Coping with Pressure Flashcards
1
Q
- You are a new FY1 doctor on an orthopaedic team. The morning
ward round is running late and both your consultant and registrar
need to go to theatre. One patient has yet to be consented for a hemiarthroplasty
after fracturing her hip. Your registrar tells you to make sure
that she is consented in time to be second on the morning list.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Consent the patient before doing any other jobs.
B Complete all urgent jobs arising from the ward round, and then consent
the patient.
C Explain that you are not suffi ciently experienced to consent patients
for this operation.
D Ask an SHO from another team who can perform hip hemiarthroplasties
to take consent.
E Agree to consent the patient and then ask experienced nurses to
show you how to do this correctly.
A
- C, D, E, A, B
GMC guidance states that the doctor providing treatment (i.e. the
operation in this example) is responsible for obtaining informed consent.
He can delegate this responsibility to someone who is suitably trained
and has suffi cient knowledge about the operation and its risks. As an
FY1 doctor, you are unlikely to satisfy these criteria. Therefore the best
option is to explain your position to the registrar (C). He should then
consent the patient himself or delegate the responsibility to someone
else. The next best option would be to ask an appropriately qualifi ed
doctor from another team to help (D). This is not the preferred option,
as such a person will have other duties, may not know the patient, and
is unlikely to be part of the operating team. If ever in doubt, it is advisable
to ask colleagues for advice. (E) is the fi rst clearly wrong answer;
however, it is redeemed to some extent by the fact that you are seeking
advice, and an experienced nurse will probably point out that you should
not consent patients for complicated procedures in FY1. The fi nal two
options—(B) and (A)—are the most unsafe. (A) is very narrowly better,
as addressing the issue urgently might ensure there is time for consent
taken in error to be rectifi ed.
2
Q
- You are the FY1 doctor on call for medicine. After seeing a patient
with pancreatitis, you recall the need to take an arterial blood gas
(ABG). Unfortunately your only experience of this procedure was on a
model two years previously. You have never attempted to perform an
ABG on a patient before and are not feeling confi dent about success.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Call the duty medical registrar and ask them to supervise your
fi rst ABG.
B Ask another FY1 doctor who is available and more confi dent with
procedures to help.
C Attempt the procedure but without warning the patient about your
inexperience.
D Wait until the end of your shift and then hand the job over to the
night team.
E Attempt the procedure twice after talking to the patient, and then ask
for help if unsuccessful.
A
- C, D, E, A, B
GMC guidance states that the doctor providing treatment (i.e. the
operation in this example) is responsible for obtaining informed consent.
He can delegate this responsibility to someone who is suitably trained
and has suffi cient knowledge about the operation and its risks. As an
FY1 doctor, you are unlikely to satisfy these criteria. Therefore the best
option is to explain your position to the registrar (C). He should then
consent the patient himself or delegate the responsibility to someone
else. The next best option would be to ask an appropriately qualifi ed
doctor from another team to help (D). This is not the preferred option,
as such a person will have other duties, may not know the patient, and
is unlikely to be part of the operating team. If ever in doubt, it is advisable
to ask colleagues for advice. (E) is the fi rst clearly wrong answer;
however, it is redeemed to some extent by the fact that you are seeking
advice, and an experienced nurse will probably point out that you should
not consent patients for complicated procedures in FY1. The fi nal two
options—(B) and (A)—are the most unsafe. (A) is very narrowly better,
as addressing the issue urgently might ensure there is time for consent
taken in error to be rectifi ed.
3
Q
- As the FY1 doctor on call you are bleeped by the pathology laboratory
about an abnormal blood result. They give you a value representing
severe hypernatraemia. You do not recall very much about hypernatraemia
and have never managed a patient with this problem before.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Call the duty medical registrar and ask what to do.
B See the patient to check that they are well, and then call the duty
medical registrar.
C Find a computer terminal and Google ‘hypernatraemia’ for inspiration.
D Consult hospital guidelines, either in paper form or online.
E Prescribe a loop diuretic such as furosemide.
A
- B, D, A, C, E
Your fi rst priority in any patient about whom you are worried is to
familiarize yourself with their details and ensure that they are stable
(e.g. Airway, Breathing, Circulation). (B) is therefore the correct
answer. The next best answer is (D) because hospital guidelines may
ensure you manage the situation correctly and are a way of solving the
problem yourself without unnecessarily overly burdening the medical
registrar (A).
The two wrong answers are (C) and (E). (C) is marginally better as it
is at least an attempt to identify the correct course of action. However,
using unregulated online resources is commonplace but should be discouraged
(C)—hospital guidelines, senior colleagues, and potentially
authoritative books (e.g., Oxford Handbook for the Foundation Programme )
are better sources of information.
The worst answer is (E) as loop diuretics are not used to manage
hypernatraemia—you would have known this had you consulted hospital
guidelines or discussed with the medical registrar.
4
Q
- You are on a busy surgical ward round. Your consultant tells you to
order an urgent CT scan and make sure that it happens that morning.
Although you make a note on your jobs list to do this, you do not
think that there is a good reason for doing the scan.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Ask the consultant what the scan is for.
B Tell the duty radiologist that you disagree with doing the scan but have
been told that it is urgent.
C Explain to your consultant you cannot order the scan as you disagree
that it is appropriate.
D Ask a colleague in your team whether they can explain why the CT
scan is necessary.
E Book an ultrasound instead and then reconsider the CT scan later
depending on its results.
A
- A, D, C, B, E
Doctors should understand (and be able to defend) any investigation
or procedure they request. You should avoid taking responsibility
for requests you do not understand, and it is particularly
difficult to persuade a radiologist to accept a scan request that you
do not understand yourself. Your best option is to ask the consultant
(A) or, not quite as good, another member of the team
(D) what the scan is for.
The other answers are incorrect. Your consultant is unlikely to appreciate
you declining to request the scan (C). However, this is probably
better than taking a similar approach with the radiologist (B). Although
the radiologist might understand why the scan is necessary, she cannot
always be expected to know what your consultant was thinking. You
should aim to be better informed than this before approaching a senior
doctor outside of your team.
The worst answer is clearly (E). If you have been asked to request
a CT scan, you should generally not do something else simply based
on your own initiative. Given that your consultant is considerably more
experienced, ordering an ultrasound scan instead may both delay the
defi nitive investigation and waste a valuable ultrasound scanning slot that
could be used by someone else.
5
Q
- Matron has raised an issue about a drug that you prescribed incorrectly.
You prescribed a times overdose which fortunately was spotted by a
vigilant pharmacist and never administered. Nevertheless, a clinical incident
form has been completed and Matron is going to contact your Educational
Supervisor. You feel that this error was caused by being overly tired.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Tell Matron that the error was not your fault because the Trust made
you work unsafe hours.
B Accept personal responsibility but explain the factors that you believe
contributed to the error.
C Ask Matron not to contact your Educational Supervisor as this was an
isolated error.
D Use your e-portfolio to record the error and refl ect on its reasons so
as to avoid this happening again.
E Ask to meet your Educational Supervisor to discuss the error and
your concerns about the night rota.
A
- B, E, D, A, C
Thankfully, no harm came to this patient as the error was spotted by
the pharmacist. The most important thing now is that both you and the
organization learn from this incident.
The best answer is (B) as you must always take responsibility for your
actions, although you should take steps to communicate the factors that
you think contributed to the error in whatever way is necessary to eff ect
appropriate organizational change.(E) is the next best answer because it raises concerns about the underlying
reasons for your error. It is important to take personal responsibility
but explaining your reasons to Matron in the correct way could lead
to positive changes in the rota. Although (D) is a positive option, it does
not raise the issue beyond your own personal refl ection area and so has
limited practical benefi t.
(A) is not a positive option because it appears defensive and raises
your concern in a forum that is unlikely to result in a constructive outcome.
The worst answer is (C) because you should never seek to cover
up your mistakes or ask colleagues to do so for you. If Matron feels that
the error is suffi ciently serious to raise with your Educational Supervisor,
you should not interfere with this decision.
6
Q
- You are enjoying an evening meal with your friends when you
remember ordering a blood test for an unwell patient, the result of
which you forgot to check or hand over.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Make a note to check the result fi rst thing in the morning before the
ward round.
B Call the duty FY1 doctor through the switchboard and ask them to
check the result.
C Put the issue out of your mind—it’s important to ‘turn off ’ after work.
D Refl ect on how this test was missed and resolve to develop a system
to ensure that such an error does not occur in the future.
E Drive back to the hospital to check the result yourself.
A
- B, E, D, A, C
Patient safety is your priority and someone should follow up this test
result immediately. The duty FY1 doctor is the most appropriate person
to do so (B). The next best option is to visit the hospital yourself and
check the test (E). Although this is of great practical inconvenience and
should not be something you do frequently, it is better than the remaining
options as the patient’s safety can then be guaranteed.
(D) is the fi rst wrong answer as it fails to address the immediate
patient safety issue. It is, however, the best of the incorrect answers as it
might stop similar problems arising in future. (A) is more incorrect as it
introduces unnecessary delay and there is no guarantee that an abnormal
result would have been recognized in time to treat the patient appropriately.
The most incorrect answer is obviously (C).
7
Q
- An FY1 doctor with whom you work closely says she is concerned
that you seem ‘down’ and have been so for a few weeks. You have
noticed that your mood is lower than normal but put this down to stress
and tiredness. You do not think that you are clinically depressed and are
embarrassed by your colleague raising the possibility.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Clarify the nature and reasons for your colleague’s concern.
B See your Educational Supervisor at the next possible opportunity to
discuss your mental health.
C Make a routine appointment with your GP.
D Ask other FY1 colleagues whether they think you are depressed.
E Use a depression screening tool to determine whether you require
drug treatment.
A
- A, C, B, D, E
You should fi rst seek to clarify what has prompted your colleague’s
concerns. There may be good explanations or she might have noticed
something that you have yet to pick up on yourself. For this reason,
(A) is the best answer, and (C) would be the next most appropriate step
if you acknowledged your colleague’s concerns. However, it could still
be an appropriate response, as you are not necessarily best placed to
assess your own health and an independent assessment could be useful
if others are worried. GMC guidance states that all doctors should
be registered with a GP so that objective advice can be sought if necessary.
You should avoid ‘corridor consultations’ with colleagues, but
could discuss this with your Educational Supervisor (B) even though
they might not be qualifi ed to assess you formally. However, it would
be less appropriate to canvass the opinion of your FY1 colleagues (D).
The worst answer is (E) because you should never attempt to formally
assess or treat yourself.
8
Q
- After an emergency operation, a patient is left with a colostomy.
You are the fi rst doctor to see the patient once he becomes conversant,
and he asks whether the bag is permanent. You are certain that
colostomies can be reversed but do not remember very much else.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Tell the patient that his colostomy will be reversed.
B Explain that you are an FY1 doctor and cannot answer complicated
surgical questions.
C Explain that colostomies can sometimes be reversed and that you will
help fi nd out the plan in his case.
D Off er to ask your registrar to drop by later on to answer specifi c
questions.
E Put time aside to read about stomas so you can answer questions
more fully next time.
A
- C, D, E, B, A
GMC guidance states that you must always be honest and recognize the
limitations of your knowledge. Your best option here is to tell the patient
what you know and explain that it is the limit of your knowledge (C).(D) is the next best alternative, as it involves a suitable senior, although
you may have been able to allay the patient’s concerns yourself before
deferring to someone else for further information. (E) suggests refl ective
practice and will improve your care for future patients but does not
address this patient’s concerns at all. Refusing to answer the patient’s
questions without providing a suitable alternative (e.g. speaking with a
senior, fi nding out the answer) is even less appropriate (B). The worst
answer is (A) as you do not know this for certain.
9
Q
- You are seeing a very unwell patient on your ward. He is complaining
of chest pain and is also becoming increasingly hypotensive,
despite fl uid resuscitation. Over the previous few minutes, he has started
to become drowsy. Although you are an FY1 doctor, you recently completed
an Advanced Life Support (ALS) course and feel confi dent in managing
acutely unwell patients.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Summon the resuscitation team.
B Continue to manage the patient regardless of their clinical condition.
C Call the consultant on his mobile phone.
D Call the SHO on her mobile phone for advice.
E Continue managing the patient unless he continues to deteriorate.
A
- A, D, C, E, B
The best answer for managing acutely unwell patients always begins with
‘ABCDE’ and calling for help at your earliest opportunity. A patient who
is clearly deteriorating quickly and whose consciousness level is falling in
front of you warrants urgent assistance as you are unlikely to be able to
manage a threatened airway independently on your ward. For this reason
(A) is the best answer. It is much less appropriate in the acute setting
described to make a telephone call for advice when you should be busy
resuscitating a patient while you are waiting for the resuscitation team to
arrive (D). However, the SHO is more likely to be readily available to
attend the ward and assist you than the consultant (C). (B) and (E) are
the worst options only because neither recognizes that you require help
in this situation. (E) is better than (B) because in the former you have
at least set parameters for which you will summon help, even if you
are likely to reach this point quickly given the patient’s current rate of
deterioration.
10
Q
- Your consultant asks you to meet her in her offi ce. She tells
you that she is concerned about your performance; specifi cally
that you sometimes arrive late for her ward rounds and that your level
of clinical knowledge is below her expectations of a doctor at your level.
You disagree with this assessment, as you have only been late twice and
do not think that there are any particular gaps in your knowledge.
Rank in order the following actions in response to this situation (1 = Most
appropriate; 5 = Least appropriate)
A Explain why you feel that her assessment is unfair, and ask her to
provide specifi c examples to illustrate her concerns.
B Ask the foundation school about the possibility of changing consultants
as there has been a relationship breakdown.
C Ask the consultant for advice about how you can act on her concerns
and improve your performance.
D Using your e-portfolio, conduct a Team Assessment of Behaviour
(TAB) round looking for evidence of concern about your performance
from other colleagues.
E Tell the consultant that you believe your knowledge to be no worse
than that of other FY1 doctors, and that you won several prizes at
medical school.
A
- C, A, D, E, B
The key here is to strike a balance between defending yourself against
an assessment that you believe is unfair and adopting a conciliatory
approach so that you can learn from the perception others may have
of you. To ensure a constructive meeting you should start by asking
for advice and listening to your consultant’s concerns; for this reason,
(C) is a better answer than (A). Part of refl ecting on this experience,
particularly as there is an apparent disagreement, would be to canvass
the opinion of others, e.g. using the Team Assessment of Behaviour tool
(D). This alone is not as good an option as (C) and (A) which are part of
the necessary dialogue with your consultant about her concerns. (B) and
(E) are both incorrect; (E) is less incorrect as although your consultant
is unlikely to be less than impressed about your assertion, this does not
involve any other parties. The worst answer is (B) as nothing in the question
indicates that there has been an irreparable breakdown in working
relationships.
11
Q
- You have always enjoyed alcohol but recently have been drinking
more than usual. There is no reason for you to think that this
has aff ected your performance and you have never been drunk at work.
However, a number of junior colleagues have commented on your alcohol
intake, and one has told you that she is concerned that you are developing a
dependency. As a result, you have begun to worry about your intake.
Choose the THREE most appropriate actions to take in this situation
A Ask a friend with whom you socialize whether he/she thinks that you
are drinking too much.
B Ask other FY1 doctors not to joke about your drinking, as you feel
that this undermines your professional reputation.
C Use a validated assessment tool (e.g. CAGE) to determine whether
you have developed an alcohol problem.
D Make an appointment with your GP to discuss your concerns about
your alcohol intake.
E Discuss the issue with your Educational Supervisor at your next
meeting.
F Stop drinking for a week to see if you develop withdrawal symptoms.
G Think carefully about your reasons for drinking more than usual
recently, and consider modifying your drinking pattern.
H Stop going out with colleagues and drink secretly instead to avoid
damage to your reputation.
A
- D, E, G
All doctors should be registered with a GP whom they should approach
with concerns about their health (D). There is no obligation to speak
with your Educational Supervisor if work is unaff ected, although theymay be better placed to support you if they are kept informed (E).
(E) is not necessarily an incorrect answer and may be something you
consider later on; however, the three correct answers listed are better.
It could certainly be helpful to gain the perspective of a friend regarding
your drinking habits (A). Note that in previous scenarios, wider discussions
with other FY1 colleagues has been considered less ideal—in
this case the distinction has been drawn, because a friend is likely to
support you and off er honest advice and be intimately aware of your
drinking pattern. If your alcohol consumption has increased recently,
you might wish to try reducing it for health and social reasons (G). You
should not threaten your physical health by attempting to provoke withdrawal
symptoms (F). You are already concerned about your drinking
and should seek advice from an independent professional rather than
attempting to manage the problem further yourself (C). Although you
might be concerned about acquiring an unhelpful reputation, asking
your colleagues to stop gossiping (B) may be ineff ective and will not
solve any underlying drinking problem. Drinking secretly will certainly
not resolve any such alcohol dependency (H).
12
Q
- You have been working as an FY1 doctor for six weeks but struggle
with intravenous cannulation; in fact, you have yet to site one
successfully despite several attempts. You are concerned about the distress
caused to patients by your unsuccessful attempts and your inability to
cannulate is starting to have an impact on the length of your working day.
Choose the THREE most appropriate actions to take in this situation
A Ask colleagues to site intravenous cannulas as often as possible until
your ability improves.
B Using your e-portfolio, refl ect on what it is that you are fi nding diffi cult
about intravenous cannulation and how you can overcome this.
C Ask a senior colleague to supervise a series of cannulation attempts.
D Avoid trying to cannulate patients with ‘diffi cult veins’, and ask colleagues
to see them instead.
E Consider modifying career aspirations to specialties that are less
procedural.
F Continue to practise, recognizing that the procedure will become
easier as you do.
G Attempt to cannulate each patient no more than once; if unsuccessful,
bleep the duty anaesthetist for assistance.
H Tell every patient that they have ‘diffi cult veins’ so that their expectations
of success are set low from the outset.
A
- B, C, F
Competence in intravenous cannulation is a fundamental skill for doctors
and mandatory for successful completion of FY1.
You should identify what exactly it is you fi nd diffi cult about cannulation
(B), ask for supervision and feedback (C), and then seek opportunities
to improve your ability (F).
Strategies to avoid cannulating patients, such as asking colleagues to
do it (A), avoiding ‘diffi cult’ cases (D), or calling a specialist after a token
attempt (G), will burden others and will not help you to improve your
ability. Covering your own defi ciencies by blaming patients (H) is not
encouraged, although it might be fair to warn patients if you genuinely
anticipate that multiple attempts may be necessary.
Career aspirations could be modifi ed if you fi nd yourself struggling
(and/or not enjoying) practical procedures (E). However, it would be
premature to make such decisions based on experiencing diffi culties with
one skill over such a short space of time.
13
Q
- You are a lone FY1 doctor seeing an elderly patient on the ward
who is hypotensive despite being given intravenous fl uids. You
are concerned that the only intervention you know for managing hypotension
has not worked in this case.
Choose the THREE most appropriate actions to take in this situation
A Ensure that the patient has a valid Not For Resuscitation order in case
they suff er cardiac arrest.
B Accept that the patient is normally hypotensive and avoid further
intravenous fl uids.
C Call your SHO or other senior doctor for advice and assistance.
D Ask the nursing staff to put out a peri-arrest call.
E Begin administering inotropes if further fl uid challenges fail to increase
the blood pressure.
F Ask the patient’s family to attend as their relative is probably dying.
G Ensure that you have good intravenous access and give another fl uid
challenge.
H Monitor the patient carefully for signs of deterioration.
A
- C, G, H
GMC guidelines require all doctors to recognize the limits of their
knowledge and experience. In this case, you have attempted to fl uid
resuscitate the patient without success. The next step is to seek advice
and/or assistance from a senior colleague (C).
As a foundation doctor, you must be able to manage patients
who are potentially deteriorating until help arrives. In this case, you
should ensure that there is good intravenous access (G) and that
the patient is being observed carefully (H) while you are waiting for
support.
Although the patient’s blood pressure may be acceptable for them,
this should not be assumed without further information (B). Similarly, itis far from clear that the patient is peri-arrest (D), dying (F), or appropriate
for a ‘Not For Resuscitation’ decision (A). Inotropes would not be an
appropriate next step in this case (E).
14
Q
- You are feeling stressed as the on-call FY1 doctor and have
just found yourself becoming angry with two sets of relatives
in quick succession.
Choose the THREE most appropriate actions to take in this situation
A Take a short break to regain perspective.
B Ask a colleague to help share your workload if they are able.
C Resolve not to speak with any more relatives on this shift as your
priority must be unwell patients.
D Apologize to the relatives so that they are unlikely to complain.
E Consider what factors led to the altercations and address these as far
as possible.
F Ask security or a nursing sister to remove the relatives so that you are
not interrupted again.
G Manage your frustration by berating a medical student because he is
unable to cannulate a patient.
H Check the time—it may nearly be time to go home.
A
- A, B, E
It is important to remain professional at all times and to take necessary
steps to avoid your own feelings aff ecting how you behave towards
others. In this case, you should recognize early on that you are behaving
unprofessionally and take remedial action. It may be helpful to
take a short break (A), ask a colleague for assistance (B), and address
any specifi c factors that you think may have contributed to your
behaviour (E).
Although patients should always be your priority, dealing with relatives
is an important job for junior doctors, even when on call (C). Apologizing
to these particular relatives (D) may well be appropriate, but the motivation
for doing so should not be to avoid complaints, and it is likely that
an insincere apology could infl ame the situation. Clock watching is not a
strong solution to the problem (H).
Action to remove relatives (F) should only be initiated if staff ,
patients, or other visitors are at risk. You should have suffi cient insight
to wonder whether two ‘clashes’ with relatives in quick succession
may refl ect your behaviour as much as theirs. The medical student
(G) is not to blame!
15
Q
- Your manager emails to say that a written complaint has been
received about your management of a patient seen in A&E.
This concerns a patient whom you saw after a fall but you did not document
a proper examination. A fractured hip was missed for 72 hours.
Choose the THREE most appropriate actions to take in this situation
A Edit the notes to include features that you honestly recall at the time
persuaded you that the patient did not have a broken hip.
B Edit the notes to include features that were not present but might
make your mistake easier to forgive.
C Submit a factual description of events within the deadline imposed.
D Think honestly about the case and what you would do diff erently in
future.
E Ignore the email as you are rotating to a new hospital next week.
F Explain that you were very busy that day and could not thoroughly
examine every patient.
G Document your formal response and ask to be informed of the outcome
of this complaint.
H Submit a response whenever you are able—the clinical care of your
current patients comes fi rst.
A
- C, D, G
You must comply as far as possible with any complaints procedure. In
this case, you should cooperate with your line manager by providing factual
details in a timely manner (C).
Regardless of the complaints process (and outcome), you must
endeavour to improve your own practice. You may identify areas of
clinical practice or communication that could be improved from this
experience (D). As well as documenting carefully, you should ask for the
complaint outcome (G) so as to aid the learning process.
At all times you must be honest and trustworthy. GMC and local disciplinary
procedures will expect this from all clinical staff . You must not
edit the notes retrospectively to protect yourself (A) (B) or obstruct the
process by not replying (E) or delaying your response (H).
Although you may need to explain your actions, being ‘busy’ is not an
excuse for failing to examine a patient thoroughly (F). Doctors must take
personal responsibility for their actions, even if other factors contribute.
16
Q
- Your consultant calls to ask you to relocate a dislocated total
hip replacement for a patient on the orthopaedic ward. He
mentions that you should give intravenous sedation fi rst. When you tell
him that you have never sedated a patient before, he tells you to use
propofol and ketamine, and then hangs up the phone.
Choose the THREE most appropriate actions to take in this situation
A Call the consultant back to clarify what doses you should use and what
movements are necessary to replace the dislocated limb.
B Call the consultant back to say that you are unwilling to do as he asks.
C Use the British National Formulary to determine doses.
D Sedate the patient and then fi nd the duty orthopaedic registrar if you
are unable to relocate the dislocated hip.
E Contact your Educational Supervisor at the fi rst possible opportunity
to discuss this request.
F Contact another senior orthopaedic colleague if your consultant does
not answer or off ers no further advice.
G Attempt to relocate the hip without using sedation.
H Sedate the patient and attempt to relocate the hip.
A
- B, E, F
As a junior doctor, you must recognize your own limitations at all times.
In this case, you are uncomfortable with the request and must ensure
patient safety even at the expense of upsetting your consultant.
You should be honest and communicate to the consultant that you
are unhappy with his request (B). It may have been miscommunicatedand/or your response may prompt the consultant to change his mind.
If you feel pressured to work beyond your limitations, this should be
raised with your Educational Supervisor at the fi rst available opportunity
(E). If you cannot recontact the consultant, you should get in touch with
another senior colleague (F) to discuss your concerns.
In this case, sedating a patient on a regular ward is likely to be unacceptable,
even for a senior doctor (D). You must always prioritize patient
safety over other considerations and should not comply with a request
that you believe might be dangerous (A) (C) (H). Attempting to relocate
the hip without sedation (G) would be very painful and may cause more
harm if you are unfamiliar with the procedure.
