Case 10- alcoholism and confidentiality

Question 1

Health consequences of recreational alcohol use

Answer 1

• Stroke
• Brain damage
• Withdrawal symptoms
• Depression, anxiety, suicide
• Cancer of mouth, throat, oesophagus, larynx
• Heart disease
• Harm to unborn baby
• Liver disease and cancer

Question 2

Impact of drug and alcohol misuse on families

Answer 2

Parental alcohol and drug dependence significantly harms the wellbeing of children
Drug and alcohol misuse can be part of a complex set of coexisting health and social problems
Misuse can impact on health&wellbeing, education, risky behaviours and result in inappropriate caring roles

Question 3

Drug and alcohol misuse effect on communities

Answer 3

communities

• 40% of victims of violence believed perpetrators to be under the influence of alcohol
• 48% of domestic abuse perpetrators had a history of alcohol dependance, 73% had been under influence of alcohol prior to event
• Alcohol and drug problems are both a cause and a symptom of homelessness
• Alcohol misuse also causes a loss of £7bn in work productivity

Question 4

Health consequences of drug use

Answer 4

STI’s, depression, cardiovascular disease, lung damage, blood born virus’s and bacterial infections

Question 5

Effect of alcohol use on spending

Answer 5

Loss productivity, More money has to be spent on crime, policing and the NHS

Question 6

How the doctor can help someone with alcohol dependence

Answer 6

They can offer help and information to the patient as well as referring them to specialist service’s. The GP should review drug and alcohol use at each session and understand local need.

Question 7

Alcohol and baby development

Answer 7

Alcohol can effect foetal development resulting in foetal alcohol spectrum disorder (FASD). This may cause the baby to have an abnormal appearance, low body weight, poor co-ordination, low intelligence, behavioural problems and problems with hearing or seeing. The most severe form of the condition is foetal alcohol syndrome (FAS) where children have restricted growth, facial abnormalities and learning and behavioural disorders.

Question 8

Summary care records (SCR)

Answer 8

An electronic record of important patient information created from GP medical records. It is created automatically when you join a GP service but it is important to check that the patient consents to this. This record is shared across the NHS.

Question 9

National data opt out

Answer 9

You can choose for your confidential patient information to not be used for purposes other then your own care and treatment

Question 10

How to legally protect patient information

Answer 10

Keep it secure
Ensure it is relevant and up to date
Only collect information you need for a specific purpose
Only hold as much as you need, for only as long as you need
Allow the subject to see the information upon request

Question 11

Legal aspects about the storage and use of electronic patient information

Answer 11

Data protection act 2018 - certain info should be provided to patients
Human Rights Act 1998 - no personal information should be stored in regards to private life, unless necessary

General Data Protection Regulation 2016:
Personal data should be collected for legitimate purposes
It should be accurate and up to date
It should be processed lawfully
Shouldn't be kept for longer than needed

Question 12

GDPR lawful bases for processing electronic patient information

Answer 12

One of these must apply at least, when processing personal data:

1) Consent
2) Contract - processing is necessary for a contract signed with the patient
3) Legal obligation - processing is necessary to comply with the law
4) Vital interests - processing is necessary to save / improve a life
5) Public task - processing is necessary to perform a task in public interest
6) Legitimate interest

Question 13

Problems with the storage and use of patient information

Answer 13

Large studies involving lots of patients make it hard to obtain informed consent from all of them. Some patients cant give consent but we still need their information

Question 14

Dual responsibilities in confidentiality

Answer 14

1) Occupational health
2) Insurance companies
3) Benefits claims
4) Prison services

Question 15

GMC’s 8 principles of confidential information

Answer 15

1) Use the minimum information necessary
2) Manage and protect information
3) Be aware of your responsibilities
4) Comply with the law
5) Share relevant information for direct care
6) Ask for explicit consent to disclose information
7) Tell patients about disclosures
8) Support the patients right to access their own information

Question 16

The DGPR’s ethical right’s for processing data

Answer 16

• The right to be informed
• The right of access
• The right to rectification
• The right to erasure
• The right to data portability
• The right to object
• The right to restrict

Question 17

Negatives of patient support groups

Answer 17

• May be run by organisations who don’t have the best interest of the patient.
• Strategies may not be evidence based.
• Medical information shared on forums may be incorrect.

Question 18

The ethical basis for confidentiality

Answer 18

1) Patients best interest)
2) Privacy rights
3) Personal integrity
4) Doctor-patient trust

Question 19

The professional basis for confidentiality

Answer 19

GMC guidance states anonymise data when possible, keep disclosures to the minimum necessary and seek patient consent for disclosure when possible

Question 20

The legal basis to break confidentiality

Answer 20

Judicial proceedings
Regulations e.g. infectious diseases
Information might be needed to support essential NHS activity

Question 21

Justified breaches of patient confidentiality

Answer 21

1) When the patient consents to disclosure
2) When disclosure is of overall benefit to the patient who cant consent
3) Disclosure is required by law
4) Disclosure can be justified in the public interest

Question 22

Benefits of patient support groups

Answer 22

Patients gain insight on their condition, feeling more in control and empowered. Saves the NHS money through reduced appointments and the patients gain self-coping strategies and support.

Question 23

What patient support groups provide?

Answer 23

• Education- information and an understanding about the condition, symptoms and management.
• Advice- on lifestyle and condition management. The advice can come from people with the condition or healthcare professionals
• Discussion forums- you meet people all over the world, provides support out of hours
• Role models
• Activities- you can meet people in support groups providing individuals with a distraction, social interaction and an opportunity to make friends
• Awareness – support groups can be linked to charities, they can run fundraisers and spread awareness of conditions.
• Group therapy.

Question 24

Why it is important for medical professionals to value diversity?

Answer 24

1) Improves patient care- more likely to open up if they feel respected
2) Increases job satisfaction
3) Learn from peoples differences
4) Maintains trust between patients and colleagues
5) Make sure you are acting with honesty and integrity

Question 25

How racial harassment can effect someone’s career?

Answer 25

• Excluding ethnic minority staff from decision making
• Allocating work beneath their ability
• Blocking opportunities for learning and development
• Withholding credit for their ideas.

Question 26

Active bystanding

Answer 26

When viewing racial discrimination, it is important to report what you see. By leaving it to BAME students you can exacerbate their isolation

Question 27

Legal framework for respecting diversity

Answer 27

• Duty of care law- duty to try to avoid inflicting harm
• Contract law: breach of contract- students and staff may have made agreements about (un)acceptable behaviour
• Protection from Harassment Act 1997
• Human Rights Act 1998, particularly acts 9 and 10 (‘freedom of expression’)- able to express religious beliefs within the limit of the law and public safety.
• Defamation Act 2013 (limits ‘freedom of expression’)
• Equality Act 2010- allowing for equal opportunity between people with a protected characteristic and does who don’t. Reduce discrimination and harassment.

Question 28

Protected characteristics

Answer 28

Age, disability, gender reassignment, pregnancy and maternity, race, religion or belief, sex, sexual orientation.

Question 29

Harassment

Answer 29

It is unwanted conduct due to a protected characteristic made to violate their dignity or create a hostile, degrading or humilitating environment.

Question 30

Ethical issues associated with organ transplant

Answer 30

• Who gets the organ?
• Relatives only get approached once death is confirmed - how is death defined, brain dead or when the heart stops?
• Coercion of living donors
• Lack of ability allow for the individual to give consent e.g. brain dead
• Issues with religious beliefs
Should the NHS pay donors?

Question 31

Legal issues with organ transplant

Answer 31

• Families can object even if the person signed the donor register.
• Opt out systems- people may not be aware. Made law in the Organ donation act 2019. Children and adults who lived outside the UK and adults who lacked capacity for a while before their death are excepted.
• Human tissue act 2004- specifies consent must be given before organ transplantation occurs. Human organs can not be sold or bought.
• Nominated representatives can make known the wishes of the patient

Question 32

An individual’s personal responsibility for health

Answer 32

1) It may not be easy to determine to what extent personal decisions are influenced by socio-economic factors beyond one’s personal control. For example, someone who is richer will be able to afford more healthy food.
2) People engage in health impairing behaviours that damage their own organs. Therefore should they be trusted with getting someone else’s?

Question 33

What factors may be morally relevant with organ donation?

Answer 33

• Age
• Should it matter whether the individual has opted out of the donor register
• Social status and value for society
• Personal choices that contributed to the liver disease
• Length of time on the waiting list
• Urgency of treatment
• Likelihood of positive outcome
• QALY