Block 2: Week 5- Truth telling: duty of candour + raising concerns

Question 1

LO: Describe the ethical principles and values that underpin the moral obligation to be truthful

Answer 1

Moral duty

Legal duty

Professional duty

Employer

Dr-Pt relationship built on trust.

Pts trust Drs will be open + honest

AUTONOMY

Question 2

What does the principle of respect for autonomy involve and require?

Answer 2

Sharing of information

Openness at all stages of contact with pt:

• Info: diagnosis/ prognosis
• Info: necessary for informed consent
• Info: progress
• Info: things go wrong

Openness + honesty is crucial to respecting autonomy: it may upset them, difficult to tell them but it is still importnant

Question 3

What does open + being honest with patients look like in clinical practice?

Answer 3

• Not telling lies
• Disclose all relavant information
  
  • Failure = not completely truthful
  • Failure to fully disclose/ shaping patients perception

Question 4

LO: Identify and critique any limits to the moral obligation to disclose relevant information to patients about their care

When do you not have to tell patients everything about everything?

What is the problem with this?

Answer 4

Therapeutic Privilege

Some situations: disclosure may cause harm

Ethical argument in favour, in specific circumstace, witholding information during consent process.

Done for Pt Benefit

BUT generally you must tell them all relavent information

Problems:

• Who is best determined what is best for pt?
• Does undermining autonomy harm pt?
• What happens if something goes wrong directly related to witheld information?

Question 5

When should you be open + honest with patients?

Answer 5

Must be open + honest with patients even when something goes wrong with their treatment or care and causes or has the potential to cause harm + distress

Open + Honest:

Patient should be fully informed about thier care: including risks + benefits

If something goes wrong continue to be honest + open: if harm/distress is consequence or may suffer it

Question 6

What do patients needs to know when things go wrong?

Links to Professional Duty of Candour

Answer 6

Inform pt ASAP!

What went wrong

Why it went wrong

Possible consequences

Explain where there are still uncertainties

APOLOGISE

Question 7

What should be included in a patient apology?

Answer 7

What happened

What can be done to deal with harm caused

What will be done to prevent further harm to anyone else

Question 8

LO: Differentiate between the statutory and professional duties of candour

What is the statutory/organisational duty of candour?

What are the levels and what should be done at each level?

Answer 8

Organisations have a duty to support staff to:

1) Report adverse incidents
2) Be open + honest with patients if something goes wrong

Set out in statue: Health & Social Care Act 2008

Formal process triggered by incident resulting in harm to patient: Levels of harm. Cause & Effect

Levels of Harm:

• No Harm: Incident use for learning
• Low Harm: Disclosure under professional duty of candour. Report incident on system
• Significant Harm: Disclosure under professional + organisational duty of candour. Regularatory consequences if failure to discolse

Question 9

LO: Describe the key points of GMC guidance on raising concerns relating to patient safety and professional behaviour

What is the Duty to raise a concern- GMC Guidance?

What is the justification?

What do you do to raise a concern?

What are the importnat considerations?

Answer 9

Duty to raise concerns

1) Pt safety/ care compromised by practices of: colleague, system, policies + procedures
2) Encourage + support culture to raise concerns

Justification = ensure patient safety + quality of care

Raising Concerns: Talk to senior and document

Important Consideration:

A) Pt’s intrests first. Overrides personal + professional loyalties

B) Legal protection against victimisation of individuals who raise concerns

C) Do not wait for proof if reasonable belief

Question 10

LO: Differentiate between the statutory and professional duties of candour

What is the professional duty of candour?

When does being open and honest start and continue?

Answer 10

• Every HCP must be open & honest with a patient when something that goes wrong w/ their tx/care causes, or has the potential to cause harm or distress
• As a Dr: You must be open & honest with patient, colleagues & employers

Being Open & Honest:

• Starts before things go wrong: Fully informed about their care, the risks as well as benefits
• Continues if something goes wrong:
  • Causes harm/ distress as a consequence
  • Or if they may suffer harm or distress in future as a consequence