Background

Question 1

Why not Nursing

Answer 1

• I have a profound respect for all healthcare professions, including nursing.
• During volunteer work, I’ve had the privilege of witnessing the incredible work nurses and other healthcare professionals do daily, and it’s clear that each role within healthcare is integral to patient care.
• Nurses are Patient advocates
• They observe and monitor then communicate with doctors and other healthcare professionals to ensure patients get the best possible care and understand their treatment plans
• Doctors receive a more general training, which ensures that they have knowledge and experience of clinical areas beyond their specialty.
• This aids the management of the patient beyond that specialty.
• Nurse specialists only have clinical expertise in that specialty whereas doctors have knowledge and experience beyond
• Nowadays, some nurses have taken roles traditionally taken by doctors, particularly in the domains of investigation, diagnosis and treatment but only a small minority have the opportunity and only in very specialised areas and highly protocol driven.
• Doctors have the ultimate responsibility for the patient.
• They are driving the decision-making process.
• Although nurses contribute greatly to that process, the final decision will rest with a doctor
• Both nurses and doctors my get involved in research activities.
• However, doctors are likely to take a lead in the research projects while nurses may be involved in the actual practical execution of projects.
• It is not a matter of one being better than the other but it’s people with different levels of responsibility and skills working together towards one goal of delivery the highest quality care to patients

Question 2

As a doctor, would you regard as part of the team?

Answer 2

Immediate Team
- Doctor
- Nurse
- Secretaries
- Radiographers

Peripheral Team
- Occupational Therapist
- Physiotherapist
- Social Worker
- Police
- Manager

PATIENT

Question 3

How important is teaching in the medical profession?

Answer 3

• Supervise other doctors on a day-to-day basis
• Help junior doctors prep for exams through mock exams
• Organise departmental teaching sessions
• Give Presentations
• Teach in theatre through observation

Important Because:
* Helps HCP develop new skills and build career - clinical governance
* Better knowledge, skills and patient care
* Can create bonds between individuals and promote team spirit (M of CAMP)

Example :
* Mock exams with first-year students involved in an initiative where I was able to teach students the first content of biology this was targeted to anyone who needed help to ensure fairness and justice - an important principle in medical ethics.

Question 4

Do you know what it is like to be a medical student?

Answer 4

• Leadership = GSP
• Organisation = Research project
• Stress Management

Question 5

What are aspects of patient care

Answer 5

Physical aspect:

• Intensity
• Duration
• Any relieving or aggravating factors
• Side effects? Sleep?

Psychological aspect:

• Is there anything which is stressing you?
• How are they coping?
• How is this affecting you?

Social aspect:

• Who is at home with you?
• Is there anyone you can talk to on a regular basis
• How is this impacting your relationship?

Financial:

• Is this affecting your job and your income-earning ability
• How are they managing to pay for amenities
• Can they afford to take so much time off?

Health literacy:

Question 6

Examples for interpersonal skills

Answer 6

1) Team Projects:
- Participated in team projects at school, work, or elsewhere, you can use these as examples of your ability to work well with others.
- Mention specific situations where you resolved conflicts, facilitated open communication, or supported team members in reaching the project’s goal.

2) Volunteering:
- Volunteered at a hospital, elderly home, or charity organisation, you can speak about your interactions with people of diverse backgrounds, ages, and situations.

3) Leadership Roles:
- Co President of Med Ethics society, or manager in a job, you can use these experiences to show your skills in motivating and guiding others, resolving conflicts, and achieving common goals.

4) Public Speaking:
- Participated in debates, or engaged in public speaking, these can all illustrate your communication skills. Effective public speaking requires you to articulate your thoughts clearly and persuasively, demonstrating strong interpersonal skills.

5) Tutoring or Mentoring:
- You can speak about how you helped others understand complex concepts, providing individualised instruction based on each student’s needs. This experience can show empathy, patience, and the ability to adjust your communication style for different people.

6) Healthcare Experiences:
If you’ve had any healthcare experience, such as shadowing a doctor, working as a medical assistant, or even personal experiences as a patient or caregiver, these experiences can highlight your ability to communicate effectively and empathetically in a healthcare setting.

Question 7

Future of the NHS

Answer 7

The Future of the NHS:

Technological Advancements:
- Rapid advancements in technology will continue to shape the NHS. With an ever-growing amount of health data available, the use of artificial intelligence (AI) and machine learning could drastically improve diagnosis, treatment and patient care, as well as reduce costs.
- Furthermore, telemedicine, which has been significantly accelerated by the COVID-19 pandemic, can offer more convenient care, particularly for those in remote areas or for those with mobility issues.

Increasing Disease Burden:
- As the UK population ages, the burden of chronic diseases such as diabetes, heart disease, and cancer will continue to increase. This presents a significant challenge to the NHS, both in terms of workload and finances.

Workforce Challenges:
- The NHS also faces staffing issues, with many roles experiencing significant shortages. This not only puts a strain on current staff but can also affect patient care.

&&Should the NHS Remain Free and Potential Solutions:**

The principle of the NHS being free at the point of service is a foundational value of the system. However, maintaining this in the face of the aforementioned challenges requires significant funding.

Potential solutions:

Efficiency Improvements:
- To improve efficiency within the NHS. This could be through better use of technology, more integrated care services, reducing waste, and improving procurement processes.

Preventative Care:
- Greater focus on preventative health could reduce the burden on the NHS.
- By investing in public health initiatives to promote healthy lifestyles and early detection of diseases, the NHS could potentially reduce the incidence of costly chronic conditions.

Charges for Certain Services:
- While the core health services should remain free, the NHS could consider introducing charges for non-essential services or for those that are prone to misuse. For example, nominal fees could be charged for missed appointments or non-essential cosmetic procedures.

Partnerships and Collaborations:
- Public-private partnerships could be explored to supplement NHS resources. While care would still be free at the point of service, the private sector could help provide certain services, bringing additional funding and efficiency.

In conclusion, while it is crucial to uphold the principles of free healthcare for all, the NHS must also adapt and evolve to meet the changing needs of the population and to ensure its sustainability.

Question 8

Clinical governance

Answer 8

A set of principles and behaviours that all doctors should adhere to in order to ensure that they offer their patients the best quality clinical care

• Doctors should ensure that their practice is compliant with the latest evidence.
• They should keep up to date and should ensure that they constantly adjust their practice to match new guidelines and new evidence from research
• Doctors should provide safe care to their patients and ensure they do not place their patients at risk (handwashing and check drugs).
• They should feel comfortable owning up to their mistakes and learning from them. They should report any incident so it can be investigated and lessons can be learnt
• They recognise when they have reached their limitations and should be willing to ask for help when necessary.
• Similarly, if doctors come across colleagues whose practice may endanger patients, they should act upon it and raise those issues with someone senior
• Doctors should ensure they constantly develop their skills and should also train and educate others. All staff should be properly supported
• Doctors should be attentive to patient needs and should take account of feedback they receive from members of the public to ensure they constantly improve their services

Question 9

The Audit Process

Answer 9

Audits are a systematic examination of current practice to assess how well an institution or a practitioner is performing against set standards. Reflecting on, reviewing and improving practice.

Why are audits important?

• The main purpose of an audit is to identify weaknesses in your practice and increase the quality of service provided to users
• Audits also help to identify inefficiencies and ultimately may lead to a better use of resources
• Audits are also used to provide information about quality of care to outside agencies
• Audits provide opportunities for training and education

Question 10

Informed Consent

Answer 10

Before patient can give their consent, doctors must explain:

• Options for treatment or management of the condition, include option not to give treatment
  -The aim of the planned procedure or treatment, including any consequences, common or serious side effects
• Details of the planned procedure or treatment, its benefits, chances of success, as well as common or serious risk and side effects, and how these might be managed
• Consequences of providing the treatment vs. not providing the treatment
• Details of any secondary intervention that may be required when undertaking the first one and for which the patient should provide consent before hand as they will be unable to do so should it be required in an emergency
• Details of who will be performing the procedure and whether doctors in training will be involved
• A reminder that the patient can change their mind and any time and that they can seek a second opinion
• Any costs that the patient may incur
• Only competent patients can give consent

Implied consent only applies to simple tasks with no real consequences. Anything else requires explicit consent to be obtained

Question 11

Competence

Answer 11

Adults:

• Adults (and children aged 16 and 17) are deemed competent unless proven otherwise
• If an adult is not competent, e.g. serious mental disorder, no other party can give consent on their behalf.

There are 2 options:
- If the patient has issued an advance directive (living will) at an earlier date stating how they would wish to be treated if at some point they were no longer able to make decisions for themselves then doctors would then need to abide by the patient’s decision, even if such a decision was not necessarily in their best interest

• If the patient has not indicated any particular wishes, the decision will rest with doctors to act in the best interest of the patient.
• However, doctors should involve relatives in order to ascertain what the patient would have wanted

Children below the age of 16 (Gillick competence/Fraser guidelines):

• Children under the age of 16 are deemed competent to give consent if they are shown to be mature enough to understand the information given to them about the procedure and its consequences.
• However, the doctor has a duty to discuss with the children the possible involvement of the parents or legal guardian in the discuss
• Note that if the child refuses to involve the parents then the doctors have to respect their decision, as this would breach confidentiality
• A doctor will only be able to involve the parents against the will of the child if the child is deemed not to be competent (in which case parental involvement is mandatory) or if the child is in danger (in which case you would involve social services or the police)

These principles are called Gillick competence or Fraser guidelines:

• The competence of a child is assessed in relation to the procedure concerned.
• Although a child can give consent for a procedure or treatment if competent, in England and Wales they cannot refuse consent for a procedure or treatment that is deemed in their best interest. I.e. if the child has cancer, surgical intervention refusal must be made by the parents
• If both the parents refused to give consent on behalf of their child for a life-saving procedure, doctors would need to act in the best interest of the child.
• If possible, they should get a court order to impose the treatment. If time is of the essence, they may need to impose the treatment first and justify that decision later in court if needed

Question 12

When can you breach confidentiality?

Answer 12

1) Implied consent has been given by the patient:

• A patient will understand that you need to provide information about them to other members of your team in order to care for them, e.g., nurses or consultant if you are referring
• If the patient visits you with a family member and openly discusses their situation with you however if you have to break bad news or deal with a sensitive issue you will need to check with a patient first

2) Information required by a court/judge:

• Medical records in the course of an investigation, court order

3) In the public interest and to protect the patient or others:

• Where the interest to society or others of disclosing the information without the patient’s consent outweighs the benefit to the patient of keeping the information confidential
• Notification to the authorities of notifiable diseases (meningitis, tuberculosis, mumps, measles but not HIV and AIDS)
• Suspected cases of child abuse or of neglect, physical or emotional abuse, where the patient cannot give consent to disclosure
• Informing the DVLA if a patient’s condition may affect his diving
• When the information can help with the fight against terrorism or in identifying a driver who committed a road traffic offence

Question 13

Euthanasia & Assisted Suicide

Answer 13

Can not recommend assisted suicide as it breaches non-maleficence

Arguments For:

• Patients should be allowed to choose what is best for them
• Patients can avoid a lengthy and unnecessary suffering period
• Patients can die with dignity at a time of their choosing
• Allows for reallocation of resources utilised for these patients

Arguments Against:

• It goes against some religious principles, doctors or relatives playing God
• Patients may change their mind later at a time when they may no longer be able to express their change of position
• Possibility of recovery
• Difficult to verbalise specific criteria for allowing or disallowing euthanasia/assisted suicide
• If the case is not clear-cut or well documented, relatives may face murder charges
• Relatives may abuse the situation to suit their own needs instead of the patient’s
• Relatives may pressure a patient they do not actually wish