Alex's FCA

FOCP

Alexandra Burke-Smith

FCA Revision Notes Dr Rosalind Herbert (r.herbert@imperial.ac.uk) & Tom Durley (t.durley@imperial.ac.uk)

Health: a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO)  There are many different definitions of health, illness and disease  If we consider health-funding or what a health-service should provide, is a complete state of well-being a feasible concept, or should the WHO definition be reconsidered.

Symptoms: a patient’s subjective perception of change to their body or its function which may indicate the possibility of injury or disease  Not all symptoms have the same significance, or perceived significance; this requires judgement  The symptom iceberg describes the fact that what doctors see is only a small proportion of symptoms within the community, and then only a few of this group will be suffering from a significant disorder and will be referred to a specialist in secondary care, and then even fewer to tertiary care Models of illness: a useful way to understand how people think about illness; their ideas about illness, causes and consequences. These include both medical and lay-models of illness.  Biomedical model - asserts that illness is caused by a pathological change in the body that may be investigated, identified and addressed  Bio-psycho-social model - recognises than an individual has psychological and social aspects to their lives and these influence health and illness in a dynamic interrelationship which is also influences by cultural and environmental factors.  Folk model (Helman) – suggests that the way that illness is perceived and responded to will depend on the answers to 6 questions: 1) What has happened?

2) Why has it happened?

3) Why to me?

4) Why now?

5) What would happen if nothing was done about it?

6) What should I do about it?

Illness Behaviour – used to describe how people consider and act upon any symptoms they may have.  Mechanic & Volkart’s definition: the ways in which symptoms are perceived, evaluated and acted upon by a person who recognises some pain, discomfort or any other signal of organic malfunction  Zola’s triggers: social factors which influence people’s decision to consult a health professional (refer to sociology notes)  Lay referral system: process whereby people may seek advice from other people, including friends and family, who they determine to have more experience and knowledge of the problem (refer to sociology notes) General Household Survey – continuous survey based on a sample of the general population resident in private households in Great Britain, to obtain information about: (see sociology notes for more information)  household and family information  housing tenure and household accommodation  consumer durables including vehicle ownership  employment and education  health and use of health services  smoking and drinking  family information including marriage, cohabitation and fertility 1

FOCP Alexandra Burke-Smith Ideas, concerns and expectations (ICE) – patients are likely to have thought about their problem before consulting a healthcare professional; therefore they are likely to have specific ideas about what the problem is, concerns about the problem and how it affects them, as well as expectations about the problem and the help they need or want.  Research shows that if patients perceive that the doctor understands them and the effect of their problem (i.e. understands their ICE) their health outcomes are better  Research also shows that by listening to the ICE of the patient, patient satisfaction is improved. Patient satisfaction is influences by a number of different factors which may be of different priority depending on the patient.

Healthcare professionals – a qualified member of the medical profession, with specialised knowledge, a monopoly of practice, autonomy to control their profession and a code of ethics.  In the medical profession this may include a doctor, nurse, health care assistant, nurse practitioner, specialised nurse.  The collation of the different roles of these healthcare professionals provide a multidisciplinary approach to healthcare Effects of illness: disability – physical effects of illness have repercussions for people in social and psychological terms, as well as on practical problems of daily living.  Patients may experience stigma as a result of chronic illness or “disability”. In addition to understand the definition of disability, it is important to consider whether disability is a condition, or a function of the way that society accommodates people with impairments. This may be expressed in the two models of disability.  Medical (individual) model of disability – disability is seen as the product of a biological abnormality (a medical problem) which only affects a small proportion of the population. However recent studies show that if we consider disability to be a limitation within the individual, a large proportion of the population may experience disability through loss, disease or illness.

Medical or individual model of disability suggests that the disabled person is the “problem” “Can’t….”

Walk, talk, see, hear, work, climb stairs, read written info, speak etc

Is passive or dependant

The Disabled Person

Is a burden Needs care, help, services, takes and doesn’t give……..

“confined” to a wheelchair, housebound etc

Is sick or ill Object of pity or sorrow

Waiting for a cure, confusion between illness and disability

Recipient of charity has “special” needs which don’t get met by mainstream services or funding etc

What’s the solution? – Change the person to make them “fit in”?

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FOCP 

Alexandra Burke-Smith Social model of disability – emphasizes disability as a complex problem which has social and political dimensions, and arises as the product of organisation and culture rather than a person’s limitation due to impairment.

Social model of disability shows that it is the barriers which are the real problem

Inaccessible physical environments Including buildings, transport, poor design etc

Information not in accessible formats

The Disabling World

Communication barriers e.g. few sign language interpreters, no induction (hearing ) loops or alternatives to telephones, assuming everyone communicates in the same way



e.g. plain language, Braille, tape, large print, disk, accessible websites etc Unintentional Prejudice

Discrimination e.g. inflexible or unfair systems in organisation

What’s the solution? –

e.g. attitudes, stereotyping, assumptions etc

Remove the barriers!

WHO integrated model – focuses more on abilities and function rather than disability and impairment. It considers impairment of body function/structure, limitation of activity and restriction of participation as well as the environmental and personal factors which influence these.

Sharing a diagnosis: research suggests that health professionals make assumptions about how people will react to the news they are told, and that it is considered “breaking bad news”. In fact some patients consider it a relief to find out what’s wrong with themselves or their child/family member as it enables them to obtain treatment and support, and others may be relieved that the diagnosis is less serious than they had suspected.  The way in which information is shared has been shown to affect how well people cope and how they benefit from medical services in the future  Patient distress may be increased when: o Information is shared with someone when they are unsupported ot lack privacy o Information is given in a rushed, impersonal and negative way o When no time is made for a follow-up appointment to repeat the information and answer questions

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