Ethical Scenario

Question 1

Explain the I SPIED structure for answering ethical scenario questions

Answer 1

An example of this could be the I SPIED structure:

Issues raised – summarise the key issues a scenario presents
E.g. This scenario raises 2 key issues – patient autonomy and confidentiality…
Seek information – finding out more information
E.g. I would speak to the patient’s family to find out more about their exact concerns…
Patient safety – before any personal or colleague issues can be addressed
E.g. My first concern would be for patient safety, therefore I would ensure…
Initial measures – what could you do in this situation to help resolve it
E.g. I would first like to approach my colleague to see if they would accept…
Escalate – in almost all ethical scenarios, involving a senior is important
E.g. I would make sure I escalate my concerns to my clinical supervisor…
Document & Reflect – keeping a record of difficult issues and learning from them
E.g. Having resolved the initial problem, I would make sure I documented these discussions in the patient notes and then reflected in my portfolio…

Question 2

Name the 4 pillars of medical ethics

Answer 2

Autonomy – all patients with capacity have the right to make their own decisions
Beneficence – maximising the benefit of our actions to help patients
Non-maleficence – we must strive to avoid causing harm to our patients
Justice – any decisions must be fair between individuals

Question 3

What is key regarding patient confidentiality

Answer 3

Patient information must only be shared on a need to know basis unless consent is given or under certain exceptional circumstances.

Question 4

What is duty of candour

Answer 4

This is our professional responsibility to inform patients about mistakes made during medical care.

Question 5

May get asked to discuss with family member/ patient what is important to remember

Answer 5

Avoid jargon
SPIKES model if BBB

Question 6

When dealing with a difficult colleage what is important

Answer 6

Escalate locally to colleague first and +/- colleagues ES if significant issue

Question 7

You are a medical SHO. One of your fellow junior doctors in training has been posting comments on public social media about the dangers of vaccination and advising people that vaccinations like the MMR vaccine can cause harm to them and their loved ones. They are posting links to websites, which have similar themes, and advising people that as a doctor they would advise people not to get vaccinated.

What is your opinion on how this doctor is conducting themselves in a public forum?

Answer 7

Important points -

• Could be dangerous and cause harm to patients
• Can post thoughts/opinions online but important to understand added responsibility as a doctor.
• GMC clearly states that IF you identiify yourself as a dr online - must post factual information so patients arent exploiting like this scenario with patients possibly being influenced to avoid vaccination.
• Not professional behaviour of Dr of any grade

Question 8

You are a medical SHO. One of your fellow junior doctors in training has been posting comments on public social media about the dangers of vaccination and advising people that vaccinations like the MMR vaccine can cause harm to them and their loved ones. They are posting links to websites, which have similar them

What would you do about these posts by this doctor?

Answer 8

Key points -

• clearly a cause for concern but as fellow professional - raise with dr first.
• Try and understand why they have posted it (e.g. misinformed, cohersion, hacked etc)
• Try and explain how this can be dangerous to post etc.
• If no further forward - advise dr that you have to escalate

Question 9

You are a medical SHO. One of your fellow junior doctors in training has been posting comments on public social media about the dangers of vaccination and advising people that vaccinations like the MMR vaccine can cause harm to them and their loved ones. They are posting links to websites, which have similar themes, and advising people that as a doctor they would advise people not to get vaccinated

Who could you escalate this incident to?

Answer 9

Key points -

• Individuals direct supervisor after discussing incidence with Dr
• Then can raise to deanary after this (postgrad dean) if needed.
• When to raise to GMC - Cannot raise with responsible person as aprt of problem, unsatisified with action after locally raising, immediate risk to patients

Question 10

You are a medical SHO. One of your fellow junior doctors in training has been posting comments on public social media about the dangers of vaccination and advising people that vaccinations like the MMR vaccine can cause harm to them and their loved ones. They are posting links to websites, which have similar themes, and advising people that as a doctor they would advise people not to get vaccinated.

Where can you turn for guidance on a doctor’s responsibility online and in social media forums?

Answer 10

• GMC sets clear guidance out online
• BMA have social media guidance
• Usually have F1/F2 teaching regarding this
• Medical defence unions give out social media support and guidance

Question 11

You are a medical SHO. One of your fellow junior doctors in training has been posting comments on public social media about the dangers of vaccination and advising people that vaccinations like the MMR vaccine can cause harm to them and their loved ones. They are posting links to websites, which have similar themes, and advising people that as a doctor they would advise people not to get vaccinated.

What are the dangers associated with his kind of post?

Answer 11

Speak about wider public health points. Important and dangerous post due to recent movement on vaccine changes -

Generally falling vaccination rates.

MMR - Fallen after Dr Andrew wakefield scandal and autism link

New president and VP Robert F Kennedy wants vaccine overall and inquiry in the US with risk of fake news causing fall in vaccine rates, already started to be seen in USA.

Question 12

You are a medical SHO working on a busy acute medical ward. One of your colleagues called in sick with an upper respiratory tract infection and has informed the consultant in charge that they are recuperating at home. You have since seen them posting pictures to social media of themselves in a restaurant with friends. They should have been on a night shift when the photos were posted and the team on nights were left short-handed because of their absence.

What are the issues that you have identified with this scenario?

Answer 12

Patient safety - at stake due to short staffed now. Can be professional issue for that Dr due to this.

Professionalism - important to isolate especially since COVID-19 pandemic. Putting others at risk of disease.

Question 13

You are a medical SHO working on a busy acute medical ward. One of your colleagues called in sick with an upper respiratory tract infection and has informed the consultant in charge that they are recuperating at home. You have since seen them posting pictures to social media of themselves in a restaurant with friends. They should have been on a night shift when the photos were posted and the team on nights were left short-handed because of their absence.

What steps would you take to address this situation?

Answer 13

• Important to colleague first. Pictures could be from different time so gather the facts first.
• If they did lie/ attended when ill - important to discuss how this can affect pt safety and their professionalism.

-Get indiviudal to discuss with own ES first before going to their ES.

Question 14

You are a medical SHO working on a busy acute medical ward. One of your colleagues called in sick with an upper respiratory tract infection and has informed the consultant in charge that they are recuperating at home. You have since seen them posting pictures to social media of themselves in a restaurant with friends. They should have been on a night shift when the photos were posted and the team on nights were left short-handed because of their absence.

Who could you escalate this issue to if you had further concerns?

Answer 14

• if still concerns, the dr inquestions ES/CS
• The med reg on that shift who is in charge.

Question 15

You are a medical SHO working on a busy acute medical ward. One of your colleagues called in sick with an upper respiratory tract infection and has informed the consultant in charge that they are recuperating at home. You have since seen them posting pictures to social media of themselves in a restaurant with friends. They should have been on a night shift when the photos were posted and the team on nights were left short-handed because of their absence.

What do you understand by professionalism and why is it important in healthcare?

Answer 15

• Professionalism is the acts and ethos that ensure we act as caring, responsible, effective and most importantly safe doctors.
• We do this by making the care and safety of patients our first concern
• keeping up to date with skills and knowledge.
• Being a good team player and responsible for our own actions with honesty and integrity

Question 16

You are a medical SHO working on a busy acute medical ward. One of your colleagues called in sick with an upper respiratory tract infection and has informed the consultant in charge that they are recuperating at home. You have since seen them posting pictures to social media of themselves in a restaurant with friends. They should have been on a night shift when the photos were posted and the team on nights were left short-handed because of their absence.

What is meant by probity and why is it important?

Answer 16

Probity is the quality of having strong moral principles such as honesty and deceny and is essential as a responsible doctor.

• Probity is important because trust is the foundation of the doctor-patient relationship.
• Need it to allow the pt to disclose key and sensitive info and to allow them to feel safe to do so.
• Also key to be honest and decent for good strong MDT teamwork arround pt centred care

Question 17

You are the IMT1 doctor working on a cardiology ward.

Whilst on the ward you see your registrar taking a bottle of morphine sulphate solution and putting it into their personal bag.

This has not been prescribed for any of their patients to your knowledge.

How would you approach this scenario?

Answer 17

• Raises patient safety risk and registrars professionalism.
• Concern that registrar may have drug addiction/for family member but important to approach registrar non-judgementally and try to discuss why they have put it in their bag and any difficulties they are facing.
• Patient safety concern - is the reg under the influence?
• First approach reg to get level of patient safety risk there is.
• Likely needs to be escalalted to registrars senior. Inform reg of this and offer them support.
• Should not deal with this scenario independently.
• Really important to reflect on scenario and document any important discussions.

Question 18

You are the IMT1 doctor working on a cardiology ward.

Whilst on the ward you see your registrar taking a bottle of morphine sulphate solution and putting it into their personal bag.

This has not been prescribed for any of their patients to your knowledge.

Please explain how you would approach and communicate with the registrar.

Answer 18

• Discuss in private
• No accusatory language by explaoining my concerns
• Ask for explination
• Support reg and empathise with difficullties
• Being assertive to explain will have to contact senior.

Question 19

You are the IMT1 doctor working on a cardiology ward.

Whilst on the ward you see your registrar taking a bottle of morphine sulphate solution and putting it into their personal bag.

This has not been prescribed for any of their patients to your knowledge.

How would you escalate the issue?

Answer 19

Escalate to most senior person my team or my own supervisor first.

Then escalate to CS/ES of reg

Any inappropriateness or difficulty of these then escalate to local training programme director

GMC is last line if required.

Question 20

You are the IMT1 doctor working on a cardiology ward.

Whilst on the ward you see your registrar taking a bottle of morphine sulphate solution and putting it into their personal bag.

This has not been prescribed for any of their patients to your knowledge.

How might patient safety be affected?

Answer 20

Most obvious is reg being under the influence so urgent escalation is key to limit patient risk.

Question 21

You are the IMT1 doctor working on a cardiology ward.

Whilst on the ward you see your registrar taking a bottle of morphine sulphate solution and putting it into their personal bag.

This has not been prescribed for any of their patients to your knowledge.

How could you support colleague?

Answer 21

Difficult discussion but important to empathise with difficulties they have so they feel they can confide in you so you can give appropriate advice.

Reg should see their own GP or occupational health or support services for doctors.

Question 22

You are the IMT1 working on the gastroenterology ward.

One of your registrars has asked you to amend an entry in the notes from yesterday in which you documented the patient’s consent for a ward-based procedure.

You have been asked to add in writing that “the risks of bleeding, infection and damage to local structures were explained to the patient who fully understands this”. At the time, you did not think these risks were fully discussed with the patient.

How would you approach this scenario?

Answer 22

Raises key concerns of patient consent and autonomy but also professionalism of senior.

• Need to clarify why colleague wants to change it. Could be because complication has happened from procedure or reg has genuienly forgotten.
• Patient safety - if patient did not have informed consent/capacity then procedure could be viewed as assault.
• Refuse to alter notes for the reg as does not constitiute GMP and could be misleading. Could add new entry with a dated and timed ammendum to now and why it is being added.
• escalate to seniors if reg was trying to escalate for sinister reasons.
• Meet with senior or written reflection to allow you to personally reflect on it

Question 23

You are the IMT1 working on the gastroenterology ward.

One of your registrars has asked you to amend an entry in the notes from yesterday in which you documented the patient’s consent for a ward-based procedure.

You have been asked to add in writing that “the risks of bleeding, infection and damage to local structures were explained to the patient who fully understands this”. At the time, you did not think these risks were fully discussed with the patient.

How would you escalate/report situation?

Answer 23

Escalate once understood why reg has asked for ammendum.

Escalate to direct consultant in charge –> ES/CS –> GMC

Question 24

You are the IMT1 working on the gastroenterology ward.

One of your registrars has asked you to amend an entry in the notes from yesterday in which you documented the patient’s consent for a ward-based procedure.

You have been asked to add in writing that “the risks of bleeding, infection and damage to local structures were explained to the patient who fully understands this”. At the time, you did not think these risks were fully discussed with the patient.

How would you define informed consent

Answer 24

Informed consent is giving patients the necessary information about a procedure/treatment to allow them to weigh up the risks and benefirst to make appropriate decisions about their care.

Main areas are risks, benefits, alternatives.

Important to formally check they have capacity if any concerns regarding this.

Question 25

You are the IMT1 working on the gastroenterology ward. One of your registrars has asked you to amend an entry in the notes from yesterday in which you documented the patient’s consent for a ward-based procedure. You have been asked to add in writing that “the risks of bleeding, infection and damage to local structures were explained to the patient who fully understands this”. At the time, you did not think these risks were fully discussed with the patient. In what scenarios is written consent needed in hospital medicine?

Answer 25

Surgical procedures, major medical procedures - LPs, ascitic drains etc. I cannot get consent for a procedure that I am not competent in or doing.

Question 26

You are the IMT1 working on the gastroenterology ward. One of your registrars has asked you to amend an entry in the notes from yesterday in which you documented the patient’s consent for a ward-based procedure. You have been asked to add in writing that “the risks of bleeding, infection and damage to local structures were explained to the patient who fully understands this”. At the time, you did not think these risks were fully discussed with the patient. What would you do about written consent if the patient is deemed not to have capacity and a procedure is needed in their best interests?

Answer 26

First - formal capacity assessment to assess if pt can communicate, understand, retain, make decisions. Give patients tools to do so - hearing aids, whiteboards etc. Important to consider if Ix/procedure can wait until pt regains capacity (if they do). Second - consider if any advance directives such as lasting power of attorney for healthcare/welfare who can help make decisions. If the patient does not have capacity and there is no advance directive to refuse treatment, then the procedure can still go ahead in a patient’s best interests. Most hospital trusts have a different written consent process (for example a ‘consent form 4’) to address this situation. Important to still discuss with NOK.

Question 27

You are the IMT1 working on the gastroenterology ward. One of your registrars has asked you to amend an entry in the notes from yesterday in which you documented the patient’s consent for a ward-based procedure. You have been asked to add in writing that “the risks of bleeding, infection and damage to local structures were explained to the patient who fully understands this”. At the time, you did not think these risks were fully discussed with the patient. Can you outline how to communicate risks and benefits of diagnositic procedure to a patient?

Answer 27

Use lay language Maximise pt involvement and give them risks and benefits and other Rx options. Always allow pt to ask questions in collaborative pt centred care.

Question 28

You are the IMT1 working on a respiratory ward. You have been asked to stay on beyond your normal working hours by the consultant due to a staff sickness leaving the evening shift uncovered at late notice. You had plans to attend a close friend’s birthday party after work. None of your current colleagues on the ward appear willing to cover the shift at present. How would you approach this situation?

Answer 28

Key points highlighted - personal wellbeing, employment rights and professional obligations. Patient safety is key - short staff is a pt safety concern. Think about what payscale would be used, if other employees from other ward could cover? could senior step down? Escalate to guardian of safe working may prevent it happening again. Reflect on personal frustrations. Overall will have to do shift if no alternative due to immediate safety concerns for patients which is priority.

Question 29

You are the IMT1 working on a respiratory ward. You have been asked to stay on beyond your normal working hours by the consultant due to a staff sickness leaving the evening shift uncovered at late notice. You had plans to attend a close friend’s birthday party after work. None of your current colleagues on the ward appear willing to cover the shift at present. How to communicate difficulties with consultant in question?

Answer 29

Stay professional and objective and having a degree of assertiveness by sticking up for self isnt a bad quality to have. However, overall important to be honest and professional and to do the shift if no alternative as pt safety concern.

Question 30

You are the IMT1 working on a respiratory ward. You have been asked to stay on beyond your normal working hours by the consultant due to a staff sickness leaving the evening shift uncovered at late notice. You had plans to attend a close friend’s birthday party after work. None of your current colleagues on the ward appear willing to cover the shift at present. If agreed to stay late, is there any avenues by which you could raise the issue on the following days?

Answer 30

Exception reporting would be key. Raising with Guardian of safe working.

Question 31

You are the IMT1 working on a respiratory ward. You have been asked to stay on beyond your normal working hours by the consultant due to a staff sickness leaving the evening shift uncovered at late notice. You had plans to attend a close friend’s birthday party after work. None of your current colleagues on the ward appear willing to cover the shift at present. What do you understand by the term burnout with regards to healthcare professionals?

Answer 31

Burnout is a major problem in the medical workforce and is likely to continue to worsen as the NHS workload remains at a high intensity. Recognising the signs of burnout such as feelings of detachment, exhaustion, compassion fatigue, loss of motivation, avoidance of responsibility, inappropriate coping strategies and excessive anger or frustration is important for all clinicians. This is particualrly important for IMTs/SpRs with intense rotas and decision fatigue therefore maintaining work-life balance would be important here, especially if happening many times.

Question 32

You are the IMT1 working on the acute medical unit. One of your FY1 colleagues has made a post on social media making fun of a patient’s behaviour following an on call shift. The post did not contain any patient identifiable information but would clearly be offensive to the individual in question if they were able to see it. How would you approach this situation?

Answer 32

Raises two main concerns - patient confidentiality and proffesionalism of F1 First step - clarify nature of the post and whether patient safety/confidentiality concerns by approaching F1. Pt can still be identified due to discription of scenario even without clear patient identifiers. Suggest to F1 to take down post and explain why. Encourage F1 to self-report issue to ES and to reflect on it. If not, report F1 to ES. Provide empathetic and educational approach to F1 as import to have mentoring role as IMT.

Question 33

You are the IMT1 working on the acute medical unit. One of your FY1 colleagues has made a post on social media making fun of a patient’s behaviour following an on call shift. The post did not contain any patient identifiable information but would clearly be offensive to the individual in question if they were able to see it. The F1 colleage becomes distressed by mistake adn calls into sick for work for the rest of the week. How could you address and support colleague?

Answer 33

Empathise that it is stressful for the F1 due to being new etc. May have worries about early impression/career implications and embarrased by this. Be empathetic and non-judgemental. Use as education opportunity to signpost colleague to resources in a non-patronising way. Explain that calling in sick is not a feasible way to manage this but try and ensure patients mood is not significantly low or worrying low due to the recent issues.

Question 34

You are the IMT1 working on the acute medical unit. One of your FY1 colleagues has made a post on social media making fun of a patient’s behaviour following an on call shift. The post did not contain any patient identifiable information but would clearly be offensive to the individual in question if they were able to see it. What are the main issues around social media use for doctors?

Answer 34

Patient confidentiality - discussing any individual cases should be avoided in a public space regardless of the use of identifiable information. Physician anonymity - identifying yourself as a doctor and including your name poses challenges to your privacy and being contacted by members of the public. Professional boundaries - the type of interactions facilitated by social media platforms could make it harder to establish clear social and professional boundaries with other users. Misinformation - any facts or sources of information posted could be subject to bias or errors. It is particularly important to be sure of the validity of any resources shared under your name as a healthcare professional. Giving medical advice is best avoided entirely due to the potential legal and ethical ramifications of unofficial interactions and potential consequences.

Question 35

You are the IMT 1 doctor working on the endocrinology ward. You are due to attend a weekly IMT teaching, but for the past 4 weeks you have been told by your consultant not to attend the teaching due to significant staffing pressures on the ward. The consultant has today again requested that you do not attend teaching and instead stay on the ward. What issues does this scenario raise?

Answer 35

Difficult balance between training and service provision is common in medical training and IMT is no different. Important to be able to attend training to ensure competent IMTs to become regs/consultants but patients safety is also a key and important issue here. If genuine medical emergency then obvs cant leave for teaching. However if staffing/culture issue then important to escalate.

Question 36

You are the IMT 1 doctor working on the endocrinology ward. You are due to attend a weekly IMT teaching, but for the past 4 weeks you have been told by your consultant not to attend the teaching due to significant staffing pressures on the ward. The consultant has today again requested that you do not attend teaching and instead stay on the ward. How would you approach this issue?

Answer 36

Raise immediate conerns with consultant and then escalate to clinical supervisor and guardian of safe working if needed. Can accept an exception report

Question 37

You are the IMT 1 doctor working on the endocrinology ward. You are due to attend a weekly IMT teaching, but for the past 4 weeks you have been told by your consultant not to attend the teaching due to significant staffing pressures on the ward. The consultant has today again requested that you do not attend teaching and instead stay on the ward. How to explain your position to consultant in question?

Answer 37

Remain calm and professional, explain this is 3rd/4th week without teaching and its key compulsory portfolio requirement. Could see if consultant lets you go after this, if not then stay on ward and explain that it will be escalated.

Question 38

You are the IMT 1 doctor working on the endocrinology ward. You are due to attend a weekly IMT teaching, but for the past 4 weeks you have been told by your consultant not to attend the teaching due to significant staffing pressures on the ward. The consultant has today again requested that you do not attend teaching and instead stay on the ward. Do consultants have a contractual obligation to help facilitate teaching for junior trainees?

Answer 38

Yes - It is a professional and contractual requirement for consultants working in areas with trainees to help facilitate their education and training. Most consultants enjoy teaching, as do I, and they too also understand its importance so are likely to encourage you to attend teaching.

Question 39

You are an FY2 on a Geriatric ward. You have been asked to see Mrs Smith on the medical take who has been admitted with a hospital acquired pneumonia. She had been on your ward three days ago following a fall at home but was discharged after the physiotherapists had declared her safe to go home. Her daughter is with her and is very upset as she feels her mother was discharged inappropriately. She told the consultant looking after her mother that she didn’t think she was safe to be discharged because no one was at home looking after her. She recognises you from the previous admission and wants to know why her mother’s pneumonia wasn’t picked up before her discharge. She would like to make a formal complaint. Who are the satekholders in this situation?

Answer 39

The patient - main concern is their safety and health. Daughter - upset regarding missed diagnosis. Consultant - important to inform them. Me - invovled in both admissions. Physio team - were the concerns addressed?

Question 40

You are an FY2 on a Geriatric ward. You have been asked to see Mrs Smith on the medical take who has been admitted with a hospital acquired pneumonia. She had been on your ward three days ago following a fall at home but was discharged after the physiotherapists had declared her safe to go home. Her daughter is with her and is very upset as she feels her mother was discharged inappropriately. She told the consultant looking after her mother that she didn’t think she was safe to be discharged because no one was at home looking after her. She recognises you from the previous admission and wants to know why her mother’s pneumonia wasn’t picked up before her discharge. She would like to make a formal complaint. How would you deal with the daughter

Answer 40

Main priority is ensuring patient safety - treating CAP etc. Important to try and diffuse situation and to ask patient and family to have time to re-read notes to refamilarise self with case and documentation regarding decisions made. Important to ensure daughter feels heard and empathised with. Try get someone to hold bleep. Apologise and showing empathy in situation will help. Giving explinations will also help. Identify daughters concerns and expictations. Give options to daughter for making formal complaint

Question 41

You are an FY2 on a Geriatric ward. You have been asked to see Mrs Smith on the medical take who has been admitted with a hospital acquired pneumonia. She had been on your ward three days ago following a fall at home but was discharged after the physiotherapists had declared her safe to go home. Her daughter is with her and is very upset as she feels her mother was discharged inappropriately. She told the consultant looking after her mother that she didn’t think she was safe to be discharged because no one was at home looking after her. She recognises you from the previous admission and wants to know why her mother’s pneumonia wasn’t picked up before her discharge. She would like to make a formal complaint. What do you understand regarding the term PALS

Answer 41

PALS stands for Patient Advice and Liaison Service. They offer confidential advice, support and information on health-related matters. They provide a point of contact for patients, families and carers. Amongst other things, PALS can give information on the NHS complaints procedure, including how to seek independent help if you want to make a complaint.

Question 42

You are an FY2 on a Geriatric ward. You have been asked to see Mrs Smith on the medical take who has been admitted with a hospital acquired pneumonia. She had been on your ward three days ago following a fall at home but was discharged after the physiotherapists had declared her safe to go home. Her daughter is with her and is very upset as she feels her mother was discharged inappropriately. She told the consultant looking after her mother that she didn’t think she was safe to be discharged because no one was at home looking after her. She recognises you from the previous admission and wants to know why her mother’s pneumonia wasn’t picked up before her discharge. She would like to make a formal complaint. How are complaints handled in the NHS?

Answer 42

Two-staged scheme - stage 1 - local resolution stage 2 - if above fails, refer the matter to the Parliamentary and Health Service Ombudsman.

Question 43

You are an FY2 on a Geriatric ward. You have been asked to see Mrs Smith on the medical take who has been admitted with a hospital acquired pneumonia. She had been on your ward three days ago following a fall at home but was discharged after the physiotherapists had declared her safe to go home. Her daughter is with her and is very upset as she feels her mother was discharged inappropriately. She told the consultant looking after her mother that she didn’t think she was safe to be discharged because no one was at home looking after her. She recognises you from the previous admission and wants to know why her mother’s pneumonia wasn’t picked up before her discharge. She would like to make a formal complaint. What is the parilmentary and health service ombudsman?

Answer 43

The PHSO is responsible for considering and handling complaints that have not been resolved by the NHS in England. They are an independent and free service that is financed by the UK Government. If they decide that the organisation has got things wrong, they may make recommendations for it to put them right. This can include explanations, apologies and recommendations for the service to learn and improve.

Question 44

Who is available for support, if a complaint is made against your practice?

Answer 44

Clinical and educational supervisor Training programme director Medical defence union Medical union such as the British Medical Association Trust legal team

Question 45

You are the medical SHO covering the AMU. One of your patients is a 66-year-old gentleman who has been admitted with haemoptysis. Following investigation it has been discovered that he has a primary lung cancer. The nurse in charge of the AMU asks you to speak to the patient’s daughter. She demands to know what is wrong with her father because “he won’t tell me.” She appears upset and won’t leave the nurse’s desk until she gets answers. She has been shouting at the nurse in charge for the last two minutes and this is why you have been called. How would you approach this situation?

Answer 45

Key features of patient confidentiality and conflict resolution. Introduce self to daughter and ask to speak to daughter privately with nurse in charge. Find out why daughter is so upset and how much she knows so far. Explain patient has right to confidentiality and thus I am not in position to share more info if he does not want to share it. However, I can chat to patient to determine if there is anything we can do to help if he is struggling to communicate what he would like to with the daugher. Then inform daughter of inappropriate behaviour to ward staff. If becomes aggressive then contact hospital security and have her removed from ward. Important to ensure sister is okay after all this.

Question 46

You are the medical SHO covering the AMU. One of your patients is a 66-year-old gentleman who has been admitted with haemoptysis. Following investigation it has been discovered that he has a primary lung cancer. The nurse in charge of the AMU asks you to speak to the patient’s daughter. She demands to know what is wrong with her father because “he won’t tell me.” She appears upset and won’t leave the nurse’s desk until she gets answers. She has been shouting at the nurse in charge for the last two minutes and this is why you have been called. What steps can be taken to resolve situation?

Answer 46

Empathise with daughter and explain paitents right to confidentiality but will talk to patient. Discussion with patient - try explain that daughter is upset for being kept in dark, find out why he wont tell her and explain that I could help/be there when bad news is broken.

Question 47

You are the medical SHO covering the AMU. One of your patients is a 66-year-old gentleman who has been admitted with haemoptysis. Following investigation it has been discovered that he has a primary lung cancer. The nurse in charge of the AMU asks you to speak to the patient’s daughter. She demands to know what is wrong with her father because “he won’t tell me.” She appears upset and won’t leave the nurse’s desk until she gets answers. She has been shouting at the nurse in charge for the last two minutes and this is why you have been called. Why is patient confidentiality so important?

Answer 47

Need for patient trust to divulge essential info for diagnosis or treatment. Also, confidentiality is part of patient autonomy and they have a right to choose who their info is shared with.

Question 48

What simple steps at work can you take to avoid breaching confidentiality?

Answer 48

Lock computer screens Tidy patients notes away Keep pt info on whiteboards/screens to a minmum Keep handover sheets anonymised and bin in confidential waste bins In an instance where the patient is accompanied, ask the patient if they are happy with that person staying while you talk and examine them. Ensure pt consent to discuss info. Be safe on social media Ensure unique identifiers used for telephone calls and gain pts consent to discuss with family.

Question 49

You are the medical SHO oncall overnight covering the AMU. The nurse in charge tells you that Miss Smith, a 28-year-old woman, who was admitted earlier today, wants to be discharged. She was admitted with pyelonephritis and has been started on IV antibiotics. She is telling the nursing staff she feels much better and needs to get home. The nurse does not think Miss Smith should be allowed to leave as she still has several days left of treatment. He has asked you to come and speak with the patient How would you approach this patient

Answer 49

Start by finding out more info via patient notes and discussing with nurse in charge. Find out with patient why she wants to leave. If feeling better - educate why this is the case and why she cant leave as rx not finished. If other reasons then explore these. If patient wants to leave, formally assess capacity. If no capacity - DOLs If capacity - send home with worsening statement advice and try to arrange alternative treatments to baalnce autonomy and beneficience such as oral antibiotics and review in ambulatory care.

Question 50

What do you understand by capacity?

Answer 50

Mental capacity is the ability to make decisions by yourself. The Mental Capacity Act 2005 states that every adult has the right to make his or her own decisions and that capacity should be assumed until proven otherwise. All individuals should be encouraged and empowered to make their own decisions. Individuals have the right to make decisions that may seem unwise to others.

Question 51

How do you assess capacity?

Answer 51

Assessing capacity is a two stage test. If there is no impairment of mind (stage 1) then the patient can be assumed to have capacity. If there is an impairment of mind then to demonstrate capacity the patient must: Understand the information relevant to the decision Retain the information Weigh up the information in the decision making process Communicate the decision

Question 52

The patient has capacity and wants to leave. Who else could help you with this situation?

Answer 52

I would contact my registrar to inform them of the situation and explain why I am concerned about the patient leaving. It may be that their greater experience in dealing with these kinds of situations may persuade the patient to stay. I would also ask the patient if there were anyone she would like me to contact. Perhaps there is a family member who will be able to convince her to stay. However, I have to be careful that I do not break confidentiality and would only talk to the patient’s relatives if she gave me permission.

Question 53

Do you still have a duty of care to the patient if she self-discharges?

Answer 53

Important to remember beneficience - safety net, medication on discharge and appropriate follow-up

Question 54

You are the medical SHO in the Ambulatory Care Unit. You are reviewing a patient who was seen in AMU last week. He is 26 years old and presented initially following a seizure. No cause was found and he was discharged. No medication was started and follow-up was arranged in the first seizure clinic in two months time. He has come in today to have a repeat blood test and general review. You note in the discharge summary that the patient was advised to stop driving. However, when the patient sits down he puts his car keys on the table. How would you approach this issue?

Answer 54

Find out more info - find out if they are still driving. Start by building rapport and determine if he remembers info regarding medication/driving and other ways of keeping himself safe after seizures - e.g. no baths, driving etc. Ask outright if he is driving and explain why he can no longer drive and must inform DVLA. Important to remain non-judgemental.

Question 55

You are the medical SHO in the Ambulatory Care Unit. You are reviewing a patient who was seen in AMU last week. He is 26 years old and presented initially following a seizure. No cause was found and he was discharged. No medication was started and follow-up was arranged in the first seizure clinic in two months time. He has come in today to have a repeat blood test and general review. You note in the discharge summary that the patient was advised to stop driving. However, when the patient sits down he puts his car keys on the table. Following discussing the risks of driving after a seizure, the patient states he understands but is refusing to stop. What is the next step?

Answer 55

Try to understand patients reasons behind this - could be needs to drive for job or family reasons. Try and reacha solution. If patient does not agree - inform DVLA and inform patient you will be doing this.

Question 56

You are the medical SHO in the Ambulatory Care Unit. You are reviewing a patient who was seen in AMU last week. He is 26 years old and presented initially following a seizure. No cause was found and he was discharged. No medication was started and follow-up was arranged in the first seizure clinic in two months time. He has come in today to have a repeat blood test and general review. You note in the discharge summary that the patient was advised to stop driving. However, when the patient sits down he puts his car keys on the table. Patient gets angry and says he will sue you if you tell DVLA, who can you ask for help in this situation?

Answer 56

Senior -reg or consultant.

Question 57

3 times confidentiality can be breached?

Answer 57

The patient consents Disclosure is in the patient's best interest, and it is neither appropriate nor practical to seek consent Disclosure is in the public interest.

Question 58

If a patient has refused to stop driving, despite advice, would you inform their employer?

Answer 58

No, as this would be a confidentiality breach – telling their employer without their consent would mean informing them of a patient’s health information without permission, which risks significant damage to the patient-doctor relationship.

Question 59

In what other conditions should patients be informed to contact the DVLA and refrain from driving for a determined period of time?

Answer 59

Alcohol Drugs and Substance Misuse and Driving Cardiovascular System and Driving Diabetes Mellitus and Driving Disorders for the Nervous System and Driving Psychiatric Disorders and Driving Visual Disorders and Driving

Question 60

You are the SHO covering the Care of the Elderly and Stroke wards overnight. You are contacted by one of the nurses asking you to come and see Mr Jones who is trying to leave the ward. He is a 92 year old man, admitted following a fall. He subsequently developed hospital acquired pneumonia and is on IV antibiotics. The patient has also been refusing food and is receiving IV fluids. On arrival to the ward you find Mr Jones in an argument with the nursing staff. He is trying to leave the ward and shouting that he doesn’t want to be kept in prison. He is trying to get through a door that a nurse is holding shut. He has a background of dementia, heart failure and COPD. How would you approach this situation?

Answer 60

First try and deescalate the situation and ask the patient to come to bedside for a chat with myself and nursing staff. If remains agitated - try and contact family member to see if they will come in, familar faces help. Try and seek more info - why pt is upset and try and explain why he is in hospital and orientate himself. If patient still wants to leave, assess capacity. Safety is key so if no capacity - put in DOLs.

Question 61

You are the SHO covering the Care of the Elderly and Stroke wards overnight. You are contacted by one of the nurses asking you to come and see Mr Jones who is trying to leave the ward. He is a 92 year old man, admitted following a fall. He subsequently developed hospital acquired pneumonia and is on IV antibiotics. The patient has also been refusing food and is receiving IV fluids. On arrival to the ward you find Mr Jones in an argument with the nursing staff. He is trying to leave the ward and shouting that he doesn’t want to be kept in prison. He is trying to get through a door that a nurse is holding shut. He has a background of dementia, heart failure and COPD. What could be causing patients onfusion and what are some simple measures you can do to help it?

Answer 61

Background of cognitive decline vs delirium. Need to get baseline cognition. Delrium causes - infection, new environment, medication., constipation, dehhydration so will need to assess for this once patient is more co-operative. Offering patients tea and biscuits often helps with settling patients.

Question 62

You determine that the patient does not have capacity. The patient is still trying to leave the ward. What could you do next?

Answer 62

Need to put in measures to keep pt safe. The Deprivation of Liberty Safeguards (DOLS) - can sign an emergency one for 7 days when on-call. The paperwork must be signed and sent to the Trust Safeguarding Team who will then review and authorise the standard DOLs. Can alst up to 12 months but should be for shortest time possible.

Question 63

How do we safeguard patients who are deprived of their liberty?

Answer 63

Needs 2 independent accessors. Family, friends and paid carers who know the person well should be consulted as part of the assessment process. They may have suggestions about how the person can be supported without having to deprive them of their liberty. Those people who have no one to represent them should have an Independent Mental Capacity Advocate (IMCA) during the assessment process.

Question 64

You are a CT1 and have covered a busy on call day shift. The night SHO is already 30 minutes late and you have 2 patients waiting to be reviewed in A&E. How would you proceed?

Answer 64

SPIES R - Seek info - why are they late/or off. Find out whos sick in ED and how urgent it is to review them. Patient safety - situation needs sorted for patient safety, short staff leads to stressed colleagues and lack of adequate cover. Me staying late when tired can also increase risk of poor quality clerking Initiative - Contact colleague ASAP to get more info. Make list of urgent jobs and do them until they get here. Escalation - update my reg and/or consultant if not already aware. Discuss issue with site manager for cover. Support - support colleague and empathise if issues as to why they are late. Reflect - Reflect on own practice on how to manage situations in future. Contact night SHO earlier in day to identify problems.

Question 65

You are a CT1 and have covered a busy on call day shift. The night SHO is already 30 minutes late and you have 2 patients waiting to be reviewed in A&E. The colleague states they are unwell. How do you proceed.

Answer 65

Patient safety is key - I would need to stay long enough to ensure adquate cover but not to complete this new shift as my tiredness would make any clinical decisions very unsafe. Important to update my reg and or consultant to escalate and help find shift cover. Ensure no emergencies at the moment. Options - Locums/cross-cover from another specialty/step down system - SpR drops down.

Question 66

You are a CT1 and have covered a busy on call day shift. The night SHO is already 30 minutes late and you have 2 patients waiting to be reviewed in A&E. Is it every acceptable to leave the hospital in situations like this?

Answer 66

No, leaving right away without taking any action to arrange cover of the shift and care of the patients is not acceptable and goes against your duties as a doctor i.e. avoiding harm to patients (non-maleficence). However it is important to know your limitations in terms of tiredness and over working, which is a risk to patient safety due to the impact on critical decision-making. Early escalation is of high importance.

Question 67

You are a CT1 and have covered a busy on call day shift. The night SHO is already 30 minutes late and you have 2 patients waiting to be reviewed in A&E. Cover is arranged for the shift but another SHO tells you this colleague has been late several times over the last few weeks. How would you proceed?

Answer 67

Empathise and discuss with colleague why he is late and what I can do to help in a non-patroinising/non-judgemental manner. Encourage colleague to discuss with ES/Occupational health/GP.

Question 68

When you are in the hospital mess you hear a CT1 telling another SHO about how hung-over he is from a late party the night before. You notice he is walking unsteadily and slightly slurring his words. How would you proceed?

Answer 68

Seek info - establish if they are still drunk Patient safety - keep CT1 away from clinical environment and ask them to leave in non-judgemental way. May need to raise concern with senior member of staff. Initiative - review any patients or jobs preformed by that CT1 that day for any errors if possible. Escalate - tell reg/consultant. Keep those aware of CT1s behaviour to a minimum. Support - try support CT1 to divulge any dependency or poor mental health if appropriate. Reflect - on own practice and how i managed situation to see how i can improve for next time.

Question 69

When you are in the hospital mess you hear a CT1 telling another SHO about how hung-over he is from a late party the night before. You notice he is walking unsteadily and slightly slurring his words. The colleague becomes upset and divulges that his friend has cancer, would you manage this situation differently?

Answer 69

Would have more concerns of the doctors psychosocial welbeing but may not be appropriate to have a long conversation with them as they are drunk but the situation needs dealt with. Try get them to discuss with GP/Occy health/CS/ES

Question 70

When you are in the hospital mess you hear a CT1 telling another SHO about how hung-over he is from a late party the night before. You notice he is walking unsteadily and slightly slurring his words. The colleague is very concerned that if you escalate this issue they will not be able to practice medicine again. What would the likely outcome of escalation be?

Answer 70

The CT1 would have a professionalism meeting with their clinical supervisor. The decision for further escalation (anything from clinical director to GMC) would be made by the consultant/ CT1’s clinical supervisor, and this would based on the severity of the situation. Likely outcomes are: formal warning, referral to GMC for review and/ or suspension. The colleague would definitely require referral for appropriate services for psychological and addiction support.

Question 71

You are an SHO working in a DGH. A patient from another local DGH is transferred for NIV. However, the hospital staff in the transferring DGH forgot to check, and your hospital does not have any NIV machines available for this patient. How would you approach this situation?

Answer 71

Patient safety is theinitial concern - A-E assessment. Find out more info - any patients ready to be stepped down? can the patient go to resp HDU/ normal HDU/ITU? Discuss above with reg/consutalnt

Question 72

You are an SHO working in a DGH. A patient from another local DGH is transferred for NIV. However, the hospital staff in the transferring DGH forgot to check, and your hospital does not have any NIV machines available for this patient. Once on NIV and stable. What needs to be done afterwards?

Answer 72

Apologise to patient, give them PALS info and submit datix

Question 73

What is duty of candour

Answer 73

Duty of Candour is a legal duty for health care professionals to be open and honest to patients and their relatives when mistakes occur. It applies to an “unintended or unexpected incident” that “could result in, or appears to have resulted in the death of a service user... or severe or moderate harm or prolonged psychological harm to the service user”.

Question 74

What is the importance of datix's

Answer 74

The Datix system enables an official record of undesirable adverse incidents to be generated. This then enables the incident to be analysed to identify areas for improvement and training needs to prevent such events from occurring in the future. By keeping a log of such events, it is possible to monitor what events are occurring in the trust, the frequency of such events and any trends.

Question 75

What is the serious incident framework?

Answer 75

The Serious Incident Framework is a national framework outlining the responsibilities within the NHS when dealing with serious incidents. It defines a serious incident as one that results in unexpected or avoidable death or injury. The Framework sets out the principles for dealing with such incidents and outlines the management process, including investigation, report writing and action planning.

Question 76

You are an SHO working in the Acute Medical Unit (AMU). One of your SHO colleagues is admitted to AMU. You find your FY1 looking at the SHO’s blood results. What issues does this raise?

Answer 76

Breeches patient confidentiality and lack of professionalism

Question 77

You are an SHO working in the Acute Medical Unit (AMU). One of your SHO colleagues is admitted to AMU. You find your FY1 looking at the SHO’s blood results. How would you manage the situation?

Answer 77

Find out more info - if F1 is responsible of the care then it may be approiate to view the bloods. If the F1 had no duty of care to the SHO then this is inappropriate and a serious patient confdentiality breach. Have a private chat with the F1. Escalate to a senior - F1s supervisor and document event. Need to ensure the F1 apologises to the F1.

Question 78

You are an SHO working in the Acute Medical Unit (AMU). One of your SHO colleagues is admitted to AMU. You find your FY1 looking at the SHO’s blood results. What will likely happen following this once the F1s ES is informed

Answer 78

Likely escalated to clinical director. May warn F1/suspend or inform GMC

Question 79

What is clinical governance?

Answer 79

Clinical governance sets on the principles that ensures that the NHS delivers a high-quality standard of care and accountability.

Question 80

Give some examples of clinical governanece

Answer 80

Research - evidence based medicine Audit - comparing current practice to recommended standards Risk management - M+M meetings/QI projects to see how future harm can be reduced. Education/training - ALS, ARCP

Question 81

You are called to a ward by the nursing staff. They report that yesterday they called another doctor to review a patient. The doctor did not see the patient in person, but did prescribe gentamicin and vancomycin fixed dose three times a day. The patient is now reporting tinnitus. You do not get on well with this doctor. What do you do?

Answer 81

Firstly - ensure the patient is stable and gather more info from the notes and nurses and check the prescription adn stop the prescription. Assess patients neuro exam. Explain and apologise as to wahts happened and give them PALS as duty of candour. Document findings and attempt to speak to dr in private and encourage them to speak to their ES. If not, discuss with my ES for appropriate escalation.

Question 82

What happens to an incident report after it is filed? What would happen to the doctor?

Answer 82

It will be sent to those involved for example the head of nursing if it is a nursing related event or the head of orthopaedics if it is orthopaedics related. There will then be an investigation in to the event, which may involve a fact finding meeting, why the event happened, if there was anything that could have stopped it, or if there were multiple issues that caused their event. The findings will prompt an action plan to prevent this happening again, for example extra training for staff, prompts on computer systems, guidelines or changes to equipment. In this case it may be that the doctor requires extra training, supervision, or in the worst case may need to stop working.

Question 83

Summarise the GMCs GMP

Answer 83

The General Medical Council’s (GMC) Good Medical Practice outlines the core principles and standards expected of doctors in the UK. It is centered around four domains: Knowledge, Skills, and Performance: Doctors must maintain up-to-date knowledge, provide high-quality care, and recognize their limits. They should seek help when necessary and engage in continuous learning. Safety and Quality: Doctors are expected to prioritize patient safety by identifying and addressing risks, reporting concerns, and learning from adverse events. Communication, Partnership, and Teamwork: Effective communication with patients, families, and colleagues is essential. Doctors must listen, explain options clearly, respect patients’ autonomy, and collaborate effectively within healthcare teams. Maintaining Trust: Doctors must uphold professionalism, act with integrity, and respect patient confidentiality. They should treat patients with dignity, avoid discrimination, and maintain public trust in the medical profession.

Question 84

A nurse tells you a family member of a patient has found some bruising on a patient. The nurse has had a look and thinks it does look like bruising. The family member is upset, and says they do not know when or how the bruising occurred. You have not met the patient before. What do you do?

Answer 84

Familairise self with patient to give context. Looking for bleeding disorders and the patients vulnerability ?adult safeguarding. Thank nurse for informing me. Chat to patient and family and introduce self. Try get more info from patient about their brusies. Examine patient for other brusies Discuss with senior to dtermine immediate risk and need for safeguarding referral. Chat to safeguarding team.

Question 85

A nurse tells you a family member of a patient has found some bruising on a patient. The nurse has had a look and thinks it does look like bruising. The family member is upset, and says they do not know when or how the bruising occurred. You have not met the patient before. Following your assessment of the patient, and discussion of the case with your registrar, you suspect this bruising may represent abuse. The patient has a background of dementia, and you are not sure they will be able to consent to the safeguarding referral. What do you do?

Answer 85

Formal capacity assessment. If lacks capacity - involve MDT and family to discuss safeguarding referral and manage in their best interests.

Question 86

What types of abuse are there?

Answer 86

Sexual abuse Physical abuse Psychological abuse Domestic abuse Discriminatory abuse Financial abuse Neglect

Question 87

What is an Independent Mental Capacity Advocate (IMCA)?

Answer 87

IMCAs are a legal safeguard for people who lack the capacity to make specific important decisions, including making decisions about where they live and about serious medical treatment options. IMCAs are mainly instructed to represent people without anyone independent of services, such as a family member or friend, who can represent the person.

Question 88

How would you give a treatment in a patient without capacity but they need it in their best interests.

Answer 88

Formal capacity assessment - DOLS. Try best to calm patient and get them on board (cups of tea etc), family input. However, in some cases, in order to give the medication, it may be necessary to give it covertly or via an IV cannula, which the patient may not want. In this scenario, completing a Deprivation of Liberties Safeguard (DOLS) form is important before initiating this medication. Discuss with senior and document also.

Question 89

You are the IMT-1 on-call and you have been asked to see a patient with a nasogastric tube, who has started coughing after feeding. You note that the x-ray undertaken prior to feeding demonstrates that the NG tube is not correctly cited and the x-ray has not been reported. What would you do?

Answer 89

REMEMBER - ethical scenario, not medical management. Patient safety is priority - ask nurse to immediately stop the feed. Do A-E assessment. Need CXR repeat, abx and fluids. This is a never event so needs discussed with reg and or consultant and datix filled in. Duty of candour to patient and explain short and long term side effects and further management. Give them PALS leaflet and ask if they want me to maek family aware.W

Question 90

What is an NHS never event?

Answer 90

Never Events are patient safety incidents that are wholly preventable through strong safety barriers are implemented to stop them happening. Have risk of causing serious harm and death.

Question 91

Why are incident reporting important in the NHS

Answer 91

Improves quality and delivery of services Maintains patient safety Not about blame, its about changing systemic issues and learning form incidents.

Question 92

Tell us about a mistake or error you have made during your training to date and how you dealt with it

Answer 92

Accidnetally printed the wrong patient stickers for blood bottles and sent them to the lab. Only realised once the results were back and they were widely abnormal. Explained to the consultant that day. Apologised and explained to patient and stated I would need to rebleed them to ensure we had the correct blood results. Felt guilty and embarrased however understand that you must act with honesty and integrity in these situations and document appropriately. Self-datixed to ensure transparency. I then relfected on this situation with my ES and wrote a reflection in my portfolio on why this happened and what I could do in future to prevent it.

Question 93

During ward round, the consultant shouts at you in front of a patient for getting an answer wrong. What do you do?

Answer 93

Issues raised - Key issues of proffesionalism and interpersonal conflict Seek information - ask the consultant if we could meet quielty afterward round to discuss further. Insist on an explanation after the WR to discuss further Patient safety - no immediate concerns but patient might have concern regarding professionalism and teamwork for their care Initial measures - find out if the consultant has concerns about preformance, if so, reflect on this but be assertive and reiteriate that it was unprofessional to shout at me. Escalate - would inform ES/CS but understand the pressure consultants are under and if it was a 1 off, I would accept the apology and move on. Document/reflect - reflect on this in my portfolio and any confounding factors that affected my response and the consultants - aka bed pressures, difficult patients etc

Question 94

What are the 4 ethical principles

Answer 94

Autonomy: Respecting a patient's right to make their own decisions about their healthcare, based on their values and preferences. This includes providing them with all necessary information to make informed choices. Beneficence: Acting in the best interest of the patient by promoting their well-being, providing appropriate care, and taking actions that benefit them. Non-maleficence: "Do no harm." This principle emphasizes avoiding actions that could cause harm or suffering to the patient, whether through negligence, errors, or unnecessary risks. Justice: Ensuring fairness in the distribution of healthcare resources and providing equal treatment for all patients, without discrimination. This also involves considering the needs of the broader community.

Question 95

Important features to remember with regards to confidentiality and how do you maintain it

Answer 95

Confidentiality should be maintained unless the patient consents or legal/ethical obligations require disclosure (e.g., child safeguarding, public health). Share information only with relevant care providers and minimize disclosure. Patient data must be protected under laws like GDPR, and breaches are allowed only when necessary, such as to prevent harm or comply with the law - child safeguarding, harm to public (weapons etc). Ways to maintain confidentiality - lock computers, dont leave notes lying around, bin notes in confidentiality bins when done, use proper translators not family.

Question 96

Important features to remember with regards to informed consent and who needs written consent

Answer 96

Informed consent is the process by which a patient voluntarily agrees to a medical treatment or procedure after being fully informed of the relevant facts to make an informed decision. This includes understanding the nature of the treatment, its risks, benefits, alternatives, and potential consequences. The patient must have the capacity to make the decision, and consent should be given freely, without coercion or undue pressure. For major procedures or operations - LPs, ascitic drains, endoscopy, biopsies

Question 97

Important features to remember with regards to lacking capacity

Answer 97

Least restrictive treatment Treat in best interests Consider DOLS View of family and NOKs Do they have a welfare PoA Whether the lack of capacity is permeant or temporary - if temporary, can it wait until they are better?

Question 98

Important features to remember with regards to mental health act 2005

Answer 98

The Mental Capacity Act 2005 (MCA) outlines key principles for decision-making for those who lack mental capacity: - Presumption of capacity: Assume a person has capacity unless proven otherwise. - Right to make unwise decisions: Individuals can make decisions that others may consider unwise, as long as they have capacity. - Best interests: Decisions for those lacking capacity must be made in their best interests. - Least restrictive option: Any intervention should be the least restrictive to the individual’s rights and freedoms.

Question 99

Important features to remember with regards to Deprivation of Liberty Safeguards (DOLS)

Answer 99

Deprivation of Liberty Safeguards (DoLS) ensure that individuals who lack mental capacity are not unlawfully deprived of their liberty. Key features include: - Best interests: Any deprivation of liberty must be in the person’s best interests. - Least restrictive: The least restrictive option should be used to protect the individual. - Assessment: A series of assessments must confirm that the person lacks capacity and requires deprivation of liberty for their safety. - Independent review: An independent assessor must review the situation to ensure the safeguards are being met. - Rights protection: Individuals must be informed of their right to challenge the decision in court. DoLS ensure legal protection for vulnerable individuals who may be restricted in care settings.

Question 100

Important features to remember with regards to Gillick competence

Answer 100

Gillick competence refers to a child’s ability to consent to medical treatment without parental approval. Key features include: - Assessment of maturity: A child under 16 may consent if they fully understand the treatment, its risks, and benefits. - Individual decision-making: Competence is assessed on a case-by-case basis, considering the child’s understanding. - Right to confidentiality: Competent minors have the right to confidentiality regarding their treatment. - Best interests: If a child is not Gillick competent, parental consent is usually required, and decisions should always consider the child’s best interests.

Question 101

Important features to remember with regards to Duty of candour

Answer 101

Duty of Candour requires healthcare professionals to be open, honest, and transparent when things go wrong. Key features include: - Immediate disclosure: Inform the patient or their family as soon as an error or harm occurs. - Full explanation: Provide a clear, honest explanation of what happened, why, and what actions will be taken. - Apology: Offer a sincere apology for the harm caused. - Support: Offer ongoing support to the patient and their family during the process. This ensures accountability, builds trust, and promotes safety in healthcare.

Question 102

One of your patients is refusing to adhere to the recommended treatment. As a result, their condition is deteriorating rapidly. What do you do?

Answer 102

Issues Raised The patient refuses treatment, causing rapid deterioration. Key concerns include autonomy, capacity, and duty of care. Seek Information Understand reasons for refusal (fear, side effects, cultural, financial). Assess capacity and ensure informed decision-making. Consult family or support networks if appropriate. Patient Safety & Initial Measures Clearly explain risks and explore alternative treatments. Use motivational interviewing and involve a multidisciplinary team. Address barriers to adherence and monitor closely. Escalate Consult ethics or safeguarding teams if capacity is in question. Engage family/carers with consent. Consider legal obligations for best-interest decisions. Document & Reflect Record discussions, interventions, and capacity assessments. Reflect on communication and seek guidance if needed.

Question 103

You are a IMT. A young female trainee refuses to deal with a male patient who is a known rapist. What do you do?

Answer 103

Issues Raised The trainee’s refusal raises ethical concerns about patient care, professionalism, and personal safety. Balancing duty of care with emotional well-being is key. Seek Information Understand the trainee’s concerns—personal trauma, fear, or moral objection? Assess if reasonable accommodations can be made. Patient Safety & Initial Measures Ensure the patient receives appropriate care without discrimination. Offer the trainee support (e.g., senior supervision or temporary reassignment). Escalate If refusal persists, involve senior clinicians, HR, or occupational health. Consider team adjustments while maintaining fairness in workload. Document & Reflect Record discussions, interventions, and decisions. Reflect on staff support structures and policies for sensitive cases.

Question 104

You are an IMT. A patient on the ward has been racist to a member of staff, what do you do?

Answer 104

Seek Information Understand the context—was the behavior intentional, due to confusion (e.g., delirium), or a pattern? Speak with the affected staff member to offer support and assess their concerns. Patient Safety & Initial Measures Ensure the patient receives necessary medical care. Address behavior directly but professionally, reinforcing a respectful environment. Escalate Report the incident to senior staff, HR, or safeguarding if required. Consider alternative staffing arrangements if necessary for staff well-being. Document & Reflect Record the incident, actions taken, and any escalation. Reflect on policies and training to handle similar cases effectively.

Question 105

How would you deal with an emergency outside the clinical setting?

Answer 105

I would yes, both on a moral and professional level. Starting with A-E. GMC states you must offer help if it is safe and you are competent to do so. Should not offer help if not competent - aka doing procedures above grade or if intoxicated. All based on professional judgement