Formative practice COPY

Question 1

Aspects of Lifestyle you may cover in a consultation when giving advice to any patient

Answer 1

Diet
Smoking
Alcohol
Exercise
Illicit Drug use
Sexual Health

Question 2

Factors that allow proper guidance from a GP

Answer 2

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

Question 3

5 types of question which may be used in a consultation and give a brief explanation
of each.

Answer 3

• 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.

Question 4

Factors encouraging a change in behaviour

Answer 4

• 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

Question 5

WHO definition of health

Answer 5

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

Question 6

Factors which influence lay beliefs about health and give an example

Answer 6

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

Question 7

Actions the government could take to stem the rise on obesity

Answer 7

- 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

Question 8

Define Cultural Competence

Answer 8

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

Question 9

Potential complications that may arise when consulting with a patient from a different culture

Answer 9

• 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

Question 10

Routes someone may be exposed to a hazardous substance

Answer 10

• Blood
• Sexual contact
• Inhalation
• Ingestion

Question 11

Categories of hazards and examples

Answer 11

• 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

Question 12

Pieces of advice you may give when safety netting

Answer 12

• Advise the patient of the expected course of
  the illness/recovery
  • Advise of symptoms indicating deterioration
  • Advise who to contact if patient deteriorates

Question 13

Ways risk can be minimised according to Nrighbour

Answer 13

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

Question 14

What is meant by the term gatekeeper?

Answer 14

The person who controls the patients access to specialist or secondary care

Question 15

What are advantages of GP’s as gatekeepers?

Answer 15

• 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

Question 16

What percentage of illnesses
occurring in the community are
referred on to secondary care?

Answer 16

1% (accept 1-5%)

Question 17

Ethical Principles

Answer 17

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)

Question 18

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.

Answer 18

• 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

Question 19

Risks to foetal well-being

Answer 19

• 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

Question 20

Define Culture

Answer 20

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)

Question 21

Define ethnocentrism

Answer 21

Evaluation of other cultures according to preconceptions originating in the standards and customs of one’s own culture.

Question 22

Common reasons for a child (of any age) in the UK seeing their GP and/or Health Visitor.

Answer 22

• Feeding problems (especially new babies)
• URTIs/colds
• Coughs
• Rashes
• Otalgia
• Sore throat
• Vomiting+/-diarrhoea
• Abdominal pain
• Behavioural problems
• Anxiety re milestones/developmental delay

Question 23

Social influences on health

Answer 23

•	Gender
•	Ethnicity
•	Housing
•	Employment
•	Financial security
•	Health system
•	Environment
•	Social class
- Education

Question 24

What are the benefits of adopting a mutual participation style consultation?

Answer 24

• 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.