Medicine in a nutshell

NHS

Elderly Medicine

Mental Health

Surgery and inpatient medicine

Emergency medicine

palliative medicine

communication skills

Principles of the NHS :

  • launched in 1948
    -three core principles : meet the health needs of everyone, free at the point of delivery, based on clinical need and not the ability to pay.
    -Initially it referred to people with physical health problems until the mental health act in 1959 that mental health problems and needs were also catered to.
    -The NHS was free for consultations and to be directed to other services that the patient needs.
    -NHS and its achievements: establishing the link between smoking and cancer, the first organ transplant, organ donor register, national vaccination programs
    -There are now 7 underlying principles that form part of the NHS constitution:
    •NHS provides a comprehensive service available to all
    •NHS is based on clinical need
    •Highest standard of excellence
    •Patient is at heart
    •NHS works across organization boundaries
    •NHS is committed to providing best value for taxpayers’ money
    •NHS is accountable to the public, communities and patients that it serves.

NHS Values:
-working together for patients
-respect and dignity
-commitment to quality of care
-compassion
-improving lives
-everyone counts

general practice

Role of the GP:
1.Seeing patients : consultations and taking a history
2.Referrals and tests
3.Liaising with hospital
4.Health promotion
5.Business management
6.Teaching
7.Home visits
8.Research
9.Special interests

SOCRATES ( site, onsite, character, radiation, associated symptoms, timing, exacerbating and relieving factors and severity )

Challenges in GP: Challenges of General Practice:
-Record number of patients
-Harder to get appointments
-Some patients then turn to A&E which is meant for managing emergencies
-High pressure of A&E department, waste of valuable but limited resources
-More number of elderly patients
-More patients will have diseases occurring together making their management very complex and costly.
-Higher cost of medications which can be difficult to balance for the patients along with treating the multiple side effects.
-Training programs for Gps are continuously undersubscribed, meaning there are not enough GPs to fill the jobs that are available.
-50% of the GPs are predicted to retire before the age, so the work force will be drastically cut.
-Many GP practices are closing across the UK.

Where are elderly patients looked after?
-Hospitals and other secondary care centers
-Residential care homes
-Homes of family and friends


Who looks after elderly patients?
-Doctors, nurses, HCAs, Speech & language therapists, Dieticians, Pharmacists, Occupational therapists, Friends and family

  • Challenges in elderly medicine:
    Costs of care
    Polypharmacy
    Availability of community and social care
    Accessibility of services
    Comorbidity, multimodorvidity and chronic disease
    Coping with loss
    Attitudes to health
    Complex and challenging treatments
    Ethical

Some of the reasons why older people may be lonely include:
•The illness and deaths of older people close to them, including their partner, friends and family
•Other reasons for rarely seeing their partner, friends and family, such as divorce or living far away
•Retiring and leaving a busy workplace
•Health problems, for example associated with reduced mobility, cognition or sensory impairment, or problems that require extensive community-based care
•Habitat characteristics, such as neighborhood, home accessibility and local services provision
•The rise of digital communications (e.g. social media) leading to fewer face-to-face interactions between people
•Not wanting to speak to anyone about being lonely.

Mental health disorders can be grouped into: mood, anxiety, schizotypal, substance misuse, personality, neurodevelopmental disorder, neurodegenerative, organic

What do you think the reasons are that doctors are vulnerable to mental health problems?
-Exam stress
-Burnout
-Poor stress management
-Workplace harassment/ bullying
-Legal investigations
-Being emotionally overwhelmed
-Overwhelming workload

What does a surgeon do? - community work, teaching, conferences, surgery, MDT meetings, conduct research, presentations, ward-based work, clinics, medicine, private practice

risks of surgery: nerve injury, reaction to anaesthesia, bleeding

qualities of a good surgeon include being practical, compassionate and ability to work underpressure

Delivering bad news: SPIKES

These are 3 things that happen when you get to A&E:
-Registering
-Assessment
-Treatment

ABCDE: airway, breathing, circulation, disability, exposure

How to treat? recognize, plan & do, communication, support, involve

Four pillars of medical ethics: Autonomy, beneficence, non maleficence, justice