VLE Flashcards

Question

What are the 5 tasks of the Calgary-Cambridge model?

Answer 1

- Open consultation. - Information gathering. - Appropriate physical examination. - Planning and explaining. - Closing the consultation.

Answer 2

- Beneficence. - Acting in patient’s best interest. - But how do we know what they are unless we find out? – requires a dialogue and sharing of info, requires respect for persons views, values, preferences

Answer 3

- Respect for autonomy. - But not about just letting them do what they want/just giving info. Info overload can even take away autonomy, information may reduce autonomy if information overload - Information presented that is relevant to the pt, their values and preferences - Autonomous decision making involves responsibility - Responsibility for consequences of decision (good or bad) - Potential psychological harm of living with poor outcome following a decision - Autonomous choice may be for someone else to make the decision - How information is presented (and in what order) influences decisions made - Potential for manipulation of patient’s decision (paternalism within an informed choice model?)

Answer 4

- Combines the ethical principles from both of the models – ie. Beneficence, respect for autonomy and best interests. - Importantly, it shares the responsibility for any decisions made. Decreased psych harm. - Must beware of coercion, as it is a fine line between negotiation and persuasion. - Challenges - Patient access to information, Patient ability to process complex information, Communication difficulties

Answer 5

• “A duty of confidence arises when one person discloses information to another in circumstances where it is reasonable to expect the information will be held in confidence” – DoH Code of Practice Requires not sharing personal information (either deliberately or accidentally) if expected not to.

Answer 6

–Common Law of Confidentiality –Data Protection Act 1998 –Human Rights Act 1998 – there is a human right to respect private and family life. –Administrative Law – such as the NHS trust

Answer 7

Trust is an essential part of the doctor-patient relationship and confidentiality is central to this. Patients may avoid seeking medical help, or may under-report symptoms, if they think their personal information will be disclosed by doctors without consent, or without the chance to have some control over the timing or amount of information shared.” – GMC Confidentiality Guidance So why does it matter? 80% of the diagnosis should be made from the history taking and the patient won’t tell you everything if they don’t trust you. It is an important part of the trust that builds up the patient/doctor relationship which is essential for care. An expectation of confidentiality is fundamental to dr-pt relationship

Answer 8

- Autonomy – I should be able to decide how info/data about myself is used. - Implied promise of a Dr. - Trustworthiness should be a virtue of a Dr./promise keeping/dishonesty - Privacy – there are somethings that people want to keep out of the public eye. - Identity – underpins confidentiality - Promise keeping/dishonesty/trust

Answer 9

Is important but not an absolute duty

Answer 10

•Disclosures with Consent –For the purposes of a patient’s healthcare; - implied consent –Clinical audit; –Employers, insurers, government department; •Disclosures Required by Law –Notification of cases of certain infectious diseases; –At request of certain regulatory bodies; –If ordered by a judge; •Disclosures Justified by the Public Interest –Gunshot and knife wounds –DVLA – someone unfit to drive may be a risk to the public –Education/Research?

Answer 11

- Balancing harms and benefits. - Impact on individual patient. (loss of trust.) - Impact on society. (loss of trust/lack of faith in the profession as a whole.) - Impact on others – ie. Harm of non-disclosure.

Answer 12

• Sharing information within healthcare teams (including administrative staff) is often necessary to provide care; – Patients generally understand and accept this; • So there is generally no expectation of absolute confidence; – Non-objection is taken as implied consent; – But information about this must be available to patients; – Patients can object to even this sort of information sharing, and this must be respected. • May be more likely in relation to particularly sensitive information; • May have to inform patient that required treatment is not a possibility unless information is shared.

Answer 13

• Organisations outside of healthcare teams can sometimes request medical information; – Insurance companies (for personal injury claims, for example) – Employers (checking fitness for specific jobs) – Government agencies (in relation to benefits claims) • Such requests can be granted, with the express consent of the patient; – You should be satisfied that the patient is sufficiently informed about what you will be disclosing – You should only disclose information that is relevant to the request – You should offer to show patient a copy of the information before it is sent (this may not always be possible) – Information disclosure should be kept to the minimum required, patient is informed and gives consent.

Answer 14

–You should be satisfied that the patient is sufficiently informed about what you will be disclosing –You should only disclose information that is relevant to the request –You should offer to show patient a copy of the information before it is sent (this may not always be possible) –Information disclosure should be kept to the minimum required, patient is informed and gives consent.

Answer 15

•In order for disclosure to be justified, it must be clear that disclosure can protect individuals or society from risks of serious harm; –So it must be clear why disclosure of this information is likely to be helpful; –Does the information have to identify the patient? •Could it be anonymised and still serve its purpose? – Compromises of privacy and autonomy should be kept to a minimum; • But has to be balanced against likelihood of preventing serious harm.

Answer 16

- a crime may have been committed • Police should be informed when a person arrives with a gunshot wound, or wound from a knife attack. – This enables police to assess risk to patient, to staff, and to others • But personal information should not usually be disclosed in the initial notification to police. – If police want to know patient’s name, etc, and the patient does not consent, a decision then has to be made whether disclosure is in public interest. – If you decide disclosure is not justified, police may still seek an order form a judge, or a warrant. – So even in potentially complex and fast-moving situations, disclosing information should still not be taken lightly.

Answer 17

– Legal responsibility for deciding whether a person is medically unfit to drive; – Provides guidance on disorders and conditions that may affect ability to drive; – Driver is legally responsible for informing the DVLA about condition or treatment making them potentially unfit to drive; • Doctor should explain to patient that condition may impact on their ability to drive; • And inform patient of the legal duty to inform the DVLA.

Answer 18

• Doctor should make reasonable efforts to persuade them to stop driving; – (If patient agrees this can include talking to relatives, friends or carers) • If patient cannot be persuaded to stop driving, doctor should contact the DVLA and disclose relevant medical information to the medical adviser • But doctor should try to notify patient of intention to do this, and confirm in writing with them when this has been done. – Disclosure is the last resort, and is still done in a way that tries to respect autonomy

Answer 19

• Communicable diseases can create tension for confidentiality; – If, for instance, a patient is diagnosed with HIV, their current, former and future partners may all be exposed to some risk. – Medical staff could also be exposed to increased risk. – But HIV is a particularly sensitive topic, which many people would expect to remain private. – So can information about the diagnosis be shared?

Answer 20

• Confidentiality is important: – Encourages people to seek advice/treatment: particularly important for communicable diseases; – But patient should be encouraged to consent to disclosure, as this will benefit his care. – But if patient still refuses consent, decision must be respected: • No risk of infection to GP or other medical staff so long as standard infection control procedures are followed. • Autonomy is respected, confidentiality is preserved, and nobody is unwittingly exposed to significant risk of harm.

Answer 21

• Patient should be encouraged to inform partner. • But if he still refuses: – Unlike GP, partner is at risk of infection and therefore harm; – So you may disclose, without consent, information to a known sexual contact of a patient; – Patient should be informed of the intended disclosure in advance (if it is safe to do so); – So this does conflict with patient’s autonomy, but there is a good reason for doing so.

Answer 22

- Common law of confidentiality - Human Rights Act 1998 - Health Protection (Notification) Regulations 2010. - Access to health records act 1990 (deceased people.) - Data Protection Act 1998

Answer 23

- Be fairly and lawfully processed - Be processed for limited purpose - Be adequate, relevant and not excessive - Be accurate and up-to-date - Be kept secure - Not be kept longer than necessary - Be processed in accordance with the rights of the data subject - Not be transferred to other countries outside the European Economic Community

Answer 24

) the nature of the information to be disclosed - (b) what use will be made of the information - (c) how many people will have access to the information - (d) the confidentiality and security arrangements in place to protect the information from further disclosure - (e) the advice of a Caldicott Guardian or similar expert adviser, who is not directly connected with the use for which disclosure is being considered, and - (f) the potential for distress or harm to patients.

Answer 25

- If court ordered. - If a notifiable disease. (Eg. Meningitis, Rubella, Anthrax, Malaria, Measles, TB.) - If the patient/other person will be at risk of serious harm if you do not disclose.

Answer 26

Senior people in NHS, local authority social care, and partner organisations, who are responsible for protecting the confidentiality of patient information and enabling appropriate information sharing.

Answer 27

– Significant part of relationships built upon trust; – An important part of respecting people and their autonomy; – We generally expect people to be honest with us.

Answer 28

– To protect ourselves; – To protect other people or things; – To avoid upsetting someone; – You may encounter similar situations as doctors.

Answer 29

Starts before things go wrong: – Patients should be fully informed about their care, including the risks, as well as the potential benefits. And continues if something goes wrong with a patient’s care: – If it causes them harm or distress as a consequence; – Or if they may suffer harm or distress in future as a consequence.

Answer 30

Patients should be informed as soon as possible; – open and transparent Share all you know/believe about the situation, including: – what went wrong; – why it went wrong; – the possible consequences for the patient; – explain where there are still uncertainties; You should also apologise to the patient.

Answer 31

–i) what happened –ii) what can be done to deal with harm caused –iii) what will be done to prevent someone else being harmed

Answer 32

Healthcare organisations have a duty to support staff to: – Report adverse incidents – Be open and honest with patients if something goes wrong This is separate to the professional duty of candour that individual doctors have.

Answer 33

* Statutory institutional duty * Set out in statute therefore legal requirement * Health and Social Care Act 2008: Regulation 20 (2014) * Formal process triggered by incident resulting in harm to patient. * Level of harm * Cause and effect

Answer 34

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

Answer 35

A) Duty to put patients’ interests first and to protect them overrides personal and professional loyalties; B) Legal protection against victimisation or dismissal for individuals who reveal information to raise genuine concerns and expose malpractice in the workplace; C) Do not need to wait for proof – able to justify raising a concern if you do so honestly, on the basis of reasonable belief and through appropriate channels, even if you are mistaken.

Answer 36

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

Answer 37

The practice of withholding pertinent medical information from patients in the belief that disclosure is medically contraindicated. This should be practiced with extreme caution!

Answer 38

-an error system failure that reaches the patient but does no result in patient harm-a'near miss'

Answer 39

- any patient safety incident that required extra observation or minor treatment and caused minimal harm - disclosure required under the professional duty of candour, incident should be reported to NRLS

Answer 40

- corresponds with NRLS 'moderate', 'severe' and 'death' and with incidents notifiable to CQC with harm explicity defined to include prolonged psychological harm in line with CGC reporting practice - disclosure would be required under both the professional and the organisational duties of candour, with proportionate regulatory consequences for a failure to disclosure harm of this kind

Answer 41

Consequentialist arguments: -Impact on the patient (breach may upset them; may affect trust and make them less likely to share info in future) -Impact on others generally (loss of public trust and therefore less effective care for many) -Impact on specific others (harm of non-disclosure) Respect for autonomy -Self-determination includes determining how information about oneself is used and how or whether this is shared Virtue ethics Promise-keeping and trustworthiness as virtues Other duties: Duty of care (data must be shared within healthcare team but usually not beyond Patient-doctor relationship

Answer 42

- Consent is the usual basis for sharing information about a patient’s care; - Can be implied or explicit; - Implied consent can be sufficient if all the below are met: - The data is being accessed to support a patient’s direct care; - Information is available to patients explaining how data will be used, and how they can object. - You have no reason to believe they would object. - You are satisfied that anyone you disclose information to will understand it is given to them in confidence, and will treat it accordingly

Answer 43

‘You should ask for consent to disclose personal information for purposes other than direct care or local clinical audit unless the information is required by law, or it is not appropriate or practicable to obtain consent ’

Answer 44

Research (Certain types of) audit (e.g. financial) Public health Education Health service planning Specific regulation for research purposes In cases of research, disclosure of identifiable info has to be approved by a Research Ethics Committee (REC)

Answer 45

a) The disclosure is required by law, including by the courts. b) The patient has given explicit consent. c) The disclosure is approved through a statutory process that sets aside the common law duty of confidentiality. d) The disclosure can, exceptionally, be justified in the public interest.

Answer 46

- It does not itself directly identify any individual - And it is unlikely to allow any individual to be identified through its combination with other data - Different types of data will have different levels of re-identification risk (small versus large dataset, for example) - Difference between anonymised and pseudonymised data

Answer 47

- the potential harm or distress to the patient arising from the disclosure – for example, in terms of their future engagement with treatment and their overall health - the potential harm to trust in doctors generally – for example, if it is widely perceived that doctors will readily disclose information about patients without consent - the potential harm to others (whether to a specific person or people, or to the public more broadly) if the information is not disclosed - the potential benefits to an individual or to society arising from the release of the information - the nature of the information to be disclosed, and any views expressed by the patient whether the harms can be avoided or benefits gained without breaching the patient’s privacy or, if not, what is the minimum intrusion.

Answer 48

(a) use anonymised or coded information if practicable and if it will serve the purpose (b) be satisfied that the patient: (i) has ready access to information that explains that their personal information might be disclosed for the sake of their own care, or for local clinical audit, and that they can object, and (ii) has not objected (c) get the patient’s express consent if identifiable information is to be disclosed for purposes other than their care or local clinical audit, unless the disclosure is required by law or can be justified in the public interest (d) keep disclosures to the minimum necessary for the purpose, (e) keep up to date with, and observe, all relevant legal requirements, including the common law and data protection law.

Answer 49

Hospital infection control: Duty microbiologist Public Health England: -Diagnosing clinician’s duty to report the case to the local health protection team -Form -Notify urgent cases by phone within 24 hrs -Legislation Public Health (Infectious Diseases) Act (1988) Public Health England regulations: Health Protection Regulations (2010)

Answer 50

The General Data Protection Regulation is a data protection framework that applies in all EU member states. A new Data Protection Act (2018) was enacted to supplement some sections of the GDPR. The two laws should generally be considered together.

Answer 51

1. Processed fairly, lawfully and in a transparent manner in relation to the data subject. 2. Collected for specified, explicit and legitimate purposes and not further processed for other purposes incompatible with those purposes. 3. Adequate, relevant and limited to what is necessary in relation to the purposes for which data is processed. 4. Accurate and, where necessary, kept up to date. 5. Kept in a form that permits identification of data subjects for no longer than is necessary for the purposes for which the personal data is processed. 6. Processed in a way that ensures appropriate security of the personal data including protection against unauthorised or unlawful processing and against accidental loss, destruction or damage, using appropriate technical or organisational measure

Answer 52

Allows access to health records of deceased people

Answer 53

- Patients - Person with parental responsibility can access child’s records (if not contrary to competent child’s wishes) - Power of attorney if patient lacks capacity - Executor of Will / dependants for deceased patients’ records - Independent Mental Health Advocates (IMHAs) - Independent Mental Capacity Advocates (IMCAs) - Police - by court order - - Solicitors - with consent of data subject - EXCEPT – If allowing access puts the patient or other person at serious risk of physical or mental harm. OR if it would reveal the identity of another person.

Answer 54

- When access likely to cause serious harm to the physical or mental health or condition of the data subject or any other person - When the data would reveal the identity of another person • Does not apply to health professionals involved in the care of the data subject (unless disclosure would cause them serious harm)

Answer 55

- Challenge accuracy - Refuse permission for use in secondary purposes - Have factual errors corrected - Claim compensation if the conditions of the Act are breached

Answer 56

Ensure the protection of confidentiality of patients and allowing appropriate information sharing. Senior people in the NHS.

Answer 57

Consent should be appropriate to the situation. - Consider: level of information needed/possible; - how/whether to facilitate capacity (e.g. pain relief, environment, timing, support). -If patient lacks capacity, proxy consent possible (MCA) Lasting power of attorney (LPA) (appointed by patient in advance); Court-appointed deputy (appointed when patient lacks capacity)

Answer 58

- Lasting power of attorney (LPA) (appointed by patient in advance); - Court-appointed deputy (appointed when patient lacks capacity)

Answer 59

- Doctrine of necessity (common law) - Urgency – emergencies may be life-threatening and may mean reduced time for assessing capacity - If patient lacks capacity, treatment must be in their best interests (MCA) - Patient can be detained under MHA – whether or not they have capacity But only under very specific conditions

Answer 60

-Understand the information necessary to make a decision; -Retain the information long enough to make a decision; - -Weigh the information; -Communicate their decision; A person must generally be assumed to have capacity – onus is on showing that patient lacks capacity.

Answer 61

- the person’s past and present wishes and feelings (and, in particular, any relevant written statement made by him when he had capacity), - (b) the beliefs and values that would be likely to influence his decision if he had capacity, - (c) the other factors that he would be likely to consider if he were able to do so.’ - In determining for the purposes of this Act what is in a person’s best interests, the person making the determination must not make it merely on the basis of - (a) the person’s age or appearance, - or (b) a condition of his, or an aspect of his behaviour, which might lead others to make unjustified assumptions about what might be in his best interests.’

Answer 62

‘D restrains P if he— (a) uses, or threatens to use, force to secure the doing of an act which P resists, or (b) restricts P’s liberty of movement, whether or not P resists.’ ‘ The first condition is that D reasonably believes that it is necessary to do the act in order to prevent harm to P. The second is that the act is a proportionate response to— (a) the likelihood of P’s suffering harm, and (b) the seriousness of that harm.’

Answer 63

- The (competent) child - Parents - Parental responsibility (under Children Act 1989) is with: - - Mother - Father if married to mother at time of child’s birth, or if registered on birth certificate, or by Parental Responsibility Agreement with mother, or by various kinds of court order

VLE Flashcards

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