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86 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Define - Empathy? |
The ability to share someone else’s feelings/experiences by imagining what it would be like to be in that person’s situation (in someone’s shoes) |
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Define - sympathy? |
Feelings of pity or sorrow for someone else’s misfortune |
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What do doctors do other than treating patients? (Examples) |
• Teaching • Research • Keep up to date -> medical journals • Manage and support colleagues • Set a healthy lifestyle example • Discuss complex cases -> meetings • Attend events -> speak • Audit -> check quality and look for improvements |
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When was the NHS founded? |
1948 |
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What 3 principles was the NHS founded on? |
• meets the needs of everyone • free at the point of delivery • based on clinical need (not ability to pay) |
These still hold true mostly. Except, some services now incur charges e.g. paying for prescriptions England and Northern Ireland (Wales Scotland free for everyone), dental services and optical services |
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What model does the NHS use? How does this model work? |
• hierarchy means • patients have to go first to a GP, before being granted access to a specialist service Exceptions - A&E, Genito-Urinary medicine |
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Name the different stages of care that might be involved in a referral pathway? |
• primary care • secondary care • tertiary care • quaternary care |
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What is primary care? |
first point of contact in NHS, e.g. GP (general practice) • easily accessible route to healthcare |
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What is the role of a primary care practitioner? |
• generalists - deal with a wide range of physical, psychological and social problems • act as patients advocate • coordinating the care of people who have multiple health problems • management of long-term illnesses- diabetes/heartdisease • provide treatment for common illnesses • prevention of future ill health through advice, immunisation, screening programmes • when necessary, refer patients to specialists |
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Why is the relationship between patient and primary care practitioner particularly important? |
Often care for patients over extended periods of time. |
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What is secondary care? |
Care provided by medical specialists and other health professionals • usually not first contact with patients • usually need to be referred by a GP • generally provided in hospitals (except psychiatry) |
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What is tertiary care? |
• super-specialised care inc. complex medical and surgical interventions • need to be referred by a secondary care health professional • e.g. cancer management, neurosurgery, cardiac surgery, palliative care |
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What is Quaternary care? |
•extremely-specialised care for very rare problems • e.g. experimental medicine, uncommon surgical procedures • there are very few of quaternary care services |
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What is the purpose of the hierarchy model of the NHS? |
• time of specialists isn’t wasted on simple cases that can be dealt with at a lower level • people who really need specialised care get it |
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What does commissioning mean in terms of the NHS? |
Awarding contracts e.g. the CCG for Yorkshire has commissioned hip surgery to Airedale |
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What do Clinical Commissioning Groups (CCGs) do? |
Make the decisions as to which healthcare provider (hospitals,GP practices, other) is allowed to provide which services • every area has one e.g. Craven CCG |
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What kind of people are involved in CCGs? |
• local GPs • Healthcare Managers • a few hospital representatives
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Can private companies offer NHS services? |
Yes, as of 2013 legislation. A local CCG can decide to award an NHS contract to a private hospital - provided there’s a good reason e.g. better quality of care |
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What services can’t CCGs commission? |
• GP services(CCG is mostly GPs) • specialist services - heart and lung transplant surgery (don’t have the knowledge to understand the nature of these services) (they’re provided on a regional or national basis) |
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How did the NHS used to finance services? |
‘Block contract’ - pre 2005 • Hospitals paid a fixed amount of money every year to cover cost of healthcare • if a hospital needed more money, the government paid more to that hospital • if a hospital spent less money (showed a profit) it would have to pay it back to the government Notice how there was no incentive to save money or work efficiently
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How does the NHS finance services now? |
‘Payment by results’ post 2005 • a tariff is set nationally for each clinic and each procedure • hospitals don’t receive a fixed amount, they’re paid for each activity they undertake • the tariff is set at roughly the average cost across all trusts for a procedure (so some hospitals make a loss, some make a profit) This encouraged people to work more efficiently. However it doesn’t encourage hospitals to improve quality of care. |
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Post 2005, how does the government ensure that hospitals are encouraged to improve quality of care, not just efficiency? |
• give patients the choice of where they want their care to be provided (list of hospitals) • imposing targets (max 4 hour A&E wait) • penalising hospitals for poor quality care - won’t pay hospitals if a patient has to be readmitted following a complication of surgery |
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Post 2005, how does the government ensure that hospitals are encouraged to improve quality of care, not just efficiency? |
• give patients the choice of where they want their care to be provided (list of hospitals) • imposing targets (max 4 hour A&E wait) • penalising hospitals for poor quality care - won’t pay hospitals if a patient has to be readmitted following a complication of surgery • introduce incentives - bonus schemes e.g. CQUIN for hospitals, rewards departments that enhance the quality of care • hospitals that provide best practice care can benefit from higher tariffs in some specialities • increasing competition between healthcare providers |
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What 2 roles does the private sector fulfil in the provision of healthcare |
• private healthcare - private hospitals, private practice doctors. Patients pay or use health insurance. • External providers contracted to do NHS work - private companies/charities provide healthcare to NHS patients at NHS tariffs. e.g. Virgin Care. No direct cost to the patient. (What people mean when they say NHS privatisation) |
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Arguments against external providers doing NHS work (privatisation of the NHS)? |
• favour making profit over providing quality care? • cherry-pick easy (most profitable) cases - leaves NHS with the more complex, loss-making cases • fragmentation of care - healthcare provided in many more venues (not just GP and hospital): patients have to travel more, issues with patient records (due to no central database) • training issues - simple cases used for medical training handled by external providers, who may be reluctant to train doctors if leads to loss of profit • risk conflict of interest amongst doctors - e.g. if GPs or consultants own external providers that compete with the hospital trust in which they work |
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Arguments for external providers doing NHS work (Privatisation of the NHS)? |
• run for Profit doesn’t necessarily mean favour profit over quality of care - NHS runs not-for-profit and hasn’t always provided the best quality care it could (Mid-Staffordshire trust) • ‘cherry-picking’ simple high-volume cases takes pressure off NHS hospitals so that they can handle the more complex cases that they have been trained to handle well • NHS trusts may be currently losing money on more complex cases, this will be resolved as tariffs are calculated better, allowing hospitals to cover their costs with these procedures as well as simple cases • commissioning services in an open and transparent manner should avoid conflict of interest amongst doctors |
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What is the NHS called in Northern Ireland? |
Health and Social care (HSC) |
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What is different about HSC to the NHS? |
HSC also provides social care services e.g. home care services, children’s services, social work services |
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Describe the management structure of HSC (Northern Ireland)? |
• the department of Health, Social services and public safety (has overall authority) • Health and Social Care Board (commissions services) • Five HSC trusts (provide services) |
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Name the 5 HSC trusts? |
• Belfast (largest) • South Eastern • Southern • Northern • Western |
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What does the Health and Social Care Board do? (Northern Ireland) |
• commissions services • has Local commissioning groups (LCGs) inside the board from each of the same geographical areas of the 5 trusts - which focus on planning and managing resources • performance improvement |
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What does the Health and Social Care Board do? (Northern Ireland) |
• commissions services • has Local commissioning groups (LCGs) inside the board from each of the geographical areas of the 5 trusts - which focus on planning and managing resources • performance improvement |
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(Northern Ireland) The budget for the Department of Health, Social Services and Public Safety is £..... |
£4 billion • 40% of Northern Ireland’s annual budget |
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What are the 4 roles of the GMC? |
• Keep register of qualified doctors • Fosters good medical practice - issues guidance on standards doctors need to adhere to • Promotes high standards of medical education and training • Dealing with doctors who may not be fit to practise |
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What is the role of the royal colleges? |
• set standards within their field • supervise the training of doctors within a specific speciality • doctors become members by passing exams |
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Who is the current Secretary of State for health and social care (health minister)? |
The Rt Hon Matt Hancock MP |
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What is the role of the BMA (British Medical Association)? |
The trade union and professional body for doctors in the UK. •protect and promote doctors common interests • negotiate pay and working conditions with employers • offers legal support e.g. defend in court cases |
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What is the role of the Medical Defence Union (MDU) and the Medical Protection Society (MPS)? |
A defence union for doctors • represent doctors in court or in a GMC hearing • insure doctors against lawsuits • provide educational activities for members (e.g. complaints management and other non-clinical skills) |
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What does NICE stand for? |
National Institute for Health and Care Excellence |
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What is the role of NICE? |
Independent organisation providing guidance on health promotion and the prevention and treatment of ill health. • Recommends which new or existing health technologies (medicines, devices, techniques) should be used in the NHS. On basis of effectiveness and cost, ‘value for money’. • Assesses the safety and provides information on a range of procedures • recommends which treatments are appropriate for people with specific diseases or conditions • produces guidelines that are designed to improve the quality of care of patients with specific conditions or diseases. These guides do not replace the clinicians judgement, ‘should be followed unless there is good reason not to do so’ • publish guidelines on different areas of public health (e.g. sexual health, drug misuse). Provides info about the amount and level of info that should be given to the public. Also recommends strategies to address key issues |
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What is the role of NICE? |
Independent organisation providing guidance on health promotion and the prevention and treatment of ill health. • Recommends which new or existing health technologies (medicines, devices, techniques) should be used in the NHS. On basis of effectiveness and cost, ‘value for money’. • Assesses the safety and provides information on a range of procedures • recommends which treatments are appropriate for people with specific diseases or conditions • produces guidelines that are designed to improve the quality of care of patients with specific conditions or diseases. These guides do not replace the clinicians judgement, ‘should be followed unless there is good reason not to do so’ • publish guidelines on different areas of public health (e.g. sexual health, drug misuse). Provides info about the amount and level of info that should be given to the public. Also recommends strategies to address key issues |
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What is the role of the Care Quality Commission (CQC)? |
Independent regulator of all health and social care services in England • inspects hospitals, care homes, GP surgeries, dental practices + other care services, to ensure they meet national standards of quality and safety |
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What is the role of ’Monitor’ ? |
A regulator looking after the finances of NHS trusts • regularly assesses trusts to ensure they’re well led (in terms of quality and finances) |
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Consequences of the Harold Shipman case? |
• a move away from single-handed GP practices • Tighter regulations on the use of controlled drugs • Tighter regulation of death certification - plans to report all deaths to a coroner • Review of the revalidation process (ensures doctors have the necessary skills to practice) - GMC criticised for acting too much in the interest of doctors and not enough in patients interest |
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Consequences of the Harold Shipman case? |
• a move away from single-handed GP practices • Tighter regulations on the use of controlled drugs • Tighter regulation of death certification - plans to report all deaths to a coroner • Review of the revalidation process (ensures doctors have the necessary skills to practice) - GMC criticised for acting too much in the interest of doctors and not enough in patients interest. Although this won’t prevent a murderer from operating, it might make it easier to stop one at an early stage. |
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Who is Andrew Wakefield? |
A surgeon who in 1998, published a research paper showing that there was a link between the administration of the MMR vaccine and the development of autism and bowel disease |
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Who is Andrew Wakefield? |
A surgeon who in 1998, published a research paper showing that there was a link between the administration of the MMR vaccine and the development of autism and bowel disease |
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Who is Andrew Wakefield? |
A surgeon who in 1998, published a research paper showing that there was a link between the administration of the MMR vaccine and the development of autism and bowel disease • He wanted MMR vaccine to be suspended until further research was done, and suggested parents opt for single jabs separated by gaps of one year |
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What issues arose that discredited the research carried out by Andrew Wakefield? |
• No other researchers could confirm his results😈 • evidence surfaced that showed Mr Wakefield applied for a patent on a single-jab measles vaccine before his paper - questionable motives! • Wakefield’s former student testified that Wakefield ignored data that conflicted with his hypothesis •Research based on 12 cases (5 had documented previous developmental concerns) • Some children reported to face experienced first behavioural symptoms within days of MMR, but records documented these had started some months after |
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What did the GMC conclude about Andrew Wakefield? |
• he was paid to conduct to conduct the study by solicitors representing patients who believed their children had been harmed by MMR • Investigated the children without the necessary paediatric qualifications and not in their clinical interest • acted dishonestly in failing to disclose how the patients were recruited for the study • conducted the study even though it wasn’t approved by the hospital’s ethics committee |
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What did the GMC conclude about Andrew Wakefield? |
• he was paid to conduct to conduct the study by solicitors representing patients who believed their children had been harmed by MMR • Investigated the children without the necessary paediatric qualifications and not in their clinical interest • acted dishonestly in failing to disclose how the patients were recruited for the study • conducted the study even though it wasn’t approved by the hospital’s ethics committee |
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What caused the measles epidemic from around 2008-2013? |
• Andrew Wakefield’s paper • a reporting failure by most media (wasn’t reporting some of the more robust studies in 2000) Caused a mass panic in parents, many opting for single-jabs or no vaccine at all. Immunisation rates dropped dramatically. Loads of people getting measles in UK and USA. |
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Give the steps of the post-medical-school training system? |
• step 1 - Foundation years (FY1 and FY2). Helps young doctors acquire a sound basis for their future training. (2yrs) • step 2 - Core Training (CT). Give trainees a good basis in their area of interest. Undertake either 2yrs Core Medical training OR 2yrs Core Surgical Training. (CT1 and CT2) • step 3 - specialist training (ST). Doctors apply through a competitive process. Ranges from 4-9 yrs. (ST3, ST4 etc.) • (Exception) Run-through specialities. (e.g. paediatrics) have Core training and Specialist training basically merged together in one large period, so don’t always need to apply to new posts in the middle! • (Exception) GP. 2yrs FY, 2yrs in hospital, 1yr in GP. (5 yrs total) |
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What is the purpose of revalidation? |
A system that imposes regular checks on doctors to ensure they are fit to practise. Thus protecting patients from poorly performing doctors, promoting good medical practice and increasing public confidence in doctors. |
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What solution was finally reached by the GMC for revalidation in 2012? |
• licensed doctors are required to link to a Responsible Officer. Responsible officer will make a recommendation to the GMC about the doctor’s fitness to practice every 5 yrs (recommendation based on the annual appraisals) • licensed doctors need to maintain a portfolio of supporting information drawn from their practice, which demonstrates how they are continuing to meet the principles and values set out in the ‘Good Medical Practice framework for appraisal and revalidation’ • Licensed doctors have to participate in annual appraisal • The GMC’s decision to revalidation a doctor will be informed by the Responsible Officer’s recommendation |
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What solution was finally reached by the GMC for revalidation in 2012? |
• licensed doctors are required to link to a Responsible Officer. Responsible officer will make a recommendation to the GMC about the doctor’s fitness to practice every 5 yrs (recommendation based on the annual appraisals) • licensed doctors need to maintain a portfolio of supporting information drawn from their practice, which demonstrates how they are continuing to meet the principles and values set out in the ‘Good Medical Practice framework for appraisal and revalidation’ • Licensed doctors have to participate in annual appraisal • The GMC’s decision to revalidation a doctor will be informed by the Responsible Officer’s recommendation |
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Define - Probity? |
Having strong moral principles, honesty and decency |
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What are the pros of the current revalidation system? |
• Formalises practices that were ad hoc • Ensures compliance with some basic requirements • Provides focus to the appraisal process |
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Cons for the current revalidation process? |
• Won’t stop another shipman (shipman was liked by colleagues and patients) • Senior clinicians don’t manage properly at other periods of the year, just around appraisals time • risk of identifying underperformance too late (once a year point) • the process may require information trusts do not hold (e.g. surgeons individual results) |
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What is ‘clinical governance’? |
A set of principles and behaviours that all doctors should adhere to so that patients get the best quality clinical care |
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What is ‘clinical governance’? |
A set of principles and behaviours that all doctors should adhere to so that patients get the best quality clinical care e.g. audit, openness, risk management, research and development |
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Give some of the fundamental principles of clinical governance? |
Doctors should: • keep up to date with the latest evidence/research, and constantly adjust their practice to match new guidelines. Inc. formally audit to these guidelines. • provide safe care and ensure they don’t place patients at risk (e.g. wash hands). Report/own up to any mistakes/incidents. • Recognise when they reach their limitations + willing to ask for help. Also if a colleague may be endangering patients, a doctor should raise those issues with a senior • constantly develop their skills + train and educate others • be attentive to patients needs + take account of public feedback in order to improve |
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Give some of the fundamental principles of clinical governance? |
Doctors should: • keep up to date with the latest evidence/research, and constantly adjust their practice to match new guidelines. Inc. formally audit to these guidelines. • provide safe care and ensure they don’t place patients at risk (e.g. wash hands). Report/own up to any mistakes/incidents. • Recognise when they reach their limitations + willing to ask for help. Also if a colleague may be endangering patients, a doctor should raise those issues with a senior • constantly develop their skills + train and educate others • be attentive to patients needs + take account of public feedback in order to improve |
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What is an Audit? |
A systematic examination of current practices to assess how an institution or practitioner is performing against set standards • NB. It is a duty of Doctors to audit |
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Why are audits important? |
• identify weaknesses • identify inefficiencies - leads to better use of resources • provide info to allow production of league tables etc. • provide opportunities for training and education |
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Detail simply how an audit works? |
1. Choose topic 2. Define a standard to achieve 3. Collect relevant data 4. Compare against standard 5. Identify necessary changes to meet standard 6. Implement changes + give them time to start working 7. Re-audit (did changes work?) |
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What are the 4 ethical principles? |
• Autonomy • Beneficence • Non-maleficence • Justice (or Equity) • sometimes ‘Right to confidentiality’ is included |
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What are some of the key details that come to mind when you think about Autonomy (as an ethical principle)? |
• Patients entitled to their opinion • Patients entitled to make decisions for themselves. Including choosing the treatment that they feel is best for them. (This doesn’t mean they can demand treatment, it simply means they can accept a treatment offered by a doctor)(the doctor still chooses which treatment is in the best interest of the patient) • Patients have the right to refuse treatment (as long as they can make an informed decision - competence) |
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What are some of the key details that come to mind when you think about Beneficence (as an ethical principle)? |
Doctors must ‘do good’ i.e. act in the best interest of their patients |
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What are some of the key details that come to mind when you think about non-maleficence (as an ethical principle)? |
Doctor should act in such a way that he does not harm their patients, whether actively (e.g. injecting a lethal dose of medicine) or omissively (e.g. failure to spot the symptoms of an illness causing the death of a patient) |
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What are some of the key details that come to mind when you think about Justice (as an ethical principle)? |
• Fairness across the population • only discriminating on the basis of clinical need • Benefits, risks and costs spread fairly. Appreciating some resources (money, time, organs) are in short supply.
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What is meant by patient confidentiality? |
• Patients have the right to control the information that pertains to their own health • Doctors should respect this and aim to keep personal information to themselves |
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What is informed consent? |
Patient has consented to a procedure, having been given and having considered all the facts that were necessary for them to make a decision in their own best interest |
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Before the patient can give their consent for a particular procedure, what facts must a doctor explain first? |
• options for treatment • the aim of the planned treatment • Details of the procedure: benefits, chance of success, common or serious risks, side effects, how these might be managed • consequences of providing the treatment vs consequences of not • Details of any secondary interventions that may be required while undertaking the first (e.g. blood transfusion in surgery), need consent beforehand • details of who will be performing the procedure (whether trainee doctors will be involved) • A reminder that the patient can change their mind at any time/seek a second opinion • any costs (private work) |
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Doctors should obtain consent for everything they do. But why don’t doctors usually ask patients if they’re okay with having their blood pressure taken for example? |
For simples tasks with no real consequences, consent can be implied consent. For example, doctor instructs patient to roll up sleeves, patient rolls up sleeves and presents arm. This signals that the patient is consenting to having their blood taken. |
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Before the patient can give their consent for a particular procedure, what facts must a doctor explain first? |
• options for treatment • the aim of the planned treatment • Details of the procedure: benefits, chance of success, common or serious risks, side effects, how these might be managed • consequences of providing the treatment vs consequences of not • Details of any secondary interventions that may be required while undertaking the first (e.g. blood transfusion in surgery), need consent beforehand • details of who will be performing the procedure (whether trainee doctors will be involved) • A reminder that the patient can change their mind at any time/seek a second opinion • any costs (private work) • also give any appropriate leaflets etc. • give the patient enough time to reflect (don’t pressure them) |
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Which patients can give consent? |
• competent patients |
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Which patients can give consent? |
• patients who are deemed to be competent |
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Define - competence (in terms of healthcare)? |
Understand the information given to them and are capable of making a rational decision by themselves. (It’s a legal judgement) |
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What is the difference between competence and capacity? |
They essentially mean the same thing. However competence is a legal judgement. Whereas capacity is a medical judgement made by doctors and nurses. |
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Give the age range of people deemed ‘competent unless proven otherwise’? |
• Adults •including children aged 16 &17 |
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What happens if an adult is not deemed competent (e.g. because they have a serious mental disorder)? |
• no other party can give consent on their behalf! Two options: • Patient may have issued an advance directive (living will) at an earlier date stating how they would wish to be treated. Even if what was written was not in the patients best interest, doctors must abide by the decision! • Patient has not indicated any particular wishes. The decision rests with doctors to act in the best interest of the patient. (Doctors should involve relatives) |
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What happens if an adult is not deemed competent (e.g. because they have a serious mental disorder)? |
• no other party can give consent on their behalf! Two options: • Patient may have issued an advance directive (living will) at an earlier date stating how they would wish to be treated. Even if what was written was not in the patients best interest, doctors must abide by the decision! • Patient has not indicated any particular wishes. The decision rests with doctors to act in the best interest of the patient. (Doctors should involve relatives) |
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What are the rules around competence for children below 16yrs? |
• can be deemed competent to consent if they are shown to be mature enough to understand the situation • Competence is assessed in relation to the procedure concerned (5yr old can be competent for antiseptic on a small cut, not for the removal of a testicle) • Duty of doctors to discuss with the child the possible involvement of parents (or legal guardian) • if child refuses to involve the parents, the doctor must respect their decision (otherwise this is a breach of confidentiality) • if child is deemed not to be competent - then parents can be involved against the will of the child • if child is deemed to be in danger - police and social services can be involved against the child’s will • (England and Wales) children cannot refuse consent for treatment deemed in their best interest. Decision would be passed on to parents. (If both parents refuse for child to have a life-saving procedure, doctors can impose the treatment and then justify it in court) |
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What are the rules around competence for children below 16yrs? |
• can be deemed competent to consent if they are shown to be mature enough to understand the situation • Competence is assessed in relation to the procedure concerned (5yr old can be competent for antiseptic on a small cut, not for the removal of a testicle) • Duty of doctors to discuss with the child the possible involvement of parents (or legal guardian) • if child refuses to involve the parents, the doctor must respect their decision (otherwise this is a breach of confidentiality) • if child is deemed not to be competent - then parents can be involved against the will of the child • if child is deemed to be in danger - police and social services can be involved against the child’s will • (England and Wales) children cannot refuse consent for treatment deemed in their best interest. Decision would be passed on to parents. (If both parents refuse for child to have a life-saving procedure, doctors can impose the treatment and then justify it in court) |
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Why is breaching confidentiality so bad? |
• can have serious consequences for the patient • can jeopardise patient’s trust in the medical profession • could prevent patient from divulging crucial information about their health in the future • it’s a serious professional fault |
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