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PACES 2.0 > Communication > Flashcards

Communication Flashcards

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1
Q

4 principles of medical ethics

A

Autonomy
Non-maleficence
Beneficence
Justice

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2
Q

Divisions of the medico-legal system

A

Common (case) law
Statute law (Acts of Parliament)

Public (criminal) law
Private (civil) law

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3
Q

Court decisions follow …

A

Judicial precedent

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4
Q

Most common law breached in medical malpractice

A

Law of tort

Most important within that are negligence and battery

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5
Q

Negligence: claimants need to prove:

A

The doctor had a duty of care
There was a breach of the appropriate standard of care:
- Bolam test - acting in accordance with a reasonable body of medical opinion (even if in the minority)
- Bolitho test - must withstand logical analysis
The breach caused harm

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6
Q

Gillick competence

A

Those under 16 can consent to BUT NOT REFUSE treatment if they are deemed mature enough to understand the implications of their actions

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7
Q

Consent: Montgomery v Lanarkshire

A

Ruling stated that if there was a significant risk that could affect the decision made by a reasonable patient, it is expected a doctor would inform them of that risk

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8
Q

Disagreements with the attorney (LPA)

A

Court of Protection adjudicates on the decision

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9
Q

Mental Health Act 1983 is evoked to

A

Treat psychiatric illness in non-consenting patients

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10
Q

Section 5(2): AKA

A

Emergency doctors holding power

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11
Q

Section 5(2): content

A

Applied on inpatient for psychiatric assessment
72 hour duration
Convert to Section 2 or 3 unless cleared or discharged

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12
Q

Section 2: AKA

A

Admission for assessment order

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13
Q

Section 2: content

A

Applied by 2 written medical recommendations and an approved social worker or relative
In the community
28 day duration
May be converted to Section 3
Patient can appeal to tribunal within 14 days

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14
Q

Section 3: AKA

A

Admission for treatment order

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15
Q

Section 3: content

A

Applied as in Section 2 on patient with known disorder
6 month duration

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16
Q

Section 4: AKA

A

Emergency admission to hospital order

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17
Q

Section 4: content

A

Applied by one doctor and an approved social worker or relative
Urgent necessity is demonstrable
Can be converted to Section 2 or 3

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18
Q

Doctors must breach confidentiality to the relevant authorities in the following cases:

A

Notifiable diseases
Drug addiction
Abortion
In vitro fertilisation
Organ transplant
Births and deaths
Police requests
Search warrant signed by a circuit judge
Court order
Prevention, apprehension, or prosecution of terrorists or perpetrators of serious crimes

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19
Q

End of life: sanctity of life arguments

A

Non-maleficence
- extending life results in suffering
Justice
- trivial life extension occurs at enormous monetary expense

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20
Q

Withdrawing treatment is considered to be a

A

Passive act and not killing

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21
Q

Are food and water medical treatments that can be withdrawn?

A

Yes

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22
Q

Doctrine of double effect distinguishes actions that are intended to harm versus

A

Those where harm is foreseen but not intended
- morphine to palliate pain -> respiratory arrest
— primary aim is to alleviate pain

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23
Q

When a decision to withhold potentially life saving treatment/CPR is being made, does the patient/family have to be involved?

A

Yes

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24
Q

Information delivery: approach

A

Introduce self and reason for discussion
Check level of knowledge
- describe nature of condition using simple language
Facilitate and answer questions
Medication explanation
- indications, logistics, side effects
Precipitating factors
Lifestyle
Plan of action
Reiterate discussion and ensure understanding
Offer further sources of information
Organise appropriate follow up
Close interview

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25
Breaking bad news: approach
Private setting Invite other healthcare workers for support Introduce self and purpose of the discussion Offer opportunity for relatives to attend Check existing awareness Gauge how much information they would like Give bad news clearly and simply Pause and acknowledge distress Explore concerns If unsure of the treatment options advised it will be discussed at MDT - arrange appointment for after this meeting Recap and check understanding Offer another chance to speak/support groups/ leaflets Enquire as to how they are getting home
26
Breaking bad news: dealing with denial
Reiterate key message Confront inconsistencies in perception Acknowledge denial in sensitive way May need to arrange another discussion at a later date to allow news to sink in
27
Breaking bad news: dealing with anger
Acknowledge anger and empathise Terminate the session if necessary and arrange to meet at later date
28
Breaking bad news: prognosis questions
Explore why they would like to know - what will it change about the way they are living Answer in broad terms
29
H. Q my
30
Disclosing HIV status to patient’s sexual partners
Not an absolute indication to break confidentiality
31
Before breaching confidentiality, get advice from …
Senior colleagues GMC BMA RCP MDU
32
Confidentiality is protected by
The Human Rights Act 1998
33
The Data Protection Act 1998 regulates ….
The processing of an individuals information, including written and computer records
34
Does the duty of confidentiality continue after a patient dies?
Yes Access to Health Records Act 1990
35
Situations where no consent is required to breach confidentiality
Reporting terrorist activity Notification of communicable diseases Reporting serious crimes If ordered by a judge
36
The Mental Health Act excludes assessment, detainment, and treatment of
Alcohol and drug dependence Learning disability
37
What is a DS 1500 form?
Form completed by GP, hospital doctor, or specialist nurse Allows terminally ill patients to claim higher disability allowance Fast track Death should be expected within 6 months
38
Things to consider when giving a patient a new diagnosis
How will it affect their job/can they continue their job? How will it affect their hobbies? Smoking, alcohol, and recreational drugs
39
Approach to a non-compliant patient
Explore reasons why - side effects - ineffective treatment Educate Offer solutions - change of therapy - direct supervision
40
Approach to the self-discharging patient
Explain reasons to stay Check capacity Offer to call relative Advise you will contact GP to inform them
41
Smear positive TB patients attempting to self-discharge …
Can be detained but not treated under the Public Health Act
42
Approach to patient driving despite contraindication
Can breach confidentiality Attempt to get patient to inform DVLA - lack of insurance cover - safety - £1000 fine Written evidence if suspicious Inform patient of disclosure Explore impact on job/lifestyle Explore how patient will get home from clinic
43
Approach to medical mistake
Advise you have just found out Apologise Check understanding Check how much detail they would like to know Immediate consequences Long term consequences Concerns Offer a written apology State that apology will be documented in the medical record Explain DATIX for formal investigation PALS
44
Reporting adverse outcome of a drug
Yellow Card scheme
45
Considerations for patients who want an advance care plan
Check symptoms Check mood Check capacity Check if they want a discussion or a formal plan now Ensure they have person with them if desired Inform of process Consent to share with other healthcare professionals Re-review at next clinic appointment Check welfare at end of appointment - okay to get home - gather thoughts in waiting room
46
Drawing up and advanced care plan
Does not need to be witnessed by a legal professional Advisable to discuss with healthcare professional and family members Cannot demand treatment Can refuse treatment Can be updated Will be checked again if certain scenarios arise
47
Advanced decisions to refuse treatment are for
Patients with capacity and wish to express wish to refuse treatment in the future should they lose capacity
48
ADRT can be witnessed by
Anyone including family members
49
A doctor is at risk of what charge if they do not comply with an ADRT?
Battery
50
Risk of Hep B infection from needle stick injury
1:3 if unvaccinated
51
Risk of Hep C infection from needle stick injury
1:30
52
Risk of HIV infection from needle stick injury
1:300
53
Steps following needle stick injury
Dispose of the needle Encourage wound to bleed Wash with water for at least 60 seconds Use a plaster Take blood samples for blood born viruses Rapid immunisation if not vaccinated for Hep B May require PEP - first dose should taken within 72 hours Contact occupational health immediately DATIX
54
Lay terms description of epilepsy
Disorganised electrical activity in the brain
55
Approach to epilepsy diagnosis
Explore social/job aspects Avoidance of precipitants - alcohol, sleep deprivation, flashing lights Discuss medical management - lamotrigine has fewer side effects Discuss compliance Discuss pregnancy and contraception - seizure can induce miscarriages - drugs are teratogenic Safety - swimming, heights - driving British Epilepsy Society Ask how getting home
56
Discussion with relatives: important to check patient has …
Consented to discussion Avoid confidentiality issues
57
Approach to paracetamol overdose
Assess competency/capacity May need to assess ADRT - cannot be sure of the circumstances in which they were written Dose of paracetamol Time paracetamol taken Alcoholism and anti-epileptics Suicidal intent Previous psych hx - previous episodes Agree treatment plan Refer to deliberate self-harm team
58
59
If in doubt, treat overdose patients under …
Common law Acting in best interests
60
The Mental Health Act cannot be invoked to treat …
Overdose patients
61
How to inform NOK about brain-stem death
They have died and only the ventilator is keeping their other organs going The part that makes them ‘them’ is gone
62
How to approach organ donation with NOK
While they are brain-dead their other organs are working well and are suitable for donation What were their wishes? Inform about: Need for operation to harvest organs HIV testing prior to donation Not all organs may be used Time delay prior to DC and release of the body Transplant coordinator
63
Brain-stem death must be established by
Two consultants independently
64
Criteria for brain-stem death
Cause of death is known and all reversible causes have been treated - irreversible - permanent Absent brain-stem reflexes with no respiratory drive at PaCO2 >50mmHg
65
Capacity in an anorexic patient
May not be competent to refuse treatment due to effect of malnutrition on cognition
66
Family therapy can be useful in treating
Anorexia nervosa
67
Vaccination compliance: conversation goal
Ensure that the patient is informed to make the best decision for herself and her baby NOT to have a vaccination
68
Vaccination during pregnancy: Covid and flu
Evidence of protection Recommended by Royal College of Obstetricians and the Joint Committee on Vaccination and Immunisation
69
Benefits of flu vaccine in pregnancy
Decreases risk of premature or low birthweight babies Decreases risk of stillbirth Protects mother from pneumonitis Protection passed on to baby to some degree
70
Benefits of Covid-19 vaccination in pregnancy
Studies show it is safe for mother and baby - over 250,000 pregnant women have been vaccinated - lower rates of infection - similar rates of hospitalisation - lower O2/vasopressor requirements Side effects are similar - myocarditis most often seen in men
71
Covid-19 and flu vaccines in breastfeeding
No concerns
72
Provoking factors deemed low risk in PE
Surgery with GA >30 minutes Trauma with fracture to bones Strict bed rest in hospital for >3 days
73
Annual risk of further PE if no provoking factors
4.5% - increased if D-dimer continues to be elevated 3 months following the event
74
Antidote to apixaban and rivaroxaban
Andexanet alpha - recombinant Factor Xa
75
A death may be referred to the coroner if:
The cause of death is unknown The patient was not seen in the 28days before or time after by a person who could issue a DC Death occurred during or soon after a medical procedure Death could be due to chemical exposure at work Death is the result of an accident or injury The death is unnatural, violent, or suspicious
76
Prohibited jobs in patients taking insulin
Driving HGVs, buses, and taxis Armed forces Airline pilots
77
DVLA: permanent ban on Type 2 license
ICD HOCM
78
Predictive genetic testing in HD: counselling patients
Can be false negative or false positive Most people choose not to do the test Results are ‘predicted (not) to be affected)
79
Pre-symptomatic HD: pre-implantation genetic diagnosis
Available for couples with ‘predicted to be affected’ result IVF with testing prior to implantation
80
Emergency treatment in those without capacity
Give in best interests unless ADRT in place
81
Smoking cessation approach
Brief advice to stop smoking Refer to local NHS stop smoking service Pre-existing respiratory or cardiovascular issues - NRT - varenicline - bupropion
82
Ethical issues relating to live-donor transplantation
Must be non-conditional Screening for suitability Work-up can reveal previously unknown issues - paternity - HIV status Human Tissue Act 2004 - commercial dealings are prohibited - donor must be interviewed by independent assessor
83

PACES 2.0 (9 decks)

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