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Phase 3 > Pink > Flashcards

Pink Flashcards

1
Q

What is Kaiser Permanentes risk stratification model of chronic disease management?

A

Level 1: with right support patients can be active in their own care, living with and managing their condition
Level 2: MDT input provide evidence based care management
Level 3: case management, key worker actively managing and joining up care

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2
Q

What is Roland and Abels stratification model of chronic care?

A

Low risk: prevention and wellness promotion
Moderate risk: supported self care
High risk: disease management
Very high risk: case management

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3
Q

What is the Wagner chronic care model?

A

Health system organisation of health care: self management support, delivery system design, decision support, clinical information systems
Community: resources and policies
Productive interactions: informed active patient, prepared proactive practice team
Leads to functional clinical outcomes

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4
Q

What are the quality standards of the long term conditions model?

A 
Person centred service
Early recognition, prompt diagnosis and treatment
Emergency and acute management 
Early and specialist rehab 
Community rehab and support
Vocational rehab
Providing equipment and accommodation
Providing personal care and support 
Palliative care
Supporting family and carers
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5
Q

How much heart disease, stroke and diabetes could be prevented?

A

80%

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6
Q

What proportion of cancers could be prevented?

A

40%

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7
Q

What are benefits of early detection of COPD?

A

Improved lung function
Improved quality of life
Reduced shortness of breath
Allows use of non pharmacological interventions

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8
Q

What early non pharmacological interventions can be used in COPD?

A

Vaccination - pneumococcal and influenza
Smoking cessation
Increased physical activity

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9
Q

What are benefits of early detection of CKD?

A

Tighter control of BP and proteinuria delay profession of CKD
Cost savings

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10
Q

What are the Wilson junger criteria for appraising the validity of a screening programme?

A

Important health problem
Natural history should be understood
Detectable early stage
Treatment at an early stage should be of more benefit than a later stage
Suitable test devised for early stage
Test should be acceptable
Intervals for repeating test should be determined
Adequate health service provision should be made for extra workload

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11
Q

What are pros and cons to screening for diabetes?

A 
Pros: important health problem
Benefits to early detection 
Simple test 
Cons: costs 
No direct evidence of benefit from population screening
Increased workload
Acceptability of test
How often to test
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12
Q

Give examples of early detection in high risk groups

A

HIV screening in pregnancy

CKD in patients with HTN

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13
Q

What is DESMOND?

A

Diabetes education and self management for ongoing and newly diagnosed
Patient self care support group

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14
Q

What is case management?

A

Integrating services around needs of people with long term conditions
Targeted
Community based
Pro active

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15
Q

What does case management involve?

A

Case finding
Assessment
Care planning
Care coordination

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16
Q

What is case finding?

A

Identify patients at highest risk of future admissions
Predictive models - precious admissions, A and E, GP records, social care data
Clinical judgement

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17
Q

What is care coordination?

A

Case manager works with patient and coordinates agencies involved
Fixed point or contact for patient
Navigational role

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18
Q

What care planning can be done in COPD?

A 
Optimise medications 
Patient education
Self management plan
Emergency supply steroids and abx
Liaison with out of hours service
Patient preference
Hospital at home/admission
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19
Q

What patient self management plans can be put in place for diabetes?

A

During illness never stop insulin
Test blood sugar more regularly - 4x daily
If type 1, test blood or urine for ketones especially if previous DKA
Increase insulin every day or 2 days if blood sugar over 13, hyperglycaemia, illness expected to continue
Keep hydrated on non sugary drinks
If feeling sick, sip sugary fluids
If vomiting - anti emetic
In type 1, if vomiting doesn’t stop - admission

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20
Q

Who can help with admission prevention?

A 
CERT team - community emergency response team
Community matrons
Virtual wards
Ambulatory care
GP
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21
Q

What is telehealth?

A

Electronic sensors or equipment that monitors vital health signs remotely, readings transmitted to trained person who can make decisions in real time without need to attend clinic

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22
Q

What is telecare?

A

Personal and environmental sensors in home that enable people to remain safe and independent in own home for longer

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23
Q

What is CAM?

A

Diverse medical and health care systems, practices and products that are not presently considered part of conventional medicine

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24
Q

What are the most commonly used CAM therapies?

A

Massage
Aromatherapy
Acupuncture

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25
Q

What types of patients are most likely to use CAM?

A

Female
University educated
Consuming >5 portions of fruit and veg
Suffering anxiety and depression

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26
Q

What is a common reason for CAM consultation?

A

Cancer

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27
Q

What are applications of CAM?

A

Exploration and development of wellbeing
Appreciation of holism - mind body links
Health problems and diseases for which there is no cure in orthodox medicine
Self care in chronic illness - self awareness and engagement

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28
Q

What are the big 5 principle CAM disciplines?

A 
Osteopathy
Chiropractic 
Acupuncture
Homeopathy
Herbal medicine
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29
Q

What are group 2 cam therapies, mostly complementary with no diagnosis?

A

Body work therapies: Alexander technique, massage, shiatsu, reflexology, zero balancing
Mind body therapies: meditation/mindfulness, hypnotherapy, visualisation, relaxation/stress management, biofeedback, counselling

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30
Q

What are group 3a cam therapies, traditional systems of health care, mind body spirit?

A

Traditional Chinese medicine: acupuncture, herbal medicine, tuina massage, meditation, energetics of food
Ayurvedic medicine: herbal medicine,meditation, diet, yoga, healing

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31
Q

What are group 3b cam therapies, other non credible?

A 
Crystal therapy
Iridology
Dowsing
Radionics
Kinesiology/EMDR/emotional freedom technique
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32
Q

What are the aims of CAM therapy?

A

Therapeutic relationship heightens tone in parasympathetic nervous system and starts self healing
Develop self awareness - bring subconscious to conscious
Clients engaged in own health
Resolves trauma patterns

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33
Q

What is the CAM view of disease?

A

Caused by imbalance in functioning of internal and external agents in complex system
Functioning of body influenced by functioning of mind and state of spirit
Effects of trauma stored in body and create suboptimal functioning
Each patient and disease pathway is individual
Change in energetic systems of the body

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34
Q

Why are RCTs not good for assessing effects of CAM therapies?

A

Control influences the way the complex system works and doesn’t assess what happens in therapy
Randomising patients confounds need for engagement
Standardising treatments confounds need for individualised care
Single validated outcome measure confounds capturing holistic change and unexpected outcomes
Identifying appropriate comparison group intervention

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35
Q

What is a better model for testing cam therapies? Why?

A

Complexity or systems theory
Unpredictable outcomes
Emergent phenomena
Everything is connected

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36
Q

What is CST?

A

Hands on therapy which is thought to assist the body’s
natural capacity to self-repair
Practitioners rely on their perceptions, not limited to a specific
sensory organ but encompass their entire being
Being able to stay ‘present’ with clients is an important catalyst for the mechanisms of action.

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37
Q

What happens in a session of CST?

A

Fully clothed and usually lie on a treatment table
Practitioner would makes light contact on the body
The head and the sacrum are the two main contact points allowing
direct contact with the craniosacral system
Sessions can take between 40 minutes to one hour

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38
Q

What conditions do people present to CST with?

A 
Stress related conditions
Mental illness
Physical pain
Emotional problems
Spiritual distress
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39
Q

How can a CST practitioner help?

A

Be compassionately present, actively listen
Work with symptoms of shock
Acknowledge pain, sadness, fear and anger
Ease anxiety
Reduce stress
Reduce fatigue
Improve sleep
Improve patients quality of life
Offer nurturing without attachment to outcome or need

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40
Q

What changes in health status are reported by patients using CST?

A

Recovery
Reduction of symptoms
Reassessment of problems

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41
Q

What areas can CST help to raise awareness in?

A 
Self concept
Psycho/emotional
Understanding mind/body/spirit links
Self care
Coping strategies
Interpersonal relationships
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42
Q

What aspects of the therapeutic relationship are important in CST?

A

Feeling cared for
Developing a sense of partnership with practitioner, creating a balance of power
Attention given to the ambiance of the environment in creating a safe space
Importance of their practitioners model of health, lack of expectation in terms of outcomes to treatment

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43
Q

What altered sensory perception can occur in CST?

A

Changes in perceptual awareness
Seeing colours
Imagery
New sensations in the body

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44
Q

What are potential challenges when measuring wellbeing?

A

Wellbeing and health related quality of life is subjective
People’s assessment of their health and the way in which they ‘adapt’ to illness changes over time
Response shift - a valuable strategy for coping with chronic disease: shift of internal standards of measurement (recalibration), shift of respondents’ values (reprioritisation), reconceptualisation of target construct
Currently - a bias to be adjusted for during analysis and reporting
‘Response shift’ may be the AIM of intervention

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45
Q

What is the euro qol 5D questionnaire?

A

Health state: mobility, self care, usual activities, pain, anxiety/depression
Evaluation: visual analogue scale

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46
Q

What is a duty of candour?

A

Professional responsibility to be honest with patients when things go wrong

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47
Q

What is the definition of an outbreak?

A

An incident in which two or more people experiencing a similar
illness are linked in time or place
A greater than expected rate of infection compared with the usual background rate for the place and time where the outbreak has
occurred
A single case for certain rare diseases such as diphtheria, botulism, rabies, viral haemorrhagic fever or polio
A suspected, anticipated or actual event involving microbial or
chemical contamination of food or water

48
Q

What are the objectives of oubreak management?

A

Protect public health by identifying source and implementing control measures to prevent further spread or recurrence of the
infection

49
Q

What are the different types of outbreak?

A 
Point Source outbreak 
Continuing Source outbreak 
Intermittent outbreak 
Point Source with Secondary Transmission
Propagated Spread
50
Q

What are features of a point source outbreak?

A

Persons exposed to the same source over brief time
Number of cases rises rapidly to a peak and falls gradually
Most cases occur within one incubation period

51
Q

What are features of continuing source outbreak?

A

Cases infected by same source over a prolonged period of time
Epidemic curve doesn’t increase sharply, doesn’t peak, reaches a plateau sustained over time until source removed

52
Q

What are features of an intermittent outbreak?

A

Common source that is not well controlled so outbreaks recur

53
Q

What are features of point source outbreak with secondary spread?

A

Index case infects other people and cases arise after an incubation period
Outbreak wanes when people no longer transmit the infection to others

54
Q

What are features of propagated spread outbreak?

A

Begins like an infection from an index case but then develops into full blown epidemic with secondary cases infecting new people who in turn are sources for other cases
Successively taller peaks, initially separated by incubation period but eventually merging into waves
Epidemic continues until remaining numbers of susceptible individuals declines or intervention takes effect

55
Q

How do we perform a risk assessment for an outbreak?

A 
Severity
Uncertainty
Spread
Intervention
Context
56
Q

How do we respond to an outbreak?

A

Incident notified
Initial response and investigation
Outbreak declared
Establish outbreak control team
Investigate: epidemiology, microbiology, environment, veterinary
Control measures: source/mode of spread, protect persons at risk, monitor effectiveness
Communications: OCT minutes, communication protocol, media
End of outbreak: declare over, action lessons learned

57
Q

Who might be a part of an outbreak control team?

A

Health Protection Teams
Communications officer (PHE)
Environmental Health/Local Authority
Microbiologist
Community/Hospital Infection Control Teams
Clinical Services
Others: HSE, FSA, Environment Agency, Police/Fire/Ambulance

58
Q

What are the 3 functions of the outbreak control team?

A

Investigations
Control Measures
Communications

59
Q

What investigations need to be done by an outbreak control team?

A

Epidemiological: who, when, where, why, Establish number of confirmed/probable cases. Interview cases to establish risk factors (analytical study). Actively seek further cases with case definition. Describe outbreak in person, time, place.
Microbiological: understand the agent. Review current lab sampling from cases. Further tests/strain typing to further characterise agent.
Environmental: understand source, Case interviews will highlight potential sources. Investigate potential source, assess for risks/hygiene, swab suspicious areas

60
Q

What control measures should be put in place by an outbreak control team?

A

Control Sources: disinfect/dispose, Closure
Control Transmission: Quarantine, barrier care
Improve host defences: Vaccine, chemoprophylaxis, immunoglobulin

61
Q

What communications should be done by an outbreak control team?

A

Agree who will have lead media responsibility and ensure they are involved at earliest possible stage
Agree a communication strategy
Identify all parties that need to receive information
Ensure accuracy and timeliness of communication, while complying with relevant legislation e.g. Data Protection Act
Prepare both proactive and reactive media statements

62
Q

When is an outbreak over?

A

No longer a risk to the public health that requires further investigation or management of control measures by an OCT
The number of cases has declined
The probable source has been identified and withdrawn

63
Q

What are the last actions of an outbreak control team?

A

Produce outbreak report and lessons learnt

Disseminate what has been learnt

64
Q

What are the Fraser guidelines?

A

The young person understands the advice being given
The young person cannot be convinced to involve parents/carers
It is likely the young person will begin/continue having intercourse with/without treatment
Unless he or she receives treatment their physical or mental health is likely to suffer
To maintain the young person’s best interests requires treatment

65
Q

What factors make an adolescent vulnerable with regards to their healthcare?

A

PSYCHOLOGICAL: Low self esteem; lack of skills; lack of knowledge
ENVIRONMENTAL: Poor access to resources; peer pressure; society attitudes
PHYSICAL: Increased susceptibility to STIs

66
Q

Why might asylum seekers and refugees have problems accessing health care in the U.K.?

A

Lack of awareness of entitlement
No fixed abode - registering for GP
Language barriers

67
Q

What is the difference between discrediting and discreditable social stigma?

A

Discredited: stigma is clearly known or visible
Discreditable: unknown and concealable

68
Q

What is the difference between enacted and felt stigma?

A

Felt: internal, self, shame and expectation of discrimination
Enacted: experience of unfair treatment by others

69
Q

What is domestic violence?

A

Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members, regardless of gender or sexuality. This can encompass, but is not limited to: psychological, physical, sexual, financial and emotional

70
Q

What is coercive control?

A

When a person with whom you are personally connected, repeatedly behaves in a way which makes you feel controlled, dependent, isolated or scared

71
Q

What effects can domestic violence have on women?

A

Significant cause of physical injury and disability
More prevalent in pregnancy than gestational diabetes or hypertension and implicated in miscarriage, still birth and foetal damage
Has significant psychological impact
Fear, shame, isolation, loss of independence
Elevated use of alcohol and drugs as coping strategy
Increased likelihood of post-natal depression
Post-traumatic stress disorder
Undermines women’s parenting

72
Q

Which groups of women are at increased risk of discrimination and violence?

A

Disabled women
Black and minority ethnic women
Refugee and asylum seeking women
Lesbian women

73
Q

What factors can help women suffering from domestic violence?

A

Need to feel safe and be safe
Coordinated services
Social, legal and practical help: Emergency provision, Advocacy services, Aftercare, Individual and group support for women and children
Recognising that women have diverse needs

74
Q

What framework for the health service should be applied to protect people suffering from domestic violence?

A

GPs/health professionals should know how to signpost women who have experienced violence to specialist services
Clear referral protocols needed re: information sharing between health
professionals and other services which maximise safety and confidentiality
Address the culture of disbelief by health professionals towards women who disclose violence
Compulsory training on violence against women for all health
professionals – identifying the signs, asking about experiences of violence, how to provide support on disclosure, and how to refer women to services
Recognise the crucial role of specialist women’s services in
providing longer-term support for women, which promotes
empowerment as a means of preventing violence
Contribute to healthy relationships education in
schools, and integrate violence against women into all health promotion and prevention work
Effectively publicise in health services the availability of women’s support services and helplines

75
Q

What might be some signs that a women is experiencing domestic violence?

A

She is never on her own and her partner is aggressive/dominant, does not let her speak
Lots of appointments, missed appointments, delayed ante-natal
care, vague symptoms
Non-compliance with treatment regimes
Appears afraid, anxious, depressed, evasive
Lots of injuries at different stages – injuries to breast and abdomen; attempts to disguise or minimise injuries
Repeated miscarriages
Inconsistent accounts and implausible explanations
Unexplained gastro-intestinal and gastro-urinary symptoms
Injuries to reproductive system; repeated STIs
Appears different when on her own

76
Q

What needs to be recorded when a woman talks to you about domestic violence?

A

A diagrammatic representation of the body with all the injuries marked on it
Where/if possible, photographs of injuries
A written record report about how the patient recounts how the injuries/abuse occurred - time, date and place; how long has been occurring
The nature of abuse
Whether children were present and their ages
The name of the alleged assailant
The relationship of the alleged assailant with the patient
Assessment of the patient’s current safety and risks (via DASH, for example)
Mental health assessment in order to identify depression or suicidal ideation
Information provided and actions taken

77
Q

Why is it important to record the medical/clinical assessment of domestic violence?

A

The woman may need evidence for a court case
The woman may need evidence for medical support for re-housing
To accumulate statistics on DV
To prevent deportation of a foreign national who leaves a
spouse within the probationary period because of domestic violence

78
Q

What are ethical concerns regarding DNACPR?

A

Inappropriate resuscitation leading to harm to patient (and family and staff)
Inappropriate use of resources when death inevitable
Inappropriate DNACPR
Lack of involvement of patient or family
Harmful effect of DNACPR on other aspects of patientcare
Less frequently referred to outreach or receive out of hours care
Reduction in the urgency attached to reviewing a deteriorating patient

79
Q

What does guidance say with regards to DNACPR decision making?

A

For a person in whom CPR may be successful, when a decision
about future CPR is being considered there should be a
presumption in favour of involvement of the person in the
decision-making process. If she or he lacks capacity those close to them must be involved in discussions to explore the person’s
wishes, feelings, beliefs and values in order to reach a ‘best-
interests’ decision. It is important to ensure that they understand that (in the absence of an applicable power of attorney) they are
not the final decision-makers, but they have an important role in
helping the healthcare team to make a decision that is in the
patient’s best interests
Where a patient or those close to a patient disagree with a
DNACPR decision a second opinion should be offered.
Endorsement of a DNACPR decision by all members of a
multidisciplinary team may avoid the need to offer a further opinion

80
Q

Which forms are now used to document DNACPR decisions and other ceiling of care plans?

A

REPECT forms

Recommended summary plan for emergency care and treatment

81
Q

What are examples of proactive medical care?

A

Prevention of illness: screening, health promotion, immunisation
Prevention of complication: monitoring, long term treatment
Anticipating and planning for future events in illness trajectory: advanced care planning, treatment limitation

82
Q

In which patients can a capacitous refusal of treatment be overridden?

A

Mental Health Act 1983 (2007)
Children under 16 years
? Young people aged 16-18 years

83
Q

Which legal framework underpins advanced decisions to refuse treatment?

A

Mental capacity act 2005

84
Q

What is an advanced decision to refuse treatment? What is required for it to be applied?

A

Applies to persons over 18 who have capacity
Applies to refusals of, not requests for, treatment
Must be valid and applicable
Decision can be cancelled at any time
Decisions regarding life sustaining treatment must be: In writing, Signed by the person making the advance refusal and
witnessed, State clearly that the decision applies even if life is at risk

85
Q

When are health care professionals protected from liability with regards advanced decisions to refuse treatment if they are not complied with?

A

If a HCP withholds or withdraws treatment because they
reasonably believe a valid and applicable advance decision exists
If they treat a person because they do not know or are not satisfied that a valid and applicable advance decision exists (having taken all practicable and appropriate steps to find out)

86
Q

How do we know if an advanced decision to refuse treatment is valid?

A

Made by a person who has capacity: Adults are assumed to have capacity unless there are reasonable grounds to doubt this, no requirement to record an assessment of a person’s
capacity at the time of making a decision but it would be good
practice to do so
Person has not withdrawn decision when he had capacity to do so
No Lasting Power of Attorney who has authority to make the relevant decisions
Person has not done anything inconsistent with the advance decision remaining his fixed decision

87
Q

How do you know if an advanced decision to refuse treatment is applicable?

A

Treatment specified in the advance decision is that which is being considered
The circumstances specified in the advance decision are present
No reasonable grounds to believe that circumstances exist which the person did not anticipate at the time of the advance decision and which would have affected his decision had he anticipated them

88
Q

What are limits to advanced decisions to refuse treatment?

A

A Lasting Power of Attorney made after the advance decision will make the ADRT invalid if the LPA gives the attorney authority to make decisions about the same treatment
Advance decisions regarding treatment for mental disorder in persons who are detained under Mental Health Act (MHA trumps MCA in this case)
Provision of basic or essential care

89
Q

What is conscientious objection?

A

HCPs do not have to do something that is against their beliefs but they must make arrangements for the patient to be transferred to the care of another health care professional

90
Q

What are the requirements for an LPA to be put in place?

A

Can only be made by a person aged 18 or over
Must be written and set out in the statutory form
Must include information about the nature and effect of the LPA
Signed statement by donor
Signed statement by donee (attorney)
Signed statement by independent third party
Must be registered with the Office of the Public Guardian
Power to make decisions about life sustaining treatment must be specified in the document

91
Q

What are limits to a patient’s options with regards to requesting treatments?

A

Treatment unavailable or not funded by NHS (nationally/locally)
Impact on others (other patients, family)
Treatment considered futile
Treatment considered not to be in patient’s interests (burden outweighs benefit) but presumption in favour of respecting patients’ wishes and in favour of life sustaining treatment

92
Q

What is required for a valid consent?

A

Capacity
Information
Freedom from coercion

93
Q

What legal frameworks underpin treatment without consent?

A

Doctrine of necessity: Common law, no time to assess capacity/life threatening
Principle of best interests: MCA, Patient lacks capacity
Detention under the Mental Health Act: Applies whether or not patient has capacity, But very specific conditions

94
Q

What are the criteria for capacity?

A

Patient is able to:
Understand the information necessary to make a decision Retain the information long enough to make a decision
Weigh the information in order to make a decision
Communicate their decision

95
Q

What is the legal framework on restraint in an emergency setting?

A

Restraint must be proportionate and minimum necessary to achieve the treatment goal
Treatment must be in the patient’s best interests and to prevent harm

96
Q

What are the components of the best interests checklist?

A

In determining for the purposes of this Act what is in a person’s best interests, the person making the determination must not make it merely on the basis of:
The person’s age or appearance
A condition of his, or an aspect of his behaviour, which might lead others to make unjustified assumptions about what might be in his best interests
In cases of life sustaining treatment the decision-maker must not be motivated by a desire to bring about the persons death
The decision maker must consider the person’s past/present wishes and feelings, beliefs and values
Take into account the views of those caring for the person and anyone with lasting power of attorney as to what would be in the person’s best interests

97
Q

What are the ethical underpinnings of treating a child in the emergency department?

A

Doctrine of necessity
Competent child’s consent
Parental consent (best interests)
Shared parental responsibility(for specific/limited situations) e.g teachers

98
Q

Who has parental responsibility for a child and can therefore consent to treatment in the emergency department?

A

Mother
Father if married to mother at time of birth
If not married, jointly registered the birth with the mother
By a parental responsibility agreement with the mother
By a parental responsibility order of the court

99
Q

What are ethical underpinnings of treating adults in the emergency department?

A

Consent from patient: Facilitate capacity, Competent refusal respected, Valid Advance refusal respected, Remember proxy consent
Doctrine of necessity
Best interests: Remember checklist
Mental Health Act (specific conditions)

100
Q

What are the major greenhouse gases?

A

Carbon dioxide
Methane
Nitrous oxide

101
Q

What factors can impact human health which are affected by climate change?

A 
Temperature effects
Air pollution
Aeroallergens
Ultraviolet radiation
Flooding
Vector-borne diseases
Water and food-borne diseases
102
Q

What reduction strategies can be used in healthcare to reduce emissions?

A

Reducing unnecessary energy use: heating, ventilation and air conditioning
Prevention of unnecessary interventions
New technologies: tele-conferencing and telemedicine can deliver efficiency savings as well as clinical gains

103
Q

What effects can diet have on climate change?

A

Rising incomes and urbanisation result in diets that are high in refined sugars, refined fats, oils and meats
This dietary shift will contribute to a predicted 80% rise in
agricultural GHG emissions from food production

104
Q

What is a sustainable system?

A

Meets the needs of the presentgeneration without compromising the ability of future generations to meet their own needs
Requires reconciliation of economic, environmental and social demands – three pillars of sustainability

105
Q

What are beneficial consequences of sharing information with a patient?

A

Benefit to patient
Benefit to other patients (improved patient safety)
Benefit to health care professionals (increased trust)
Benefit to the Institution (increased trust, reputational benefit, reduced complaints and litigation)

106
Q

What are potential reasons for non disclosure of information to patients?

A

Harm to patients and/or their families
Concept of ‘therapeutic privilege’
Harm to health care professionals (difficult conversations)
Harm to the Institution (Disclosure of error)
Resource implications (time involved)

107
Q

What virtues are required of a good doctor?

A

Honesty
Trustworthiness
Respectfulness
Courage

108
Q

What is therapeutic privilege?

A

Practice of withholding pertinent medical information from patients in belief that disclosure is medically contraindicated

109
Q

What does the Tracey judgment mean for disclosure of information to patients?

A

Disclosure of information relevant to a patient’s care to that patient is a legal obligation
Consent (common law)
Withholding treatment (Human Rights Act/Tracey)
Medical error (duty of candour)
It is also a professional obligation (GMC guidance)

110
Q

What is the duty of candour?

A

Statutory institutional duty
Set out in statute therefore legal requirement
Health and Social Care Act 2008: Regulation 20 (2014)
Formal process triggered by incident resultingin harm to patient: Level of harm, Cause and effect
Every healthcare professional must be open and honest with patients when something goes wrong with treatment or care which causes, or has potential to cause harm or distress. Must tell patient (or where appropriate, patient’s advocate, carer or family) when something has gone wrong, apologise, offer an appropriate remedy or support to put matters right (if possible) and explain fully, short and long term effects of what happened

111
Q

What counts as no harm, low harm and significant harm according to the statutory duty of candour?

A

No harm: An error or system failure that reaches the patient but does not result in patient harm – a near miss
Low harm: Any patient safety incident that required extra observation or minor treatment (first aid, additional therapy, additional medication)
Significant harm: Corresponds with National Reporting and Learning Service ‘moderate’, ‘severe’ and ‘death’, and with incidents notifiable to CQC with harm explicitly defined to include prolonged psychological harm in line with CQC reporting practice

112
Q

What is the GMC guidance on raising concerns?

A

All doctors have a duty to raise concerns where they believe that patient safety or care is being compromised by practice of colleagues or systems, policies and procedures in organisations in which they work. They must also encourage and support a culture in which staff can raise concerns openly and safely

113
Q

What fears might staff have about raising concerns?

A

Upsetting colleagues
Harm to career
Fear of complaint

114
Q

What processes need to be followed in order to raise concerns?

A

First raise concern with your manager/senior (Consultant, Clinical or medical director, or practice partner)
If concern is about that person you may need to go to clinical governance lead
Doctors in training, it may be a named person in Deanery or clinical supervisor
Document your concerns

115
Q

What are the duties of a medical student in raising concerns?

A

Moral responsibility to raise concerns about patient safety, dignity and comfort
Professionalism is not about doing minimum – it is about doing what is necessary to protect patients

Phase 3 (23 decks)

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