* Critical thinking

Question 1

In what ways can doctors promote good health other than through the direct treatment of an illness

Answer 1

During consultation, the doctors could encourage patients to lead healthy lifestyles. This can be done by promoting safe sex and promoting the importance of exercise via display posters in their surgery

Doctors should also promote support groups so that those suffering from some sort of addiction can find help

Immunisation campaigns are also an important component and provide appropriate immunisation services such as vaccine buses and centres. These immunisation campaigns can extend into social media

Question 2

How does politics influence healthcare decisions

Answer 2

Politics is involved with the funding of the healthcare system.

The level of care that the NHS can provide is determined by the budget that the government provides. This budget comes from National insurance contributions, which is limited if the elected positions do not want to anger the voters. Therefore, often the budgeting of the NHS is often a balance between meeting the needs of the healthcare system and not losing voters goodwill by increasing the taxes.

The way in which awareness campaigns are often influenced by the personal beliefs of politicians and often intertwined with politics e.g. the fight against covid

There is a complex argument between whether clinicians should have more control over the NHS compared to politicians. The argument that favours clinicians states that they know best about patients care while the argument in favour of politicians states that the NHS is a public institution funded by taxpayers and so it is only right that policy should be directed by the people

Question 3

Do you think it is eight to allow private healthcare to run alongside the NHS

Answer 3

There are valid arguments for both for and against private healthcare systems

For example, if there were no private healthcare sector in the UK, many might go abroad to receive treatment. If any complications occur, it would be ultimately up to the NHS to follow up on this issue once the patient returned to the UK.
This, therefore, leads to the argument that it is better to treat patients where you have control over the quality of care rather than dealing with the potentially negative consequences of their treatment abroad

Private healthcare also takes relieves the pressure that the NHS faces daily. This is because it makes the waiting list shorter and so NHS users can be seen too quickly.

An argument against private healthcare, however, such as the fact that it is financially driven. This raises issues with the motivation of the doctor, which may not necessarily align with the core values of the NHS e.t.c integrity. Furthermore, due to the financial incentive, the doctors may simply go along with the patients’ wishes rather than considering their best interests

Another issue for private healthcare is that it does not provide full coverage. For example, if a patient requires intensive care, they may be needed to be transported to a better-equipped NHS hospital for example. This can result in the suffering of the patient who was already in a fragile situation

After considering both sides of the argument,
I believe that there is a place for both private and public healthcare

Question 4

What do you think of the way doctors are perceived in the media

Answer 4

In some cases, doctors can be portrayed as heroic, for example during the pandemic and even in TV series where the acts of doctors are glorified.

However, cases like Harold Shipman can easily lead the media to distrust the doctors

In my opinion, the media can be used to aid the public trust in the healthcare system. But as easily it does this, the media can easily dramatize cases that lead to the villainization of the healthcare system

Question 5

what does the phrase “inequalities in healthcare” mean to you

Answer 5

Most who live in lower socio-economic areas may have received a poorer education. This can easily lead to them not understanding their health needs or having a poor understanding of the available services that can better their health such as gyms, addiction centres, alcoholic anomalous e.t.c

Private healthcare sectors may also pose another inequality. This is because private healthcare typically helps the wealthier part of the population which neglects the needs of the poor who are often the ones who requires the most help

Where a person lives may also lead to others being more advantaged than others in the context of healthcare. For example, there is an uneven distribution of resources leading to issues in access to primary healthcare

Question 6

what are the arguments for and against people paying for their own healthcare

Answer 6

There are both pros and cons to paying for your own healthcare

For example
The current system of healthcare calls for everyone to pay National Insurance despite being in good health. Therefore, only paying whenever you are ill can be seen as a clear advantage since logically, in the grand scheme of things, you would save a lot of money

Having people who are beneficial to the NHS as it would motivate people to not only live a significantly more healthiest lifestyle but stop people from going to the hospital over minor issues such as a simple cold.

However, the cons of paying for your own healthcare would be that it would negatively impact the poorer of society. Considering that those living in disadvantaged geographical areas often are the ones with bad health. It, therefore, follows that they would suffer the worse if you had to pay for your own healthcare.

Patients, therefore, seek cheaper alternatives which can be less effective and not safe

Question 7

whar are alternative medicine/complementary therapies

What are your opinions on them

Answer 7

Again, there are both pros and cons to using alternative treatments. Examples of alternative therapies are:
-hypnosis
-Chinese medicine
-Herbalism

e.g. acupuncture, the deeper patient-therapist relationship may fulfil the needs of patients who may require a much more holistic approach to treatment

Crystals
which a person may use alongside their treatment may fulfil the patients’ spiritual needs. This can be a source of calm for the patients which can ultimately contribute to better mental health especially if the treatment they receive was highly invasive

Arguments
However, an issue with alternative therapies is that they are often poorly regulated. This has led to fakes exploiting the trust that patients who believe in the legitimacy of the treatments - which is without saying is unethical

Furthermore, some complementary therapies involve taking substances that can be toxic e.g. kiver toxicity of some Chinese Medicine treatments. This means that they ultimately can lead to more harm than good and potentially worsen the condition that they are currently receiving conventional treatment for

Question 8

what is an alternative medicine

Answer 8

therapy that is taken instead of conventional treatment

Question 9

what complementary therapy

Answer 9

therapy taken alongside conventional treatment

Question 10

should the NHS deal with patients who have self-inflicted diseases

Answer 10

This is a difficult question to ask. This is because the majority of diseases are self-inflicted even though it may not necessarily be obvious e.g. sexually transmitted diseases such as HIV. Therefore, neglecting to treat these diseases would ultimately lead to the healthcare system only treating a small minority of conditions
Furthermore, it is difficult to see the extent to which a disease is actually self-inflicted. This raises a major practical issue for only treating non-self inflicting diseases

On the other hand, treating patients with a self-inflicted disease may only serve as a temporary solution. The patient can easily relapse to the previous habits that led to their current condition. Therefore, it follows that treating self-inflicted diseases does not actually solve the deeper issue at hand and makes people feel less responsible for their own health.

Ultimately, it is up to those who use the healthcare system to decide how they would use the healthcare system.

Question 11

Should alcoholics and smokers receive equal treatment to those who don’t drink and don’t smoke

Answer 11

similar to self-inflicted diseases

The resources in the healthcare system are already scarce, therefore it may worsen the public image of the healthcare system if they say that these resources are being sued on people that are “underserving”

On the other hand, treating patients with a self-inflicted disease may only serve as a temporary solution. The patient can easily relapse to the previous habits that led to their current condition. Therefore, it follows that treating self-inflicted diseases does not actually solve the deeper issue at hand and makes people feel less responsible for their own health.

Question 12

what are the arguments for and against the sale of tobacco

Answer 12

A very obvious argument for the sale of tobacco would be that people have the right to choose what is good for them. It is their choice to take a health risk. Furthermore, banning the sale of tobacco would simply lead to it being sold underground like many drugs. The tobacco situation would simply grow to the point where it is uncontrollable.

Tobacco leads to serious respiratory issues. The resources in the healthcare system are already scarce, therefore it may worsen the public image of the healthcare system if they say that these resources are being sued on people that are “underserving”

Question 13

how do you go on researching something you know nothing about

Answer 13

-Talk to people who are experts in the field or have undertaken a similar type of research previously

-Look on the internet and in specialist medical databases

-Consult journals and magazines. Look in books

Question 14

How do you know what you don’t know

Answer 14

First, it is important to look to identify any weaknesses that you have in your knowledge. This can be done by obtaining feedback from others and assessing yourself against a known list of criteria such as a syllabus, tick list of skills e.t.c.

After this, it is important to fix the gaps in your knowledge. This can be done via seeking advice and learning from colleagues and attending suitable courses. You can then test your new knowledge acquired through assessment

Question 15

Should the NHS fund non-essential surgery

Answer 15

Non- essential surgery can be an incredibly subjective topic

Non - essential surgery may seem like they are not important, however, in the grand scheme of things, the surgery may actually be good for the long term mental health of the patients. This reduces the potential of the patient developing depression which can further put a strain on the NHS

That being said, the surgery may actually not address the deeper issue of low - self-esteem which can be treated better through psychological or psychiatric intervention and so treating the underlying problem may also be more suitable than cosmetic surgery.

Question 16

would you say that Medicine is an art or a science

Answer 16

As much as Medicine is a science as an art.

Medicine is to a certain degree requires an element of creativity. For example, there are times where one must think outside the box and utilise your imagination in order to find a diagnosis. Furthermore, other obvious links between medicine and art would be the skilful ability that a surgeon has to mend wounds and extract abnormalities without leaving any scar.

The communication aspect in Medicine is an art within itself. Doctors are called to craft their sentences in a masterful way in order to clearly get their points across. On top of this, the communication aspect calls you yo be adapt your language depending on who you are addressing. This again is art in itself

Therefore, I would say that it is valid to say that Medicine is as much a science as it is an art

Question 17

How do you solve the problem of transplant organ shortage

Answer 17

There are two approaches that can solve the problem of organ transport:

• Remove the need for transplants of living organs by increasing research to find alternative solutions to using real organs (e.g. grow organs on demand, use animal organs or find alternative cures for diseases)

-Increase the number of organs being donated. This is probably the most realistic and quickest implement option. How does this happen:

-imposing that everyone should be a donor
Although this is a good method, it does impose some ethical issues in regards to the autonomy

-financial incentives
Paying for organs is currently illegal in the UK and the financial incentives would create a market that is morally grey and the sellers would mainly be from poorer areas trying to make ends meet

Question 18

why do you think it is that we cannot give a guarantee that medical treatment or surgical procedure will be successful

Answer 18

Success is relative to the person. For example, for most patients, the level of success depends on the level at which they can return back to ordinary life, furthermore, if a permanent scar is left in an obvious area, the patient may only view this surgery as a success to a certain degree.

There are both patient-linked and doctor linked patients linked to the success of the surgical procedure

Patient factors include:
- the possibility that the patient develops further complications that may have an adverse/reverse effect on the success of the treatment it the procedure

Doctor-linked factors
- The surgeon may not be fully competent in the procedure or in handling the condition

-not all treatments work on all people and so the doctor would not want to guarantee success

Question 19

Do charities have a role in society or do you think that the government should decide where all the money should go

Answer 19

Charities have a major role in society as it highlights and brings awareness to many relevant issues. This can often bring about important social change.
Furthermore, charities are significantly much more targeted therefore meaning that they can help to solve issues in a significantly more intimate way.

By leaving all decisions to the government would result in funds being directed to areas where the majority would benefit. Money would be used to better society however, it would disadvantage unrepresented groups. Governments would also be able to pool resources resulting in reducing overheads and general costs

Ultimately, I believe that governments and charities can co-exist together

Question 20

what are the disadvantages and advantages of admitting when mistakes are made

Answer 20

There are significantly more advantages to admitting to a mistake compared to the disadvantages.

My friend entrusted me with her files which she placed in my locker. I was on my way to return her files to her but I had, unfortunately, dropped them. This led to the file breaking. Although it was difficult, I had to own up to my mistake and apologised as I acknowledged that apologising earlier would resolve the issue faster. I offered to pay for a new file, however, she declined and appreciated my honesty.

Question 21

Do you think it is appropriate for doctors to accept small gifts from patients as a thank you gesture

Answer 21

There are two aspects to consider:

-Professional judgement
must care for all patients without prejudice and without being influenced by bribes. This causes the question: does a small thank you gesture to represent a bribe or not? Is it likely to influence your judgement? to arise

-Doctor-Patient relationship
what if the present comes from an old lady whom you have been treating for many years and who is obviously not trying to bribe you - what would the impact on the doctor-patient relationship of refusing the bribe

Policy 1:
-accept nothing
-Share gifts with the staff
-give to charity

Policy 2: accept if the gift is small but do not accept cash
-if the value is over a certain amount e.g. £10 then discuss with the practice manager
-This helps to avoid damaging the patient - Doctor relationship
anything above this amount refuse. Make sure to clearly show appreciation to their gift but that it could be seen as clouding-your judgement

Question 22

do you think that it is right to make their own best interest

Answer 22

This is a highly complex topic that has many valid arguments for and against.

For example, patients are responsible for their own body. If they can make their lifestyle, they should also be able to make decisions about the healthcare that supports it. They are also more likely to go through with the treatment if they have been involved in the decision making process

That being said, the patient may not have the background knowledge to make the best decision for themselves and so they can’t really make an informed decision.

Therefore, as a doctor, you should give them a fully detailed outline of the treatment which puts the patient a better position to make an informed decision

Question 23

how do you address patient related situations

Answer 23

you need to address:

• PHYSICAL

-PSYCHOLOGICAL

-SOCIAL

-FINANCIAL

make sure to look at the whole picture rather than just the medical aspect

Question 24

For religious reasons, Jehovah’s Witness cannot accept blood transfusions

Would you be happy to let a Jehavoh’s Witness die because he refused a blood transfusion

Answer 24

In accordance to autonomy,, any patient is entitled woo make their own decisions and therefore, if the patient is competent, or if they have made a “living will” reducing a transfusion, then you will have to respect their decision

According to beneficence, as a doctor, you still have a duty of beneficence, even if it is sometimes overridden by the patient’s autonomy. Beneficience also means considering other options other than a blood transfusion that still aligns with their beliefs. Once you have done everything possible to help the patient, you can only accept the final verdict of the patient. This does not mean that you will be happy to see them die but you can be content that you did everything that you possibly could in order to help

Question 25

what would you do if a Jehovah’s Witness arrived in A&E unconscious, bleeding profusely and needing an urgent blood transfusion

Answer 25

• first stop the bleeding. Unless the patient has previously indicated that they would not want to be treated in case they have stated prior
  This is because cannot give consent as they are unconcious
• you can’t presume that the patient follows the religion strictly and so it follows the patient may want to have a blood transfusion. This information could be found in the patients records or if you have time, via calling relatives
  Although the relatives may help you final decision, it is still ultimately still up to you
• to play it safe, you could find an alternate blood transfusion or just ultimately go through with the blood transfusion. As long as you are justified with your decision, then you have nothing to fear if a law suit happened. However, you may want to involve the hospitals law team

Question 26

A mother comes to A&E with a child who is bleeding profusely and refuses yo allow a blood transfusion yo the child

Why and what would you do

Answer 26

• could be due to fear of infection e.g. HIV
  -distrust of the healthcare system

if it is because of these issues, then you can reassure her and even bring in senior doctors to help your case
If the mother still refuse. then your decision should be in line with the best decisions of the child which can potentially lead to going against parents
-make sure that if law suit occurs you can justify out actions

always make sure to involve senior trams and hospital lawyers

Question 27

You have one liver left and must consider one of the two patients
-mother of two young children who damaged her liver due to alcohol

-13-year-old child with a congenital liver defect

Answer 27

1. In order to make an accurate decision, I would have to have a more deeper understanding on both of the patients background in order to avoid basing my decision on prejudice and assumptions.
   -This information may be the chances of relapse

-the chances that the child could potentially get the disease again

• The level of support they have after the surgery

-any other underlying health conditions that may negatively be affected due to the surgery

BIOLOGICAL FACTORS TO CONSIDER:
- factors that influence the survival of the surgery such as

the matching
age

Question 28

What are the advantages and the disadvantages of the increasing role of nurses

Answer 28

The advantages of nurses taking up more roles that may have traditionally been done by doctors would be that it may free up doctor’s time which enables doctors to take up much more complex patients or procedures
In turn, this reduces the waiting list and therefore increases the patients’ satisfaction which is ultimately the most important thing

It can provide better continuity of care for patients. Doctors change posts often throughout their training whereas nurses do not move as frequently. This sense of stability may bring the patient at ease - especially if they have to stay at the hospital for a prolonged period of time.

On the other hand, when nurses take charge of less complex patients and simpler procedures, which were typically done by junior doctors, this reduces the learning opportunities for junior doctors and therefore impacts their training as a whole.

Furthermore, there is an issue concerning the patients’ confidence. They may not want to be treated by a nurse and request to be seen by a qualified doctor

Overall, doctors and nurses are both working towards the same goal and so the most important thing is to strike a balance in order to ensure the best quality of care to patients.

Question 29

what would you do if an obese patient demanded an immediate total hip replacement, which will fail in 6 months

Answer 29

First, consider the ethical implications of denying him or going ahead with the treatment:

• JUSTICE
  the patients need is the same as other people (who may not be obese ) and therefore he is equally entitled to the hip replacement as anyone else. One could also effectively argue that this would ve a basic human right for the patient.
  However, considering that the hup replacement will fail within the next 6 months it may not be in the best interest to give him the hip replacement. Rather, the best solution may actually be treating the route of the problem which is his obesity

This can involve many steps such as:
-involving a dietician
-setting manageable weight goals
-discussing the nature of the situation with the patient ensuring he fully understands why this is happening and the consequences of his obesity

Although the patient has autonomy, such decisions are can only be made within the options that the doctor’s and the Trust has given him. Therefore, ultimately he will have very little that he can do unless he takes it up to court

Question 30

For and against euthanasia

Answer 30

No matter how excellent our palliative care services may be, there will always be some patients for whom their illness causes intolerable suffering. To help those patients end their lives would be the compassionate thing to do to end their suffering.

Autonomy is one of the four pillars of medical ethics. This means allowing patients to decide for themselves when to end their lives at a point where medical treatment is no longer able to prolong life and is not providing adequate symptom control.

The current UK law, as it stands, means that patients who want to end their lives have to travel abroad to do so. In 2018, 43 people from the UK died at Dignitas and Life Circle (two facilities in Switzerland). It is likely not how they would have chosen to die (usually at home surrounded by loved ones) if the law allowed.

Evidence shows that the public increasingly supports assisted dying. Governments ought to represent the wishes of their people in a democracy.
A change in the law would also provide comfort to the dying from knowing that the option is there, even if they choose not to take it.

In our liberal society, we allow people to make their own decisions about their health and lifestyles, as long as they do not harm other people. Choosing to end your life would not cause direct harm to others. It is, therefore, your right to do as you wish – you are the best judge of what’s best for you.

When assisted dying is illegal, there will be people who try to end their lives alone and may not be able to carry it out properly, leading to increased suffering. Legalising assisted dying would prevent such deaths, similar to how legalising abortion prevented deaths from botched backstreet abortions (despite many people still objecting to abortion on moral or religious grounds).

The moral norms of society are constantly changing, and this legislation would reflect changing attitudes.
Some Doctors argue that the legislation would provide a clearer legal framework for end-of-life care. There is a concern that current decisions about end-of-life care can hinge on the doctrine of double effect, whereby it is legal to give a patient treatment that may shorten their life if the Doctor’s main goal is to relieve their pain.

There is a similar law in the US state of Oregon called the ‘Death with Dignity’ Act. The Oregon Hospice Association was initially opposed to the legislation. However, it withdrew its opposition after eight years conceding that there was “no evidence that assisted dying has undermined Oregon’s end-of-life care or harmed the interests of vulnerable people”. The numbers of people dying there have not increased – lending weight to the argument that the legislation wouldn’t bring about the deaths of more people, it would lead to more people having a ‘good’ death.

Many argue that the legislation would “turn Doctors into executioners”. This is at odds with the principle of non-maleficence which means do no harm. However, this principle could also be used to argue for the other side – that Doctors are causing more harm by prolonging suffering.

Many are concerned that if the law on assisted dying is changed now, this paves the way for the law to change to apply to more people. For example, Belgium now has a law that legalises euthanasia for children.

Another concern is that the legislation could be used to justify assisted dying in vulnerable groups, such as those with disabilities and mental illnesses. The legislation sends out a message that, where a life falls short of certain conditions, it is not worth preserving.

The legislation debated does not deal with the issue of those with terminal illnesses who are unable to take their own lives. It would not help those with illnesses such as locked-in syndrome or motor neurone disease.

Although autonomy is a pillar of medical ethics, patients still do not have a right to demand treatment and Doctors can refuse treatments they believe not to be in the patient’s best interests. The drugs prescribed to end life could be seen as a ‘treatment’ like any other.

Although public support for assisted dying is growing, governments are generally in a better position than individuals to understand and foresee the effects of individual actions or a change in the law on society.

The legislation also assumes that Doctors are at all times benevolent. If the patient asks for help to die and helping the patient would be the easier route for the Doctor, theoretically, this could lead to an increase in deaths that otherwise would not have occurred. These decisions are irreversible.

Another significant concern is that vulnerable people may feel pressure to spare their carers the burden of looking after them or, worse, might be bullied into choosing death. There could never be sufficient safeguards to ensure that a patient is not being softly pressurised – either by their own families or by societal expectations.

It could be argued that the potential negative consequences of this legislation – the premature ending of lives – outweigh the small number of people this would benefit.

Question 31

opt in vs opt out for organ donation

Answer 31

Looking at data from the UK, Wales has been leading the way with its organ donation consent rate compared to other UK nations since it adopted a soft opt-out system in 2015.
However, it can be argued that there isn’t conclusive evidence, on a global scale, that an opt-out system is ultimately more effective than an opt-in system. Although many European countries are covered by a body called Eurotransplant, there is significant variance in organ donation across different countries. Spain, which has a soft opt-out system, has the world’s highest organ donation rate, whereas other opt-out countries such as Luxembourg and Bulgaria have very low rates.
Hard opt-out systems around the world have seen increases of 25% in the donor rate, but it can cause controversy that this type of system disregards the opinions of surviving family members. Alternatively, Israel has an opt-in system which gives priority to patients on the donor register if they ever require a transplant themselves, providing an incentive to opt in.
Some argue that increasing the number of organ donors has less to do with the type of system adopted and more to do with how the system is managed. The recently introduced opt-out system in England, Wales and Scotland will need to be supported by ongoing communication with the public to raise awareness. Investment in education and training will also be required to ensure success.