Ethics in Medicine

Ethics in Medicine

• Ethics involves principles of right and wrong in healthcare behavior and decision-making.
• Key ethical principles include autonomy, justice, beneficence, and non-maleficence.
• Autonomy refers to a patient's right to make their own healthcare choices.
• Justice ensures equal access and quality of healthcare for all individuals.
• Beneficence involves acting in the patient's best interest.
• Non-maleficence involves avoiding harm to patients.

Ethical Issues in Healthcare

• The UK uses an "opt-out" system for organ donation, which raises ethical questions about consent and autonomy, with family involvement still considered.
• Abortion is legal in the UK up to 24 weeks in most cases, leading to ethical debates about women's rights versus fetal rights.
• Patient confidentiality is vital as a medical student for trust and open communication, and is also a legal duty.
• Medical students must be careful on social media and only discuss patient information with staff directly involved in their care.
• Rationing involves limiting healthcare resources like treatments, scans, time, and funding, requiring fair distribution based on cost-effectiveness, clinical need, and evidence.
• NICE might not fund expensive treatments if the cost doesn’t justify the benefit, as seen with a recent Alzheimer's drug.
• The COVID-19 pandemic showed how limited ICU beds and ventilators led to rationing of critical care.

Human Factors Science

• Human factors involves studying how humans interact with system elements to improve safety and reduce errors.
• System thinking focuses on the overall system, not just individual performance.
• System approach: focuses on how workplace factors such as staffing, procedures or overall contributed to the error vs. blaming the individual involved
• Widespread errors suggests the systems need to be developed with these failures in mind
• Systems should provide safeguards, and promote a general culture of safety

Person vs. System Approaches to Human Error

• The person approach blames individuals for carelessness or forgetfulness when errors occur.
• The system approach examines how the system contributed to the error, such as through poor staffing, unclear protocols, or overwork.
• Blaming individuals for widespread errors is ineffective without addressing the root causes.
• Errors need to be prevented with an understanding that the systems must be developed with it in mind
• Effective systems should promote safeguards and a general culture of error reporting

SEIPS (Systems Engineering Initiative for Patient Safety) Model

• The SEIPS model examines how work systems affect healthcare outcomes.
• Elements include people, tasks, tools/technology, environment, and organization.
• This model asks, what are the characteristics of the person using a tool, completing a task?
• It also asks, what in the organization allows or prevents exposure to errors, and what outside the organization hinders patient safety?
• SEIPS promotes looking at the holistic picture of all factors affecting patient safety.

Work System Factors from the SEIPS Model

• A change from the traditional luer connector to the new connector is a safety design change to prevent wrong-route medication errors.
• The new design is color-coded, fits only specific connectors, and has a unique size and shape.

Relevance of Human Factors to Healthcare Improvement

• Human factors help design safer systems and reduce burnout by improving workflow.
• They also improve communication and teamwork and prevent errors by understanding human limits.

Social Determinants of Health

• Health inequalities are unfair, avoidable health differences between different groups, often resulting from social inequalities.
• Wider determinants are social, economic, and environmental factors impacting health.
• Inequalities due to income, unemployment, and housing lead to chronic addiction, mental health issues, shorter life expectancies.

Socioecological Model of Wider Determinants

• Constitutional factors are age, sex, genetics, and personal behaviors like smoking and diet.
• Individual lifestyle factors include social networks, support systems, and family relationships.
• Social and community networks include living and working conditions.
• General socio-economic, cultural, and environmental conditions include laws, regulations, and policies impacting health, such as access to resources, services, education, employment, and healthcare.

Public Health

• Public health is the science and art of preventing disease, prolonging life, and promoting health through organized societal efforts.
• It considers social justice and equity to include everyone.
• Public health aims to tackle health inequalities.

Epidemiology

• Epidemiology is the study of how often diseases occur in different groups and why, focusing on distribution, patterns, and determinants of health/disease.
• Includes surveillance, statistical analysis, and field investigations.

Domains of Public Health

• Education provides the public with information on factors impacting health.
• Research focuses on diet/lifestyle, environmental factors, and social determinants.
• Public health influences political policy by advising governments on changes in public interest and developing NHS policies.
• Outbreak prevention and limiting outbreaks include contact tracing and mass testing.

Primary and Secondary Prevention

• Primary prevention includes actions to avoid disease manifestation, such as vaccinations, wearing a seatbelt, and water fluoridation.
• Secondary prevention involves early detection to improve chances for positive health outcomes, like screening programs and regular exams.

Governmental and Institutional Roles in Health

• The UK Government/DHSC sets national public health strategy, policy, and legislation.
• They fund public health initiatives like vaccinations and anti-smoking campaigns.
• Governmental regulations on single-use vapes, speed limits, indoor smoking bans are further examples
• The WHO provides guidelines for health promotion, promotes healthy cities, and supports sustainable development goals.

Herd Immunity

• Vaccinated people help stop transmission, protecting vulnerable individuals.
• The percentage of the population needing immunity varies by disease.

Structure of Healthcare

• Primary care is the first point of contact in the healthcare system, like GPs.
• Secondary care is specialist care, usually via referral, including hospitals and specialists.
• Patients start in primary care and, if needed, are referred to secondary care.
• After specialist treatment, patients are often discharged back to primary care for follow-up.

Advantages and Disadvantages of Government-Funded Healthcare

• Advantages include free access at the point of use, equal access regardless of income, funding through taxation, and encouragement of preventative care.
• Disadvantages can include long waiting times, underfunding, staff shortages, and resource rationing.
• The Scottish NHS provides free prescriptions and has different pay structures than the NHS in other UK regions.

Healthcare Funding Models

• The UK's NHS is tax-funded, ensuring universal access, while the U.S. uses a mixed system with private insurance and public programs like Medicare and Medicaid.
• Germany uses social health insurance ("sickness funds") with contributions from employers and employees.
• Australia has a mixed system with public (Medicare) and private insurance options.

Global Healthcare Structures

• The four main areas of global health are infectious diseases, non-communicable diseases (NCDs), maternal and child health, and environmental health.
• Infectious diseases of public health concern include COVID-19, HIV, AIDS, and TB, monitored through global surveillance and vaccination programs.
• Non-communicable diseases include heart disease, diabetes, and cancer.
• Addressing maternal and child health involves reducing maternal and infant mortality and improving family planning.
• Environmental health focuses on mitigating climate change impacts.

UK (NHS) vs. United States Healthcare Systems

• The UK uses a tax-funded, universal system (NHS) with free access for residents funded by taxation and National Insurance.
• The U.S. has a mixed, predominantly private system with public programs like Medicare and Medicaid, reliant on private insurance premiums, out-of-pocket payments, and public funding.
• Health spending per capita in 2022 was $4,693 USD in the UK and $12,555 USD in the USA.
• In 2022, healthcare expenditure as a percent of GDP was 11.3% in the UK and 17.3% in the USA.
• Life expectancy at birth (2022): UK is 80.7 years and USA is 76.4 years.
• Infant Mortality (per 1,000 live births, 2022): UK is 3.5 and USA is 5.4.
• Maternal Mortality (per 100,000 live births): UK is 7 and USA is 23.8.
• The UK has 100% coverage through the NHS, whereas in the USA, 8.4% (27.6 million people) were uninsured in 2022.

Lifestyle Medicine

• Lifestyle medicine is evidence-based clinical care supporting behavior change through person-centered techniques.
• The goal is the improvement of mental well-being, social connection, healthy eating, physical activity, sleep, and minimizing harmful substances and behaviors.
• The six pillars are nutrition, physical activity, sleep, stress management, social Connection, and substance Use

Six Pillars of Lifestyle Medicine

• Whole Food, Plant-Predominant Eating Pattern promotes health, prevents and treats disease.
• Regular Physical Activity is essential for overall health.
• Restorative Sleep leads to the body repairing tissue
• Stress Management is essential for health
• Positive social connection is essential for health
• Substance use: support and promote health

Careers in Medicine

• Several training stages starting with medical school and initial foundation training to progress towards specialty training in chosen area
• Career choices affected by location preferences, financial considerations, family and partnership commitments and preferences surrounding part-time or full-time work