Flashcards in Ethics 2 - Making Mistakes Deck (21)
What are the 4 domains?
The standards expected of a doctor:
1. Knowledge, skills and performance
2. Safety and quality
3. Communication, partnership and teamwork
4. Maintaining trust
List the 6 reasons Sokol and Bergson state for mistakes being made.
Covering (for colleagues)
Independent decision making (alone)
Fear admitting uncertainty
Where do mistakes morally differ?
Between whether a mistake is avoidable or unavoidable
From where did the Duty of Candour originate?
The Francis Report
What is the (medical) Duty of Candour?
A statutory obligation which states that doctors and nurses have to be open and honest with patients about mistakes
What does the Duty of Candour state in reference to an organisation apologising?
An apology is a statement of sorrow or regret in respect of the unintended or unexpected incident which does not of itself amount to an admission of negligence or the breach of a statutory obligation
What are 3 possible scenarios that could be put into action following a mistake being made by a medical professional?
Legal action - negligence
NHS Complaints Procedure
As a professional, what are the 4 things you must do following a mistake being made, as stated in the professional Duty of Candour?
Describe a little bit about what the Bolam test involves.
If a skilled group of medical professionals agree with how the accused doctor acted in a given situation, then he is said to have done the right thing
What does the Bolitho amendment to the Bolam test state?
That basically, the accused doctor can't go around persuading his colleagues to agree with his stance - must be capable of withstanding LOGICAL ANALYSIS
What is the stance given on experience?
There is no preferential treatment given to junior doctors or those who are less experienced
What are the 3 questions doctors must ask themselves before administering treatment?
Do they know the risks?
Do they know about the alternatives?
Have I take reasonable car to ensure the patient knows this?
When legally claiming against the medical profession, what must the claimant be able to prove?
Owed a duty of care
Duty was breached
Breach caused injuries, which in turn are not too remote - causation & proximity
List the 3 stages of the NHS Scotland complaints procedure.
1. Local resolution
2. Scottish Public Services Ombudsman
(3.) Judicial review
What type of correctional approach is preferred?
Systems based approach rather than a person centred approach
How does the systems based approach work?
Considers the environment and seeks to minimise the opportunity for errors to occur
How has medicine sought to
address some of the failures in
the current system?
Requirement to retrain
Data collections of incidents
Protocols & guidelines
Improved instrument design
What are the problematic areas that Bowman highlight?
Everyone makes mistakes - does that make the incompetent?
Medicine is not an exact science
A 'norm of non-criticism'
Whistle blowing is not easy
Who (if you like) founded the Duty of Candour?
Robert Francis 2013
What is the limitation with taking a legal action negligence approach?
Not an effective way to learn from errors as outcome bias exists
Culpability does not depend on blameworthiness, but on consequences