Communication Station Flashcards
What do you need to consider with a patient with an undisclosed HIV diagnosis to partner?
Confidentiality balanced with public health risk.
Offer to notify on her behalf or help with that.
Ethics support and law department within trust.
Patient wants to know about the diagnosis of Huntingtons, his mother has recently been diagnosed. What are the key things you need to explore?
Firstly check consent if going to be sharing information about his mother.
Assess what family member already knows.
Explain diagnosis of Huntingtons- progressive neurodegenerative condition with a wide spectrum of symptoms including movement disorder, progressive decline in cognitive ability and psychiatric disorders such as depression.
No cure, only supportive therapy.
Will in time need full time nursing care. May want to think about POA or advanced refusal of treatment.
Inherited condition, 50% chance of passing onto children. Explain anticipation.
Screening is available, cannot tell people when they will get the disease and the severity with which they will be affected.
Prenatal screening is available and also able to do pre-genetic screening.
Offer appointment with genetic counsellor and get in touch with Huntingtons Society. Follow up appt and written info.
What is the Bolam test?
The doctor is not negligent if he or she acted in accordance with what a responsible/reasonable body of medical opinion would do.
What is the bolitho test?
The answer must withstand logical analysis.
What is Gillick compentance?
Ability to consent to treatment (but not refuse) in under 16yo.
When is negligence usuall found in regards to a procedure?
When a patient does not recieve certain relevant information when consented for a procedure.
Is it a legal requirement to ask a relative to sign a consent form on behalf of a patient who cannot consent?
It is best practice to discuss intended procedures and document aggremeny but it is not legally binding and does not constitute consent.
What are the requirements of a lasting power of attorney.
Must be signed by a solicitor and then registered with the Office of the Public guardian.
Who can be consulted if the decision of a Lasting PoA is disagreed with?
Court of protection who will ultimately adjudicate over this decision.
Ideally how should a ADRT be performed?
Ideally witnessed and signed. Include the name and adress of the GP and be forwarded to the GP. The decision being refused should be clearly documented and the circumstances in which this would apply and the words ‘even if life were at risk’ to life sustaining treatments.
When would doctors have discretion to break confidentiality?
When another party is at risk of serious harm. For example non disclosure of HIV.
What is the process of breaking confidentiality?
Encourage patient to disclose.
Notify patient in writing of the reason for disclosure, the content, to whom the disclosure has been made and the likely consequence for the patient.
Detainment of patients with TB?
Patients with smear positive TB can be detained but not treated under the public health act.
How might you try and persuade someone not to drive if they are disqualified from driving.
Insurance will be invalidated.
Risk of harm to themselves and others.
Risk of £1000 fine if DVLA not notified.
What to include in information delivery station.
Explanation of condition, demonstration and discussion of regular and PRN medications, sude effects, lifestyle facts, follow up and leaflets.
