BMJ one examination - SJT Flashcards
You think consultant performing endoscopies is using alcohol.
Contact defence organisation,
Speak to consultant privately
Discuss with ES
If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body or the GMC
Unfortunately, drug and alcohol misuse is common among doctors and other professionals. We each have a duty of care to raise concerns about behaviour which endangers patients and this must be done promptly (7). Many hospitals will have a policy on dealing with drug and alcohol misuse among staff; this involves giving affected staff members support and professional assistance in identifying their problems and trying to overcome them.
Patient safety must be maintained always and measures must be taken in this situation to protect that as your first priority. You should approach this issue ideally by talking to your educational supervisor (8) and potentially your defence organisation (4) first, but you do need to speak to the doctor him/herself as well (3). It is not appropriate to involve multiple other, unconnected members of the hospital team if you can avoid it (1, 5) and it would be unprofessional and unnecessary to confront the consultant in front of colleagues (2). It is unlikely that as a foundation doctor you would have the expertise to take over an endoscopy list (6).
5 month baby and >40 degrees. Paeds reg tells you not to send the patient to hospital. Your supervisor has gone home.
Speak to paediatric consultant on-call.
Highlight reservations to paeds reg and ask him to review.
Send patient to emergency department.
In this situation you would be responsible should the baby become seriously unwell as it is you and not the paediatric registrar who has assessed him. If there were difficulties with the registrar, you should discuss the case with the consultant.
Your first duty is to the patient and you should arrange further assessment if you feel uncomfortable sending him home. You would be justified in doing this as the height of his fever suggests serious infection. For further information, see NICE guidance on Feverish illness in children (CG160).
The presence of intercostal recession could suggest an early lower respiratory tract infection. It is highly unlikely the paediatric team would refuse to the see the patient if you explained your concerns and requested they assess the patient.
Explaining your concerns and course of action with the baby’s mother so that she can respond as necessary is appropriate but this would be no substitute for admission at this time.
Child brought in by mother with fractured ribs. You suspect abuse. Father comes in and demands to know what is going on (they are divorced).
- retrieve notes and explain to father about admission
- encourage father to discuss admission with Childs mother
- tell father child has been admitted with fractured ribs without revealing suspicion of abuse
There are two key areas to consider here: patient confidentiality (including that of minors) and safeguarding concerns. With regards to confidentiality, the father, despite being out of the immediate family circle, has a right to know why his daughter has been admitted without needing permission from the mother (2, 5, 8). Ideally, you would encourage the mother and father to discuss this together in preference to managing the conversation with each of them separately (4).
You do not need to and should not get permission from the child to discuss this (1) and Gillick competence is only relevant to consent to treatment (3).
As this is an early stage, it may not be the best environment to discuss your suspicions of abuse with the father (6, 7). However, if you suspect abuse, you must act. You should discuss your concerns initially with the paediatrics team who will be able to advise on how to take the matter forward. Most hospitals have a safeguarding children policy and a lead contact for child protection concerns.
You think child has cancer, mum asks you whether cancer is back?
- ask mum to move into side room
- ask nurse to accompany you into quiet room
- check patients notes to see if a consultant has seen her since admission
The problem here is that the discussion regarding the possibility of recurrence was avoiding initially when you saw the patient in the Emergency Department. Of course, sometimes this is unavoidable. However, as the mother is obviously concerned and has explicitly asked you about the possible diagnosis it results in a difficult situation in the middle of the ward.
It is important that you discuss the patient’s situation in the right environment, ideally a quiet side room or relatives’ room (2, 6). In addition to seeing her in a quiet side room, another option would be to ask a nurse to accompany you and her (1). While it can be difficult to manage the competing demands of answering the mother’s question as soon as possible, it’s vital that you make sure you fully understand the patient’s situation by reading the notes to understand the plan before you talk to her (4). Following the discussion, you should document this important conversation in full for the benefit of your ward colleagues (8).
Unfortunately, while it can be very difficult to have this conversation as a foundation doctor, it’s not appropriate to hand this important communication job off to a nurse (3). Similarly, the mother has asked you a direct question and is likely very worried so delaying this conversation or trying to wait for a consultant to be available is also inappropriate (5, 7).
Receptionist talking bad stuff about another GP. Patients asks you about other GP.
- carry on consultation and address patient’s presenting complaint
- Explain to patient you can’t comment on a fellow GP
- Arrange a meeting with yourself, the receptionist, the practise manager and GP colleague
Your priority is to complete the patient consultation in a professional manner (2, 6); you should not let her comments affect the quality of care you provide (7).
Following the consultation, you need to determine the best way to address the apparent conversation that the receptionist had with the patient. Obviously, there should be no further action on your part until more information has been obtained, ideally with all appropriate parties present (1). Similarly, you cannot afford to delay this or attempt to resolve it outside of the work environment (5, 8). You should not be tackling this situation by yourself or without more information about what happened (3, 4).
References:
Gossip about GP partner and patient. What should you do?
Speak to the senior partner
Mention it to your educational supervisor
Speak to the practice manager
Absolutely nothing
Report the partner to the GMC for professional misconduct
- Mention to ES
- Speak to senior partner
- Speak to practise manager
- Report partner to GMC for professional misconduct
- Do nothing
Your car breaks down on the way to home visit a breathless old lady.
Ask one of your colleagues to do the housecall instead on their way home
Telephone your patient to assess the urgency of the call
Arrange for a 999 ambulance to be despatched to your patient’s home
Abandon the call and schedule a visit in your diary for the following day
Wait for the recovery service to arrive so that you can proceed
Call for a taxi to come and take you to your destination
- Telephone your patient to assess the urgency of the call
- Ask one of your colleagues to do the housecall instead on their way home
- Call for a taxi to come and take you to your destination
- Wait for the recovery service to arrive so that you can proceed
- Arrange for a 999 ambulance to be 6. despatched to your patient’s home
Abandon the call and schedule a visit in your diary for the following day
One of your regular patients (Tom), says another patient (Mr Brown) is rude and swearing at him. You know Mr Brown has just been diagnosed with prostate cancer.
Obtain more details from Tom and the receptionists
Speak to Mr Brown about his behaviour
Tell Tom that you are unable to do anything about it
Advise Mr Brown that he could be offlisted if he continues to swear and be abusive to others
Explain to Tom that he’s probably unhappy because of his prostate cancer
- obtain more information from Tom
- Speak to Mr Brown
- Advise Mr Brown he will be offlisted if he swears and is abusive to others
- Tell Tom you are unable to do anything about it
- Explain to Tom that he’s probably unhappy because of prostate cancer
You are in GP practise attending to vomiting patient. Receptionist comes in and tells you a patent in next room as collapsed and looks blue.
Go immediately to the collapsed patient and tell the receptionist to dial 999 from you room while she stays with your vomiting patient
Advise her to go away because you are busy with a sick patient and can’t do two things at once
Leave your vomiting patient with the receptionist so that you can tend to the collapsed patient
Advise her to try to find somebody else to deal with it
Tell her to call 999
- Go immediately to the collapsed patient and tell the receptionist to dial 999 from you room while she stays with your vomiting patient
- Leave your vomiting patient with the receptionist so that you can tend to the collapsed patient
- Tell her to call 999
- Advise her to try to find somebody else to deal with it
- Advise her to go away because you are busy with a sick patient and can’t do two things at once
