You are a consultant at a hospital. Once a year, an IT security professional discusses changes to the IT security system and trains hospital staff in making use of any new system features. Esther, another consultant, does not want to attend the mandatory session, saying “It’s the same stuff every year.” How do you respond?
- Encourage friend to attend
- Professionalism
- Importance of IT security (secure IT systems ensure confidentiality of patient info & hospital records)
Why is attendance mandatory in the medical profession, & throughout medical school?
- Establishes professionalism (it’s a key value, & diligent, timely attendance demonstrates this. Good attendance allows a good standard of care to patients, which is our main duty)
- Skills are up to date
- Opportunities to practice existing skills
- Engage with others & build communication skills
You are a medical student and a patient, Mrs. Khan, confesses to you that she is no longer taking her prescribed medication as she has read a lot about herbal remedies online and wants to try them instead. She mentions that she hasn’t informed any doctors about this yet. What would you do?
- What is the remedy?
- Explore patient beliefs
- Be respectful (respect her ideas about her medications & the fact that she is confiding in you)
- Inform staff (important for someone involved in her care to be aware that she is not taking her medication; be sure to ask Mrs Khan if this is ok so as not to break her trust})
You are part of the committee responsible for deciding the order of patients on a waiting list for a new liver. Currently, you are discussing three patients, aged 23, 40, and 77 who are all in need of a new liver. What factors are important in making your
decision?
- Age: younger patient would generally live longer if given a liver transplant, meaning more QALYs (quality adjusted life years) will be saved
- Biological match (& HLA match): are the patients biological matches for the liver; is the size appropriate? MOST IMPORTANT FACTOR
- alcoholism status: is there a risk of alcoholism? If so, will there eventually be a need for another liver if they revert?
- urgency: consider the urgency of need for the liver transplant
- contribution to society/others: do the patients have dependents; are they gainfully employed?
- prognosis
What do you understand about the phrase ‘informed consent?’ Why is it important to make sure patients are providing informed consent?
- Define consent: the patient agrees to and allows a specific action to be taken (procedure, medication, etc)
- Define informed: patients must understand the particular procedure prior to providing consent, including what is involved, why it’s being done, & potential side effects. This ensures competence.
- Discuss importance: understanding that patients need to be aware of what specifically they are consenting to, and the implications.
- Speak about autonomy: If patients are not providing informed consent, this means they lose a great level of autonomy. Can mention medical paternalism.
What are some of the issues raised if medical staff inappropriately obtain informed consent?
- Ethical considerations (autonomy)
- Poor rapport (patient might feel powerless, unhealthy relationship)
- Health implications (e.g. side effects, and physical / mental wellbeing)
- Professionalism & public opinion
When might a patient not provide informed consent? Are there any instances in which medical staff may proceed with a particular action without obtaining informed consent?
- If the patient is unconscious (family / carers should be consulted)
- If the patient does not consent
- When the patient is not competent (due to young age, cognitive impairment)
- Life-changing & time-sensitive procedures (e.g. CPR, stopping a major bleed)
What is an ethical issue, currently or recently in the news, that interests you? Why?
- Discuss a topic that is recent
- Mention ethical issues at play
- Have an opinion (also show that you’ve done your research & extra reading)
You are a junior doctor and are taking care of a patient who has made a number of rude, personal comments to and about you. How do you behave in this scenario?
- Maintain professionalism (as a doctor, you must treat each patient the same, even if they are giving you a difficult time)
- Demonstrate an understanding of the strain this may put on a doctor’s rapport with the patient, even if dealt with in a professional way
- Explore comments (there may be some ways in which your care could improve, there may also be a specific reason the patient is acting out - explore these)
- Speak with patient (let the patient know that the comments are bothering you in a gentle manner)
- Consider how poor mental health (for the doctor) may have impacts on patient care that are not limited to this particular patient, therefore the comments should not just be ignored
- Seek help (there are counsellors that can provide support for difficult workplace situations)
You are a GP and regular patient, Tommy, comes into your practice. He is 29 and has a learning disability and generally attends consultations with his carer, Ruth. You currently want to refer him to specialist services. What do you do? Do you do anything differently?
- Establish rapport with both Tommy & Ruth
- Ensure competence: before referring Tommy to specialist service, make sure that both him & Ruth understand why & what for. Have clear & simple communication.
- Be patient & respectful: take the time necessary to make sure that Tommy can provide informed consent
- Inform specialist: discuss with the specialist that Tommy has learned disabilities & has complex care needs; ensure that they can be accommodated
