Aspects of Lifestyle you may cover in a consultation when giving advice to any patient
Diet
Smoking
Alcohol
Exercise
Illicit Drug use
Sexual Health
Factors that allow proper guidance from a GP
Knowledge of past medical history
Awareness of social circumstances
Knowledge of a broad range of illness and health conditions
Trusted health professional
GP has a role in prevention as well as diagnosis/treating illness/ disease
GP accesible to patients as they are usually local
5 types of question which may be used in a consultation and give a brief explanation
of each.
- Direct question-asks about a specific item
- Closed question-can only be answered by
“yes” or “no” - Leading question-presumes the answer (and
is best avoided) - Reflected question-the doctor does not
answer the question but asks the patient to
think about the answer themselves - Open Questions: This type of question is not
seeking any particular answer, but simply signals
to the patient to tell their story or voice their
concerns.
Factors encouraging a change in behaviour
- Advantages outweigh the disadvantages
- Anticipates positive response from others to her behaviour change
- Social pressure
- New behaviour to be consistent with her self image
- Belief that you can carry out the behaviour in a range of circumstances
WHO definition of health
Health is a state of complete
physical (1 mark), mental
(1 mark) and social (1 mark)
well-being and not merely the
absence of disease or infirmity
Factors which influence lay beliefs about health and give an example
Age-older people concentrate on functional ability,
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 functional
(ability to be productive, take care of others), women
of higher social class or educational qualifications
have a more multidimensional view of health
• Gender-men and women appear to think about
health differently (women may find the concept of
health more interesting, women include a social
aspect to health)
• Culture-different perceptions of illness/disease,
differences in concordance with treatment
Actions the government could take to stem the rise on obesity
- Health education-diet and exercise
• Tax on unhealthy foods, “fat tax”
• Legislation-proper labelling, lists of ingredients/food
content
• Enforcement of legislation
• Ban on advertising unhealthy food
• Improve exercise/sport facilities
• Subsidise healthy food
• Transport policy e.g. cycle lanes
• Funding of NHS treatment for obesity e.g. specialist
clinics, bariatric surgery
Define Cultural Competence
Cultural competence is the ongoing capacity of
healthcare systems, organizations and
professionals to provide for diverse patient
populations high quality care that is safe,
patient- and family- centered, evidence-based,
and equitable
Potential complications that may arise when consulting with a patient from a different culture
• Lack of knowledge about NHS/UK health care system
• Lack of knowledge about common health issues/different health beliefs
• Fear and distrust
• Racism
• Bias and ethnocentrism
• Stereotyping
• Language barriers
• Presence of a third party e.g. family member, translator in the room
• Examination taboos
• Gender difference between doctor and patient
• Religious beliefs
• Difficulties using language line
• Patient may not be entitled to NHS care
Routes someone may be exposed to a hazardous substance
• Blood
• Sexual contact
• Inhalation
• Ingestion
Categories of hazards and examples
- Physical - heat, noise, radiation from lab
equipment
• Mechanical - trips and slips
• Biological - spread of infection amongst
colleagues e.g. respiratory, GI
• Psychological/stress - anxiety re job security,
relationships with colleagues, stressful when
busy/deadlines to meet
Pieces of advice you may give when safety netting
- Advise the patient of the expected course of
the illness/recovery
• Advise of symptoms indicating deterioration
• Advise who to contact if patient deteriorates
Ways risk can be minimised according to Nrighbour
Safety netting
Summarise and verbally check that reasons for attendance are clear
Hand over and bring the consultation to a close (hand over to the patient and 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
What is meant by the term gatekeeper?
The person who controls the patients access to specialist or secondary care
What are advantages of GP’s as gatekeepers?
- Identify those patients who are in need of 2° care assessment
• Personal advocacy
• Patient does not necessarily know which specialty to go to
• Increases likelihood of referral to appropriate department
• Increases likelihood of appropriate referral/use of resources
• Limits exposure to certain investigations e.g. MRI scan, X-rays
• GP acts as co-ordinator of care
• Puts GP in position to provide patient education
What percentage of illnesses
occurring in the community are
referred on to secondary care?
1% (accept 1-5%)
Ethical Principles
Justice
Benificence (care is maximised i.e treatment of infection, discussion with colleagues in other departments, involvement of practice team, referral to secondary care for specialist opinion
Non-malificence (i.e culture of sputum and discussion with microbiology to minimise the risk of antibiotic resistance)
Autonomy (- patients right not to take advised
treatment (inhalers) even if fully informed of benefits)
Aspects of health which are likely to be worse for children (of all ages) living in the most deprived areas compared to those living in the least deprived areas.
• Lower birth weight
• Less likely to benefit from breast feeding in infancy
• Poorer dental health
• Higher rates of obesity and/or poor nutrition
• Higher rates of teenage pregnancy
• More likely to take up smoking/alcohol misuse/substance misuse
• Greater risk of admission to hospital
• Greater risk of infant mortality
• Less likely to benefit from health promotion and prevention programme e.g. immunisation
Risks to foetal well-being
• Smoking
• Illicit drugs
• Prescription drugs
• OTC medication, internet sourced remedies, herbal medication
• X-rays
• Diet e.g. poor nutrition, lack of dietary folic acid, soft cheese, pate
• Infectious diseases e.g. TORCH (Toxoplsma, Rubella, Cytomegalovirus, Herpes)
• Maternal disease e.g. diabetes, epilepsy
Define Culture
Culture - a complex whole which includes knowledge, beliefs, art, morals, law, customs etc. (Tyler, 1874) OR systems of shared ideas, systems of concepts rules and meanings that underlie and are expressed in the way that human beings live (Keesing, 1981)
Define ethnocentrism
Evaluation of other cultures according to preconceptions originating in the standards and customs of one’s own culture.
Common reasons for a child (of any age) in the UK seeing their GP and/or Health Visitor.
• Feeding problems (especially new babies)
• URTIs/colds
• Coughs
• Rashes
• Otalgia
• Sore throat
• Vomiting+/-diarrhoea
• Abdominal pain
• Behavioural problems
• Anxiety re milestones/developmental delay
Social influences on health
• Gender
• Ethnicity
• Housing
• Employment
• Financial security
• Health system
• Environment
• Social class
- Education
What are the benefits of adopting a mutual participation style consultation?
• Patients take on a larger portion of responsibility for their own health through sharing of information and decision-making
• Patients feel a greater sense of autonomy since more participation
• Patient compliance is improved
• Patient satisfaction is improved because they have been fully informed – less likely to complain about treatment.
