1
Q
What are the 4 domains of the Good Medical Practice guide?
A
1) Knowledge, skills and performance
2) Safety and quality
3) Communication, partnership and teamwork
4) Maintaining trust
2
Q
What falls under the “knowledge, skills and performance” domain of the GMP guide?
A
- Make care of the patient your first concern
* Provide a good standard of practice and care
3
Q
What falls under the “safety and quality” domain of the GMP guide?
A
- Take prompt action if you think that patient safety, dignity or comfort is being compromised.
- Protect and promote the health of patients and the public.
4
Q
What falls under the “communication, partnership and teamwork” domain of the GMP guide?
A
- Treat patients as individuals and respect their dignity.
- Work in partnership with patients.
- Work with colleagues in the ways that best serve patients’ interests.
5
Q
What falls under the “maintaining trust” domain of the GMP guide?
A
- Be honest and open and act with integrity.
- Never discriminate unfairly against patients or colleagues.
- Never abuse your patients’ trust in you or the public’s trust in the profession.
6
Q
Give a quick run-through of medical history.
A
- Imhotep - First recorded physician in history (an Egyptian)
- Hippocrates - Laid out duties and roles of doctor (Hippocratic Oath)
- Roman Empire - Romans were the first to set up a public health system
- Middle Ages - Introduction of hospitals and medicals, drawing on Greek and Arab knowledge. Authority began to be rejected and humour theory started to be questioned.
- 16th and 17th centuries - Hierarchy emerged among medical specialists. Anatomy developed (first textbook), first ideas of bacteria, first observation of bacteria, first prosthetics, circulation of blood discovered, first blood transfusion.
- 18th century - Better diagnostics (thermometers, etc.), Better therapeutics (scurvy treated with limes, smallpox vaccine), Large gap between old and new treatments, Veterinary science & dentistry split off
- 19th century - Cell theory, Germ theory, Anaesthesia, Antiseptics
- 20th century - Boost in pharmacology, Imaging, Surgery, Artificial organs, Prosthetics, Computers, Understanding of immune system, Genetics
7
Q
What is cell theory?
A
- The idea that all living things are made up of cells.
- This came about in the 19th century and was used to demonstrate that changes to cells can cause diseases such as cancer.
8
Q
What is germ theory?
A
- This idea replaced miasma theory and stated that microorganisms spread disease by being passed between individuals.
- Until then, most physicians believed that disease-causing germs appeared spontaneously.
- Germ theory was more accepted in the 19th century when John Snow traced cholera back to sewage-contaminated water.
- Specific bacteria were identified as the cause of various diseases.
9
Q
Describe the discovery of anaesthesia?
A
- First used in the 19th century, ether was the first true anaesthetic.
- Due to side effects, it was then replaced with chloroform.
10
Q
Describe the discovery of antiseptics.
A
- In the 19th century, a Hungarian physician first found that infections could be due to poor hand washing.
- Joseph Lister later reduced death from gangrene by dipping bandages in acid before use.
11
Q
Describe the advancements in pharmacology in the 20th century.
A
- Aspirin synthesised at the very end of the 19th century
- In 1909, first antibiotic was used to treat syphilis
- In 1928, Alexander Fleming discovered penicillin, which was effective against multiple diseases. It only became widely available in 1944.
- Vaccines against tetanus, smallpox and polio
- Cortisone, a steroid hormone to reduce inflammation and suppress the immune system response
- Contraceptive pill
- Antipsychotics and antidepressants
- Antiretroviral drugs to combat AIDS
12
Q
Describe the advancements in imaging in the 20th century.
A
- 1895 - X-rays
- 1901 - ECG
- 1949 - CT
- 1975 - PET
- Late 1970s - MRI
13
Q
Describe the advancements in surgery in the 20th century.
A
- Cardiopulmonary bypass made major heart surgery more routine (due to heart-lung machine in mid-20th century)
- Laparoscopic surgery (in the 1970s) due to flexible endoscopes
14
Q
Describe the advancement in prosthetics in the 20th century.
A
• Discovery of plastic and carbon fibre meant that prosthetics could be operated when electronically attached to muscles
15
Q
What have computers helped to achieve in the 20th century?
A
- Scanning technology
- Running machines in surgical theatres and intensive care units
- Handling of data on a large scale
- Mapping the human genome
16
Q
Describe the advancements in immunology in the 20th century.
A
- Immunisation was brought to the West from Ancient China by Edward Jenner, but no-one understood how it worked until the 20th century
- Phagocytosis and antibodies were both discovered
- Autoimmune diseases were discovered and so were immunosuppressants
- Identification of HIV prompted treatments to be developed, although an AIDS vaccine is yet to be found, since the HIV virus mutates so frequently
17
Q
Describe the advancements in genetics in the 20th century.
A
- DNA was first isolated in 1869 by Friedrich Miescher
- Structure of DNA decoded by Watson and Crick in 1953
- Knowledge of DNA structure made it possible to determine the location of each gene
- By the early 21st century, scientists mapped the entire human genome
- This allowed for testing of genetic diseases and the creation of drugs derived from human body chemicals (such as insulin)
- Gene therapy is an avenue of research that would allow abnormal genes to be replaced by normal ones by means of a virus
18
Q
What year was the NHS founded?
A
1948
19
Q
What are the 3 principles on which the NHS was founded?
A
1) That it met the needs of everyone
2) That it be free at the point of delivery
3) That is be based on clinical need and not ability to pay
20
Q
Who founded the NHS?
A
Aneurin Bevan - Labour PM
21
Q
What is the GP gateway model?
A
The model used in the NHS by which the access to a specialist is through a GP.
22
Q
What is primary care?
A
- The first point of contact in healthcare
* i.e. GP
23
Q
Are GPs employed by the NHS?
A
No, they are essentially businesses that are contracted
24
Q
What is secondary care?
A
- Care provided by specialists and other health professionals who you are usually referred to by a GP
- i.e. Specialist care in hospitals
25
What is tertiary care?
* Super-specialised care provided by health professionals who you are usually referred to by a secondary specialist
* i.e. Complex specialist care in hospitals
26
What is quaternary care?
Care that is so specialised that only a few people with very rare problems will ever need it. It is very uncommon.
27
Explain commissioning.
* Commissioning is the awarding of contracts to provide services for the NHS.
* The providers may be individual hospitals or external providers (e.g. charities or private companies)
* Clinical Commissioning Groups (CCGs) decide which provider is allowed to provide which service (e.g. only hospitals Y and Z can provide hip replacements, but not hospital X)
28
What are CCGs?
Clinical Commissioning Groups - The groups made of GPs and managers that control commissioning of services.
29
What are CCGs made of?
Mostly local GPs and managers.
30
Who commissions GP services and specialist services? Why?
NHS England - GPs cannot commission themselves and they do not have sufficient understanding of specialist services.
31
Explain block contracts and payment by result.
* Block contracts - Where hospitals were paid a fixed amount of money every year to cover the cost of healthcare. If the hospital spent more or less than that amount, they would receive more or have to pay back money to the government. The problem with this was that there was no incentive for saving money.
* Payment by result - Each procedure is given a fixed tariff based on an average cost across the country. Each hospital is given money per procedure. If the procedure costs more than this in a hospital, they are motivated to work more efficiently and survive.
32
What is the problem with payment by result and how was this solved?
• It encouraged efficient work, but not necessarily quality
SOLUTIONS:
• Giving patients a choice of where to have treatment
• Imposing targets on care (e.g. waiting times)
• Penalties for poor quality of care
• Incentives for good care
• Increasing competition between healthcare providers
33
Give some examples of incentives for good quality of care in the NHS.
* CQUIN - Commissioning for Quality and Innovation, which rewards departments that enhance quality of care.
* QOF - Quality of Outcomes Framework, which are used in GP practices.
34
What are the different types of private healthcare providers?
1) Private practice doctors ("private healthcare") - These are doctors working in private hospitals or for themselves, who provide care for private patients who want to bypass NHS waiting lists.
2) External providers contracted to do NHS work - CCG-selected companies, charities or organisations who are commissioned to provide services for NHS patients. i.e. NHS care provided by non-NHS providers
35
What type of private healthcare has led to fears of privatisation of the NHS?
External providers being commissioned to provide NHS services
36
What are some arguments for and against privatisation of the NHS?
FOR
• Takes strain off of the NHS
AGAINST
• Private companies may favour profit over quality -> However, the NHS being run on a non-profit basis hasn't always provided excellent care either
• Private companies may cherry-pick the easiest cases that are most profitable, leaving the NHS with complex, loss-making cases -> However, this may not be a bad thing since the NHS' expertise is needed to safely deal with tricky cases + tariffs can be adjusted to deal with the costs
• Fragmentation of care -> Patients have to travel to multiple places and there is no central patient records
• Training of doctors will be more difficult if the easier cases are all privatised
• Conflicting interests of doctors -> May own some private businesses which compete with the NHS services
37
Name some important medical bodies.
* GMC
* The Royal Colleges
* BMA
* MDU/MPS
* NICE
* CQC
* Monitor
38
What does GMC stand for?
General Medical Council
39
What does BMA stand for?
British Medical Association
40
What does MDU/MPS stand for?
MDU - Medical Defence Union
| MPS - Medical Protection Society
41
What does NICE stand for?
National Institute for Health and Care Excellence
42
What does CQC stand for?
Care Quality Commission
43
What are the four roles of the GMC?
* Keeping a register of all qualified doctors
* Fostering good medical practice (by issuing guidance)
* Promoting high standards of education and training
* Dealing with doctors who are not fit to practice
44
What are Royal Colleges?
* Institutions charged with setting standards within their field for supervising the training of doctors within that specialty.
* Most require passing some exams to get in. Membership is compulsory if you want to work in that field.
45
What is the BMA?
* British Medical Association
* Essentially the trade union representing doctors
* Membership is not compulsory
46
What are the MDU and MPS?
* Medical Defence Union and Medical Protection Society
* Two largest defence unions for doctors
* Represent doctors in court or in GMC hearings, and provide educational activities
47
What is NICE?
* National Institute for Health and Care Excellence
| * Independent organisation providing guidance on health promotion and the prevention and treatment of illness
48
What does NICE give guidance on?
* Health technologies -> Focus on value for money
* Intervention procedures -> Assessing safety of various procedures
* Clinical practice
* Public health
49
What part of NICE deals with public health?
Centre for Public Health Excellence
50
What is the CQC?
* Care Quality Commission
| * Independent regulator of all health and social services in the UK, ensuring they meet national standards
51
What is Monitor?
Regulator looking after finances of NHS trusts, assessing trusts to ensure they are well led.
52
What is the Harold Shipman case and what were the results of it?
• Harold Shipman was a GP who murdered a suspected 215+ patients in the 1990s by giving them opiates (e.g. morphine) and then forged some of their wills to get money. This was despite an earlier drug conviction.
RESULTS:
• Move away from single-handed GP practices
• Tighter regulation on use of controlled drugs
• Tighter regulation of death certification
• Review of revalidation process, which ensures that doctors have the right skills to practice, by the GMC
53
Describe the case of the MMR vaccine scandal and the 2013 measles epidemic.
MMR VACCINE SCANDAL:
• In 1998, a surgeon called Andrew Wakefield published a research paper showing a link between the MMR vaccine and autism and bowel disease.
• He called for the suspension of the triple vaccine and suggested single jabs instead.
• However, his work was soon discredited.
MEASLES EPIDEMIC:
• The scandal and slanted reporting from the media caused a drop in infant vaccination.
• In 2013, over 1200 people became infected with measles, which led to a vaccination campaign.
54
Why was the 1998 MMR vaccine report promptly dismissed?
* No other researchers could confirm the results
* A Sunday Times reporter had evidence that Andrew Wakefield had applied for a patent on a single-jab measles vaccine before his campaign
* One of Wakefield's former students testified that he ignored lab data that conflicted with his hypothesis
* The research was based off of only 12 cases
* Some children were reported to show symptoms a long time after the vaccine, while the report stated the effect was immediate
55
Describe how the NHS changed in structure over time.
* At first, it was divided into a tripartite system: Primary care, Hospital services, Community services
* There were calls to unity these and in 1962 a 10-year plan was drawn up to build a new general district hospital for each area of at least 125,000
* In the 1980s, the Black Report showed higher infant mortality and shorter life expectancy in the poor. Also, there was an increasing cost of treatments.
* To resolve this, Thatcher's government introduced an internal market into the NHS.
* In 1990, regional health authorities were given budgets for treatment, which encouraged competition between hospitals.
* In 2003, payment by result was introduced.
* In 2012, there was a huge structural change in the NHS, making it what it is today.
56
Describe the structure of NHS England.
* Department of Health - Government department responsible for funding and deciding policies on the NHS.
* NHS England - Independent umbrella body that oversees healthcare in general. The Department of Health cannot interfere with it.
* CCGs - In charge of commissioning healthcare in the local area.
* NHS Foundation Trusts - Provide care that CCGs commission. They include hospital, ambulance, mental health, social care and primary care services.
57
What is the Department of Health?
Government department responsible for funding and deciding policies on the NHS.
58
What is NHS England?
Independent umbrella body that oversees healthcare in general. The Department of Health cannot interfere with it.
59
What are NHS Foundation Trusts?
Provide care that CCGs commission. They include hospital, ambulance, mental health, social care and primary care services.
60
What is devolution and what are the pros and cons?
The splitting of NHS powers and funds into separate countries, which can each decide how to spend their money. This can sometimes be further devolved into regional services.
PROS:
• Money spent in a way that suits the area better
CONS:
• Complicating an already complex system
61
What are some challenges facing the NHS right now?
* Ageing population
* Growing population
* Evolving healthcare needs -> Obesity and antibiotic resistance
* Progress in medical technology costs the NHS at least an extra £10bn a year
* Closure of local services due to centralisation pushes
* Increased reliance on privatised services
62
What are some benefits of working with the NHS?
* Flexible working hours
* A final salary pension scheme
* A graduate training scheme to get into healthcare management
* Flexible career paths within the system
63
What are some disadvantages of working with the NHS?
* Occasional long or unsociable hours
* A high level of accountability
* Flexibility – it is sometimes necessary to move around to take up jobs in different areas of the country
64
What are 3 areas that you can take your career down in the NHS?
* Teaching and training
* Management
* Research
65
Describe the structure of medical training.
```
• Medical school (4-7 years)
• Foundation years (2 years)
Then either:
• GP training (3 years)
OR
• Core medical/surgical training (2/3 years) then specialist training (4-9 years)
OR
• Run-through specialist training (core training and specialist training are essentially merged)
```
• After completing specialist training, you *may* become a consultant
66
```
What is the abbreviation for these:
• Foundation years
• Core medical training
• Core surgical training
• Specialist training
```
* FY (e.g. FY1, FY2)
* CMT (e.g. CT1, CT2, CT3)
* CST (e.g. CT1, CT2, CT3)
* ST (e.g. ST3, ST4, etc.)
67
What are foundation years?
* 2 years after medical school
| * Designed to help young doctors get a sound basis for future training
68
What is core training?
* 2 or 3 years after foundation years
* For medical specialties: Core Medical Training (CMT)
* For surgical specialties: Core Surgical Training (CST)
* Some specialties have their own core training (e.g. psychiatry)
* These all give a doctor a good basis of interest in their chosen area before applying for specialist training
69
What is specialist training?
* 4 to 9 years after core training
| * Necessary to fully qualify as a specialist or surgeon
70
What are run-through specialties?
Specialties that do not require a core training period before taking on trainees at specialist level. Instead, they merge Core Training and Specialist Training into one large period. Once you are in, you are in.
71
Give some examples of run-through specialties.
* Paediatrics
* Obstetrics & gynaecology
* Ophthalmology
* Radiology
72
What is the shortest possible time to become a consultant?
* 7 years
* The shortest training programmes after 2 FYs include Public Heath, Clinical Radiology, Clinical Pathology and Microbiology/Virology, which last 5 years and have no CT.
73
Describe GP training.
* 2 foundation years
* 3 years of GP training - 2 years in hospital, 1 year in GP
NOTE: There are talks of increasing GP training to 4 years.
74
How many doctors become GPs?
About 50%
75
What is revalidation?
The mechanism used to ensure the continuing competence of health practitioners, making sure they are fit to practise.
76
Describe how revalidation came about.
The Shipman scandal led to the GMC being accused of not looking out for patients. In the Shipman case, it was accused of failing to audit Shipman on:
• Cremation forms (a second signature applied basically without checks)
• High mortality among patients
• Large prescription of diamorphine
Overall, Shipman was well-liked by colleagues and would have easily passed appraisals, if these were to be introduced. A different revalidation had to be thought of, which eventually came into effect in 2012.
77
When did revalidation start?
2012
78
What does revalidation consist of?
Regular appraisals with the employer, based on GMP.
• Licensed doctors need to link to a Responsible Officer
• Licensed doctors need to maintain a portfolio of supporting information from their work, showing they meet the right values and principles
• Licensed doctors are expected to take part in an annual process of appraisal
• Responsible Officer will make recommendations every 5 years about a doctor's fitness to practise
79
What does a doctor's revalidation portfolio need to include?
1. General information - Health, scope of work, etc.
2. Continuous Professional Development (CPD) report - Record of courses and conferences attended, journals read, etc.
3. Review of own practice - Review of clinical outcomes, etc.
4. Feedback on practise - From colleagues and patients
80
What are the pros and cons of revalidation?
PROS
• Formalises practices that may have been done on an ad hoc basis before
• Ensures compliance with basic requirements and provides focus to appraisal process
CONS
• Will not stop another Shipman
• Senior clinicians may see it as the main focus and therefore ignore proper management at other parts of the year
• May be too late to help in some cases
81
What is clinical governance?
A set of principles and behaviours that all doctors should adhere to in order to ensure that they offer their patients the best quality of care.
82
What are some fundamental principles of clinical governance?
1. Doctors should ensure their practice is up to date with the latest evidence.
2. Doctors should provide safe care to patients and ensure they do not place patients at risk.
3. Doctors should recognise when they have reached their limitations.
4. Doctors should constantly develop their skills and train others.
5. Doctors should be attentive to patient needs and take into account feedback.
83
What are audits?
* Systematic examinations of current practice to assess how well an institution or practitioner is performing against set standards.
* Used to reflect, review and improve practice.
84
What is the audit process sometimes referred to as and why?
The audit cycle, because it is a continuous loop.
85
How does an audit work?
1. Choose topic for audit (e.g. a practice to be investigated)
2. Define a standard to be achieved
3. Collect data
4. Identify necessary changes to achieve standard
5. Implement changes and give time
6. Re-audit to measure impact of change
86
Define blame culture.
* A mentality in which we are more keen to place the blame on an individual or a mistake, and focus on punishing them rather than learning from our mistakes.
* It means that doctors are more willing to hide their mistakes and not speak out.
87
Describe the Mid-Staffordshire NHS Foundation Trust scandal. (Francis Report)
• Between 2009 and 2013, a series of inquiries were done into Stafford Hospital, where patients and relatives were unhappy with the standard of care.
• There were poor care standards, little attempt to act on problems and a very high mortality rate.
• There was also poor management and a blame culture.
As a result, a report made several recommendations:
• More focus on compassion and caring
• Patient safety should be the no. 1 priority
• Quality accounts should be made public
• Increased patient involvement
88
What is informed consent?
When the patient has consented to a procedure or treatment, having been given and having considered all the facts that were necessary for making a decision.
89
Does a doctor always have to obtain informed consent?
No, with very small tasks it can be taken as implied. For example, with taking blood pressure, if the patient rolls up their sleeve, it is taken to mean that the patient consents to the procedure.
90
When does implied consent apply?
With small procedures, like taking blood pressure.
91
What are some of the things a doctor must explain before a patient can give informed consent?
• Options for treatment (and the possibility of no treatment)
• Aim of the procedure
• Details of the procedure, its benefits, chances of success and risks
• Details of any secondary interventions (e.g. blood transfusions)
• Details of who will perform the procedure
• A reminder that the patient can change their mind at any time or seek a second opinion
• Any costs
ASIDE FROM THIS:
• Patient should be given any leaflets about their procedure
• Patient should be given time to reflect and come to a decision
92
What are the limitations of informed consent?
The patient must be competent.
93
What does competent mean?
When a patient understands the information given to them and is capable of making a rational decision by themselves.
94
What is the difference between competence and mental capacity?
Competence is a legal term, while mental capacity is a medial term.
95
If a patient is not competent, can someone else give consent for them?
No, it is essentially in the doctor's hands. The family, etc. can help decide what the patient would have wanted, however.
96
What are the two options if a patient is not competent and a decision needs to be made?
1. If the patient has given an advanced directive (also called "living will") at an earlier date wishing how they would like to be treated, this should be followed where possible.
2. If the patient has not issued instructions, the decision rests with the doctors to act in the best interest of the patient. However, family members may be involved to help determine what the patient would've wanted.
97
What is the age limit for Gillick competence?
16
98
If a child is deemed to be competent by Gillick competence, and they refuse to involve their parents, what must the doctor do?
They must respect the child's decision, or it would be breaking confidentiality.
Exceptions:
• The child is not competent (parental involvement is then mandatory)
• The child is in danger (in which case you involve social services or police)
99
Is Gillick competence the same for every procedure?
No, the competence is assessed relative to each procedure. For example, a 5 year old can consent to an antiseptic on a small cut, but cannot consent to an important operation.
100
Can a child under 16 refuse consent for a treatment that is deemed in their best interest?
No, in England and Wales, the decision would need to be made by the parents.
101
What happens if a child refuses consent for a life-saving procedure, and both parents refuse on their behalf also?
* The doctor should act in the best interest of the child.
* If possible, they should get a court order to impose treatment. If time is of the essence, they may need to impose the treatment and then justify it in court later.
102
What is duty of confidentiality?
The need for a doctor to protect a patient's information at all costs, except in some extenuating circumstances.
103
When can confidentiality be breached?
1. Implied consent has been given by the patient (e.g. to tell other team members, unless otherwise specified)
2. Information required by court/judge
3. In the public interest and to protect the patient or others
104
Describe some situations where you can breach confidentiality for public interest and to protect the patient or others.
* When the interest to society or others of disclosing the information outweighs the benefit to the patient of keeping the information confidential
* Notifying authorities of *notifiable* diseases (e.g. mumps)
* Suspected cases of child abuse or neglect
* Informing the DVLA if a patient's condition may affect their driving
* When the information can help fight against terrorism or in identifying a driver who committed a road traffic offence
105
What are notifiable diseases?
Diseases that doctors have a duty to report to authorities (even against patient confidentiality). NOTE: This does not include HIV and AIDS.
106
What is euthanasia?
When someone ends someone else's life through an intentional act in order to alleviate their pain and suffering.
107
What are the two types of euthanasia?
* Active - Ending someone's life by a practical action, such as poisoning them
* Passive - When the lack of action results in the death of the patient, such as withholding treatment
108
What are the different types of euthanasia in terms of voluntariness?
* Voluntary euthanasia - Where the person has given their consent
* Non-voluntary euthanasia - Where the person is not in a position to give consent (e.g. in a vegetative state)
* Involuntary euthanasia - Where the person would've been in a position to give consent, but was either not asked or refused
109
What is assisted suicide?
When a person commits suicide with the help of another (e.g. a doctor prescribing medication to induce death).
110
Can a doctor recommend for a patient to go a country that allows euthanasia in order to die there?
No - this would be very much against non-maleficence.
111
What are some arguments in favour of euthanasia and assisted suicide?
1. Patients should be allowed to choose what's best for them.
2. Patients can avoid suffering
3. Patients can die with dignity when they want
4. It frees up beds and other NHS resources
112
What are some arguments against euthanasia and assisted suicide?
1. It goes against some religious ideas e.g. playing at God
2. Someone who expresses a willingness to receive euthanasia while they can may change their mind at a time when they can no longer express their ideas
3. There have been cases of recovery from a position that was considered hopeless
4. It would be difficult to verbalise criteria for allowing or not allowing euthanasia
5. If the case is not clear, the family may face murder charges
6. Relatives may abuse the situation by allowing convenient euthanasia to suit their own needs
7. Relatives may pressure a patient into a situation they do not actually wish
113
Is euthanasia and assisted suicide legal?
Not in the UK.
114
Is it legal for a person to arrange travel for another person to go to a country like Switzerland and have euthanasia there?
Sort of. It can be seen as the person facilitating that person's death, which makes it assisted suicide. However, if it can be proved that the person wanted to die and it was of free will, then it is usually not illegal.
115
What happens when a patient is in a position that is unlikely to resolve, they cannot give consent, and there is the possibility of withdrawing treatment?
If no Advanced Directive has been issued, the decision lies with the doctor. It is good practice to consult with the family, however.
116
What are the most common causes of death worldwide?
1. Ischaemic heart disease (Coronary heart disease)
2. Stroke
3. Chronic obstructive pulmonary diseases
4. Lower respiratory infections
5. Alzheimer's and other types of dementia
6. Trachea, bronchus, lung cancers
7. Diabetes mellitus
8. Road injury
9. Diarrhoeal diseases
10. Tuberculosis
117
Describe how the causes of death vary between low income and high income countries.
* Higher proportion of deaths in high income countries are due to non-communicable diseases
* Higher proportion of deaths in low income countries are due to communicable, nutritional and maternal diseases
* Lower respiratory infections are common to both types of country
118
What are the 7 principles included in the GMC code of conduct?
1. Selflessness
2. Integrity
3. Objectivity
4. Accountability
5. Openness
6. Honesty
7. Leadership
119
Who is the Health Secretary?
Matt Hancock
120
What are the 6 summary points of the 2011 NHS constitution?
* Working together for patients
* Compassion
* Improving lives
* Everyone counts
* Respect and dignity
* Commitment to quality of care
121
What is bed blocking?
When a patient cannot be discharged for a long time from hospital, so they take up a bed for another potential patient.
122
What is social care?
Care provided by the local authority that helps with everyday living in a community.
123
What is residential care?
Sheltered accommodation for residents who may not be able to live independently.
124
What is a detainee?
A person held in custody, often for political reasons.
125
What is the difference between a migrant, refugee and asylum seeker?
* Migrant – A person that lives and works outside their country of origin.
* Refugee – A person who has been forced to leave their country to escape war, persecution, or natural disaster.
* Asylum seeker – A person claiming to be a refugee whose claim has not yet been validated. They have fled their country of origin as they have a well-founded fear of persecution because of their race, religion, nationality, political belief or membership of a particular social group.
Medicine Interview
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