health Act enforced laws about slum clearance, provision of sewers and clean water, and the removal of nuisances

What are the aims of public health?

Aim to reduce the amount of disease, premature death and discomfort and disability in the population

Describe the premise behind public health

Factors contributing to health problems are identified and plans are drawn up to deal with them - factors contributing to ill health are the determinants of health

What is incidence a measure of?

Disease risk

What is prevalence a measure of?

Disease burden

Define incidence

-the no. of new cases of a disease during a specific time period divided by the number no. of people at risk for that disease at that same period

Define prevalence

-the no. of infected people in the population divided by all the people in the population at specific point in time

How do you get the no. of new cases per 1000 population/no. Of new cases per 100 population

-times by 1000/ times by 100

What is the difference between incidence and prevalence?

-prevalence also takes duration into account

What is the equation for prevalence

-prevalence=incidence x duration

How would prevalence be affected if the no. of people who die/are cured increases?

-prevalence decreases

How would prevalence be affected if the no. of people who die/are cured decreases?

-prevalence increases

How do you calculate incidence?

(Number of new cases during specified period)/(Size of population at risk at the start of period)

Is prevalence a rate?

No!

What is deontology? (3)

-The study of the nature of duty and obligation

-In moral philosophy, deontological ethics or deontology is the normative ethical theory that the morality of an action should be based upon whether that action itself is right or wrong upon a series of rules, rather than based on the consequences of an action

-the deontological approach is patient-centered, opposite to the society-centered utalitarian approach

What is consequential ethics? (2)

-consequential ethics anticipate likely results of an action and decide if its beneficial or harmful

-moral laws not involved

What is utilitarianism?

-looks at the greater good

What are virtue ethics? (3)

-person rather than action based

-looks at the virtue or moral character of the person carrying out an action, rather than at ethical rules + duties or the consequences of particular actions

-virtue ethics teaches that an action is only right if it is an action that a virtuous person would carry out in the sam circumstances

What is the hippocratic oath? (3)

-written by the greek physician Hippocrates

-sworn agreement made by physicians when they become doctors

-not a law-> guiding principle for doctors

Outline the hippocratic oath (5)

-openly share knowledge w/ the physicians that follow them

-treatments will be used for the benefit of the ill and not for harm -> do no harm

-doctors will not administer a deadly drug or tell someone else how to do so/ conduct an abortion -> this part has often been removed or rewritten in modern versions

-doctors will allow specialistis to complete surgeries, being aware of their own limits + will not use their position to complete sexual acts or take advantage of their patients

-doctor-patient confidentiality

Relevance of the hippocratic oath today

-Although some authors have deemed the Oath as out of date for the purposes of modern medicine, new variants of the Oath are used, with some Universities asking student doctors to acknowledge this Oath on entry to and graduation from medical school

List the GMC ethical guidelines available (8)

-good medical practice

-confidentiality

-consent

-raising and acting on concerns

-leadership and management

-protecting young people

-end of life care

-prescribing

Name and outline the first domain of good medical practice (4)

-Knowledge, skills and performance

-develop and maintain your professional performance

-apply knowledge and experience to practice

-record your work clearly, accurately and legibly

Name and outline the second domain of good medical practice (4)

-Safety and quality

-contribute to and comply with systems to protect patients

-responds to risks to safety

-risks posed by your health: if you know you have a serious condition that you could pass onto patients/ if your judgement or performance could be affected by a condition or its treatment, consult a suitably qualified colleague + get immunised against common communicable diseases

Name and outline the third domain of good medical practice (6)

-Communication, partnership and teamwork

-communicate effectively: listen to patients, give information in a way that they can understand, be readily accessible to patients and colleagues seeking info when on duty

-working w/ colleagues: work collaberatively + treat them fairly & respectfully

-teaching, training, supporting and assessing: be prepared to contribute to teaching and training doctors and students, be willing to take on a mentoring role for more junior doctors and other healthcare professionals

-continuity and coordination of care: contribute to the safe transfer of patients between healthcare providers and between health and social care providers

-establish and maintain relationships w/ patients: be polite, considerate + fair, work in partnership w/ patients sharing info they need to make decisions about their care

Name and outline the fourth domain of good medical practice (4)

-Maintaining trust

-show respect for patients

-treat patients and colleagues fairly and w/o discrimination

-act w/ honesty and integrity

What is meant by medical professionalism?

-ensuring the well being of patients and to protect them from harm lies at the heart of medical professionalism

How can doctors maintain their medical professionalism?

-patients expect doctors to be technically competent, open and honest, and to show them respect -> by demonstrating these qualities, doctors can earn the trust that makes their professional status possible

What should modern medical professionalism promote?

-modern medical professionalism should actively promote engagement between doctors, patients, medical institutions and policy-makers

Outline the 4 pillars of medical ethics (4)

-Autonomy: patient has ultimate control over whether they receive treatment or not i.e. medical practioners may not force treatment under normal circumstances; exception: when patients cannot be deemed able to reasonably make decisions for themselves e.g. when detained under the Mental Capacity Act 2005

-Beneficence: idea of having the best outcome for the patient in mind at all times

-non-maleficence: essentially a concise version of the Hippocratic oath: Do No Harm; the risk of an intervention should always be weighed up against the outcome of doing nothing at all

-Justice: identifying whether or not an action is fair in society and within the relams of the law