EVERYTHING

Question 1

What are the 3 C’s of medical ethics?

Answer 1

Consent
- Confidentiality
- Capacity

Question 2

What is consent?

Answer 2

when a patient gives permission before receiving any form of medical treatment, examination or test.

Question 3

When is consent valid?

Answer 3

• if it is voluntary- it is informed- they have Capacity

Question 4

Good medical practice: Domain 1

Answer 4

Knowledge, skills and performance

Question 5

Good medical practice: Domain 2

Answer 5

Safety and quality

Question 6

Good medical practice: Domain 3

Answer 6

Communication, partnership and teamwork

Question 7

Good medical practice: Domain 4

Answer 7

Maintaining trust –

Question 8

Domain 1: Knowledge, skills and performance

Answer 8

doctors must develop and maintain
their professional performance, must apply their knowledge and experience and
practise within the limits of their competence and must record their work clearly,
accurately and legibly. They must have the necessary knowledge of the English language
to provide a good standard of practice and care in the UK.

Question 9

Domain 2: Safety and quality

Answer 9

doctors must contribute to and comply with systems to protect patients, respond to risks safely and protect patients and colleagues from any
risk posed by their own health

Question 10

Domain 3: Communication, partnership and teamwork

Answer 10

– doctors must communicate
effectively with patients and establish and maintain partnerships with them. They must
work collaboratively with colleagues, be willing to contribute to teaching, training,
supporting and assessing and must contribute to the continuity and coordination of care
for patients transferring between providers

Question 11

Domain 4: Maintaining trust

Answer 11

doctors must show respect for patients, treat patients
and colleagues fairly and without discrimination and must act with honesty and
integrity.

Question 12

A question of fitness to practise is likely to arise if:

Answer 12

• a doctor’s performance has harmed patients or put patients at risk of harm
• a doctor has shown a deliberate or reckless disregard of clinical responsibilities
  towards patients a doctor’s health is compromising patient safety or poses a risk to public confidence
  in the profession
• a doctor has abused a patient’s trust or violated a patient’s autonomy or other
  fundamental rights
• a doctor has behaved dishonestly, fraudulently or in a way designed to mislead or harm others

Question 13

Why should a doctor be fit to practice?

Answer 13

Doctors have a respected position in
society and their work gives them privileged access to patients, some of whom may be very vulnerable. A doctor whose conduct has shown that they cannot justify the trust placed in them should not continue in unrestricted practice while that remains the case.
-They must establish and
maintain effective relationships with patients, respect patients’ autonomy and act
responsibly and appropriately

Question 14

The Medical Act 1983 *(as amended) makes it clear that public protection is
the overarching objective of the GMC and that this involves:

Answer 14

• protecting, promoting and maintaining the health, safety and wellbeing of the public
• promoting and maintaining public confidence in the medical profession
• promoting and maintaining proper professional standards and conduct for members of that profession.

Question 15

why would a doctor’s fitness to practise be questioned

Answer 15

failure to seek the appropriate help or engage in the process to manage any condition that may call into question their ftness to practise.

Question 16

Pros of being a doctor?

Answer 16

Ability to Make a Difference
Contribution to Research
Opportunities for Leadership
Team Collaboration
Job Security
Continuous Learning
Respected Profession
Diverse Specialties
Intellectual Challenge
Job Satisfaction

Question 17

Cons of being a doctor

Answer 17

Extensive Education and Training
Long and Irregular Hours
High Levels of Stress
Administrative Burden
Legal and Ethical Challenges
Emotional Toll
Continuous Learning Requirements
Patient Expectations
Healthcare System Issues
Risk of Burnout

Question 18

What is primary healthcare?

Answer 18

is the first point of contact for patients and focuses on providing essential healthcare services. Primary care aims to address common health concerns, offer preventative care, and manage chronic conditions.
- It includes general practitioners, dentists, opticians and community healthcare providers.
- directing patients to the appropriate specialists when needed.

Question 19

What is secondary healthcare?

Answer 19

refers to specialised medical services provided by healthcare professionals who are typically the second contact with a patient after a referral from a primary care provider. Secondary care is often required when a patient needs further investigation, diagnosis, or treatment for a specific condition.
- These services are delivered by specialists such as cardiologists, dermatologists, and orthopaedic surgeons.

Question 20

What is tertiary healthcare?

Answer 20

• comprises highly specialised medical care provided to patients with complex, severe, or rare health conditions. This level of care requires advanced knowledge, technology, and facilities.
• such as oncology, neurosurgery, or organ transplantation.

Question 21

why is it good for the NHS to have primary, secondary and tertiary healthcare?

Answer 21

a foundation for organising and delivering the appropriate care to patients based on the severity and complexity of their health conditions.
The transition between these levels of care is a crucial aspect of healthcare delivery, as it ensures that patients receive appropriate, timely, and coordinated care.

The transition between the primary, secondary, and tertiary levels of care aims to optimise patients’ outcomes by ensuring that they receive the right care at the right time, in the right setting.

To facilitate smooth transitions and minimise potential gaps in care, effective communication between healthcare professionals and accurate, timely transfer of relevant information is crucial.

Comprehensive Patient Care:
-This tiered approach ensures that patients receive comprehensive and appropriate care based on the severity of their health condition.

Early Intervention and Prevention:
-Primary healthcare focuses on preventive measures, early detection of health issues, and managing chronic conditions. This can contribute to reducing the incidence of serious illnesses and preventing the progression of existing conditions, ultimately leading to improved overall population health.

Question 22

Who does a consultant surgeon answer to?

Answer 22

Clinical Lead or Clinical Director:

In many healthcare organizations, consultant surgeons may report to a Clinical Lead or Clinical Director within their department or specialty. This individual often oversees the clinical activities, quality of care, and performance within the department.
Departmental Head or Division Chief

Chief Executive Officer (CEO) or Trust Board:

Ultimately, the consultant surgeon answers to the hospital’s Chief Executive Officer (CEO) or Trust Board, depending on the organizational structure. The CEO and Trust Board are responsible for the overall management, strategy, and governance of the healthcare organization.
Professional Regulatory Bodies: General Medical Council

Question 23

What are the main components of the NHS?

Answer 23

Government / Prime Minister

Secretary of State for Health and Social Care
Department of Health and Social care
Department for Education (DfE)

Care Quality Commission

NHS England

NHS England Regional Teams

Integrated care systems

Primary Care Networks

Service providers

Question 24

What is Government / Prime Minister role in the NHS?

Answer 24

Decides how much money it gives to the NHS. The Government also decides on top- level priority setting

Question 25

Where does funding for the NHS come from?

Answer 25

taxation

a percentage of National Insurance contributions

prescription charges

dental service charges

local income which can be generated and then introduced by local activities such as car parking charges, selling of property, private provision of services, etc.

Question 26

What is SoS H&SC / DHSC role in the NHS?

Answer 26

The Secretary of State is responsible for the work of the Department of Health and Social Care, including:

overall financial control and oversight of NHS delivery and performance

oversight of health and social care policy

DHSC sets out the direction of future healthcare and helps to deliver the Government’s health objectives

Question 27

What is Care Quality Commission role in the NHS?

Answer 27

Independent regulatory body for all health and social care service providers reporting to the SoS H&SC
is to register care providers and monitor, inspect and rate their services in order to protect users. CQC also publishes independent views on major quality issues in health and social care

Question 28

What is NHS England role in the NHS?

Answer 28

Responsible for providing unified, national leadership for the NHS. NHSE is a single regulatory body responsible for overseeing the funding, planning, delivery, transformation, and performance of NHS healthcare in England.
Oversees the commissioning, planning, and buying of services. Commissions some services itself nationally but passes on the majority of its money to ICSs.

including NHS England, NHS Improvement, Health Education England, and NHS Digital

Question 29

What is NHS England Regional Teams role in the NHS?

Answer 29

Responsible for the quality, financial, and operational performance of all NHS organisations in their region, working with integrated care systems (ICSs) to oversee performance and support their development

• seven of them

Question 30

What is NHS England Regional Teams role in the NHS?

Answer 30

Integrated care systems (ICSs) are partnerships of organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area.

following:

· integrated care partnership (ICP)

· integrated care board (ICB)

· local authorities

· place-based partnerships

· provider collaboratives

Question 31

Integrated care partnership

Answer 31

ICPs are committees that aim to bring the NHS ICB, local authorities and providers of health and care together. The role of an ICP is to develop and set an integrated care strategy for joined up care for the ICS area.

ICPs will drive the direction and policies of the integrated care system
ICPs will be rooted in the needs of people, communities, and places
ICPs create a space to develop and oversee population health strategies to improve health outcomes and experiences
ICPs will support integrated approaches and subsidiarity
take an open and inclusive approach to strategy development and leadership, involving communities and partners, and utilise local data and insights

Question 32

Integrated Care Systems (ICSs)

Answer 32

An ICS is a partnership of organisations in the same geographical area that come together to plan and deliver health and care services to improve the lives of people who live and work in their area.

Question 33

Integrated Care Boards

Answer 33

ICBs have replaced Clinical Commissioning Groups (CCGs) and have taken on many of the responsibilities that CCGs used to have. ICBs also carry out several functions that were previously carried out nationally by NHS England. They facilitate integration between local NHS organisations in their area.

There is an ICB within each Integrated Care System (ICS), which has responsibility for commissioning most NHS services on behalf of the ICS.

Question 34

What is Primary Care Networks role in the NHS?

Answer 34

Groups of GP practices working together with community, mental health, social care, pharmacy, hospital, and voluntary services to provide care closer to home and to deliver economies of scale.

PCNs are not legal entities under current arrangements.

Question 35

What is Servvice Providers role in the NHS?

Answer 35

Providers include, hospital services, general practice, ambulance services, district nursing, health visiting, mental health providers, combined mental health, learning disability and community providers, specialist providers such as cancer treatment, integrated providers such as organisations providing acute and community care

Question 36

What are the risks of accepting gifts from patients?

Answer 36

• Peter Rowan was erased from the medical register as a result of having accepted a £1.2m legacy and £150 000 in cheques from an elderly patient.
• It may be entirely reasonable to accept a small token of appreciation from a patient. In fact, refusing it may cause embarrassment that could unnecessarily harm the relationship between a doctor and a patient.
• risk that accepting a gift could, or could be perceived to, impact on the doctor-patient relationship by altering the way in which a patient is treated or encouraging favouritism or preferential treatment.
• The NHS (General Medical Services Contracts) Regulations 2004 require GPs to keep a register of gifts from patients or their relatives that have a value of £100 or more.

Question 37

Ethical issues of accepting gifts from patients?

Answer 37

“You must not encourage patients to give, lend or bequeath money or gifts that will directly or indirectly benefit you.”
may accept unsolicited gifts from patients or their relatives “provided:
a) it does not affect, or appear to affect, the way you prescribe for, advise, treat, refer, or commission services for patients and
b) you have not used your influence to pressurise or persuade patients or their relatives to offer you gifts.”

Question 38

Why do patients give gifts?

Answer 38

wish to express feelings of affection for their doctor, and a simple gift may be accompanied by a romantic letter or a more inappropriate gift. Patients may also use gifts to gain the attention of their doctor or to attempt to manipulate doctors into providing preferential services or treatment.

Question 39

Power imbalance in medicine

Answer 39

Even when patients are well educated and well informed, many still find it difficult to use this knowledge to participate meaningfully in decisions about their health‑
care

patients often feel prohibited from speaking up, even when they are extremely concerned about safety or
the quality of care they are receiving

feeling that they represent a disease rather than that
they are an individual and aware of a pressure to
be compliant and passive.

many patients currently feel that they can’t participate in shared decision making rather than that they don’t want to

undervalue their ability to understand the information given to them and underplay their knowledge gain relative to that of the clinician. Therefore, they tend to
defer the decision to the expert who “owns” the
knowledge

Many patients also do not recognise the unique expertise that they bring to the clinical encounter—that is, knowledge about their personal preferences

Question 40

Examples of the misuse of power in the doctor / patient relationship

Answer 40

Material Making- decisions about investigative resources or management influenced by own monetary gain

Information & knowledge -
- Withholding medical information from patient to maintain positionof superiority;
= Continuing treatment when doctor’s knowledge & skills are inadequate
- Controlling or punishing patient because patient is not following advice or is disliked;
- Making decisions not in patient’s best interest because based on doctor’s own beliefs & values.

Question 41

What to do if a colleague is drunk?

Answer 41

-If you are concerned about the health of a colleague, a first step is often to speak to the individual concerned, to ask how they ar
-Sometimes a sympathetic approach will allow a colleague to talk about the difficulties they are experiencing and may lead the doctor to seek help through occupational health services, or their own GP.
Remember that the individual involved will be going through a really difficult and distressing time, and your support and understanding of this can make all the difference.
- If raising your worries with the doctor themselves has been ineffective or not possible, you will need to consider who else you should speak to. 
- Once you have brought your concerns to the attention of an appropriate person such as the educational supervisor or the clinical director, the matter should be looked into by the Trust, deanery or local education and training board (LETB), in a sympathetic but structured way, to determine whether the concerns reflect a health problem serious enough to impact on the doctor’s work.  

Question 42

Do you know of any examples where a doctor’s professional judgement has failed?

Answer 42

• Peter Rowan was erased from the medical register as a result of having accepted a £1.2m legacy and £150 000 in cheques from an elderly patient.
  prescribed former debutante Patricia May ‘inappropriate’ doses of sedatives in the weeks before her death.
  The eating disorder specialist had led a ‘blurred and secretive’ relationship with the wealthy woman, and allowed her cash gifts to ‘cloud’ his judgement.
  He has been told that his willingness to accept gifts ‘of extraordinary financial worth’ had ‘seriously compromised’ his professional relationship with the patient.

Question 43

Why medicine and not nursing?

Answer 43

• get to tackle diagnostic challenges
  -> as a doctor you have to problem solve from information. Which is very rewarding. This links to further maths
  -> the benefits of diagnosis
  -> most nurses arent able to
• Medicine has many avenues you can go down
  -> research, community, abroad, charity work, specialities.
  ->good as i have considered research, and idk my specialty
• Doctors direct patient care
  -> as junior you will be working under supervision of senior dr
  -> ultimately in charge of patient care
• Med school provide wider and broader knowledge
  -> goes into more science and physiology
  -> nursing have a more clinical focus and practical skills

Question 44

‘what not are nurse practitioners?

Answer 44

-> is for very experienced nurses, so takes a long time
-> limited opportunities in progression
-> medicine offers some areas that NO cant di.

Question 45

What is the NHS constitution

Answer 45

A document outlining principles, values and guidelines

Question 46

first principle of NHS constitution?

Answer 46

1) NHS provides a comprehensive service available for all
-> people shouldn’t be discriminated

Question 47

second principle of NHS constitution?

Answer 47

Access to NHS services is based on clinical need, not an individual’s ability to pay
-> This principle states unequivocally that NHS services should be free at the point of use, except where charges are expressly provided for in legislation (for example, prescription charging and dentistry)

Question 48

Principle 3

Answer 48

The NHS aspires to the highest standards of excellence and professionalism

Question 49

Principle 4:

Answer 49

The patient will be at the heart of everything the NHS does
-> NHS services must reflect, and should be co-ordinated around and tailored to, the needs and preferences of patients, their families and their carers.

Question 50

Principle 5

Answer 50

The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population
-> This principle makes clear that patient interest comes before institutional interest, and that organisations involved in delivering NHS services (including local authority public health services) must work with each other and with other organisations if they are to achieve genuine improvements in the population’s health and wellbeing
-> or example social care services, children’s services and education services. The NHS should also work with other public sector organisations, for example, the police and criminal justice system, as well as private and voluntary sector organisations

Question 51

Principle 6

Answer 51

The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources
-> As the NHS is funded by public money, this principle highlights the importance of using this funding fairly in a way that benefits everyone the NHS serves.

Question 52

Principle 7

Answer 52

The NHS is accountable to the public, communities and patients that it serves
-> s that as a taxpayer-funded service, the government is accountable to Parliament for the outcomes and spending of the NHS.

Question 53

The six NHS core values

Answer 53

ensure that patients receive the best possible care
1. Respect And Dignity
2. Commitment To Quality Of Care
3. Compassion
4. Improving Lives
5. Working Together For Patients
6. Everyone Counts

Question 54

how you’ve demonstrated Respect And Dignity and doctors

Answer 54

-> thyroid eye
-> awake nasal intubation
-> maths mentor
-> volunteer

Question 55

Respect And Dignity NHS value

Answer 55

All those who come into contact with the NHS will be treated with the utmost respect and dignity, whether that is patients, families or staff. This involves respecting others’ opinions, their needs, their privacy as well as promoting equality and diversity in the workplace.

If a Doctor didn’t respect a patient’s wishes, this would be a loss of autonomy for the patient even if the Doctor was acting on the principle of beneficence. It makes the patient feel like they have not been listened to and reinforces the ‘Doctor is always right’ paternalistic mentality which Medicine has grown out of over the years.

Question 56

how you’ve demonstrated Commitment To Quality Of Care and doctors

Answer 56

You could talk about how Doctors have to be revalidated every few years to ensure their knowledge is kept up to date. Also, mention the importance of clinical audits and what would happen if we didn’t do them. What are the feedback/complaints processes at your local hospital? Sometimes it’s the little things that really make a difference.
-> volunteerng

Question 57

Commitment To Quality Of Care NHS value

Answer 57

The care that the NHS provide its patients should be of the highest quality, and if it isn’t, they should look into what’s going wrong. They can be done in a few ways. Clinical audits compare current practices to the gold standard and where they don’t match, change is implemented.

Another way is to encourage patients, families, carers and staff to provide feedback on the care they receive. This shows that the NHS is receptive to making improvements and that they really value the opinions of the public.

Question 58

Compassion MHS value

Answer 58

This value is about being kind and empathetic towards your patients. Put yourselves in their shoes and think about how you would like to be treated if you were them.

Question 59

how you’ve demonstrated compassion and doctors

Answer 59

-> volunteering
-> awake intubation
->

Question 60

how you’ve demonstrated Improving Lives and doctors

Answer 60

Think of a patient you may have seen where their health condition impacted their whole life, and the Doctor took all this into account before making a decision on their care.
-> thyroid eye- physical difference

Question 61

Improving Lives

Answer 61

The NHS seeks to improve not just the health of each patient, but their whole lives – think of a biopsychosocial approach. A patient’s health condition may affect their physical health but also their mental health, their occupation, their family relationships and so on. So when you provide treatment for a patient, you provide the best treatment that is suited to them in their current life situation.

The NHS also focusses on prevention of diseases, especially heart disease, diabetes etc. After all, prevention is better than cure. This involves creating leaflets and TV adverts concerning public health and encouraging people to lead healthy lives by exercising, eating better, and getting a good amount of sleep.

Question 62

Working Together For Patients NHS values

Answer 62

All staff working together to provide a reliable, compassionate health service for their patients is what the NHS is built on. This is important so that patients feel like they come first, and that their needs are put above all else.

Question 63

how you’ve demonstrated Working Together For Patients and doctors

Answer 63

Think about the work shadowing you have done. How did the Doctors work with the nurses to provide care for the patient? How well did they work with other health care professionals? Talk about what would happen if this teamwork and communication broke down, and how it would affect patient care.
-> a&e respiratory distress. Nurses to get x-rey, oxygen cylinder and anaesthetist

Question 64

Everyone Counts NHS value

Answer 64

This value is about the fact that everyone matters. Everyone should be included, and not discriminated against on any grounds when providing care. It is also about distributive justice and the fair allocation of resources to those in need.

Question 65

How many adults are obese and overweight

Answer 65

1/4 adults are obese
65% of adults are overweight

Question 66

What illnesses are linked to obesity?

Answer 66

Diabetes
High BP
Cancers
Arthritis
Stroke
Overall cost

Question 67

facts on sugar tax

Answer 67

• it was supported by evidence. BMJ said 20% on soft drinks will reduce obesity by 1.3%
  -International taxes do work- soft drink consumption fell by 12% in Mexico after tax

Question 68

2020 Anti-obesity strategy points

Answer 68

-motivated by Covid-19
- an advertising campaign
- New free weight loss app
- Partnership with diet companies

Question 69

Pros of sugar tax

Answer 69

• case study mexico
• increased funding
  less spent on treatments
• ethical responsabilites
• reducing obesity

Question 70

Cons of sugar tax

Answer 70

• long term impact
• socioeconomic inequality
• better to encourage healthy eating rather than punishing unhealthy
• ethical arguments - gov shouldn’t be paternalistic, autonomy
• other causes of obesity

Question 71

What is obesity?

Answer 71

WHO- abnormal or excessive fat accumulation that may impair health

Question 72

BMI of overweight and obese people

Answer 72

overweight >25
obesity <30

Question 73

Why is BMI debated

Answer 73

• doesnt consider mass of muscle

Question 74

What factors contribute to obesity?

Answer 74

bodyweight is multifactorial
- food
- activity
- stress
- sleep
- health and meds
- environment
- genetics

Question 75

What is Prader-will syndrome?

Answer 75

• genetic condition caused by loss of function of certain genes on chromosome 15, due to no paternal copies being inherited
• it is thought to affect hypothalamus (involved inn hormone production) leading to hormonal changes
• leading to insatiable appetite that drives obesity
• no treatment but affects of obesity can be treated

Question 76

Consequences of obesity to the individual

Answer 76

• increases risk of chronic conditions such as fatty liver disease and heart disease
• associated with worse mental health outcomes and a poorer quality of life
• affects quality of care, evidence to suggest doctors show weight bias and associating obesity with negative personal traits
• can affect performance in physical activities

Question 77

Consequences of obesity to the NHS

Answer 77

• overweight and obesity related conditions are costing the NHS £6.1 billion a year
• over the last 5 year there is a 20% increase in hospital admissions directly linked to obesity
• cost of campaigns seeking to prevent obesity

Question 78

Pros of prevention and cons of treatment

Answer 78

• successful prevention is usually cheaper for the NHS than treatment
• prevention avoids many long-term consequences of obesity
• treatment of obesity id not always successful as people can relapse

Question 79

Pros of treatment cons of prevention

Answer 79

• prevention is not always effective, mot all types of obesity can be prevented
• educational and social campaigns are hard to justify when money could be spent elsewhere
• treatment is highly effective and somewhat simple - leptin replacement

Question 80

Positive impacts of Covie-19

Answer 80

• improved ability to tackle infectious diseases
• improved resourcing in the NHS
• integration of technology within the healthcare system
• increased mental health support

Question 81

Negative impacts of covid-19

Answer 81

• longer waiting lists for elective procedures
  -patients have deteriorated due to lack of access
• various condition have been undiagnosed
• reduced resources for covid patients