Dealing with Legislation - What Happens when it All Goes Wrong?

Question 1

causes of stress/distress in doctors and dentists: multifactorial

Answer 1

loss of control
excessive workload
experience of suffering
poor self-care
maladaptive coping strategies
stressful life events

Question 2

causes of stress/distress in doctors and dentists: stressful work enviromment

Answer 2

excessive demanding workload: emotionally draining, experience of suffering
working patterns: shift, nights, working in isolation, loss of control, time pressures
poor functioning teams
poor communication
bullying and harassment
poor levels of social support at work

Question 3

common mental health problems in doctors and dentists

Answer 3

stress
anxiety inc PTSD
depression inc bipolar
alcohol and drug problems
behavioural addictions
eating disorders
ADHD
ASD

Question 4

what may contribute to illness and delayed recovery in doctors and dentists?

Answer 4

tendency to conceal or deny problems
continue working when ill 
seek help late
bypass formal channels
access to prescription drugs
working environment

Question 5

effects of drugs and alcohol and the work

Answer 5

absence
inefficiency
poor decision making
impaired customer relations

Question 6

alcohol impairs

Answer 6

thinking
concentration
judgement
mood

Question 7

alcohol productivity problems

Answer 7

inconsistent 
performance
poor quality of work
lower productivity
more mistakes/accidents

Question 8

consequences of mental ill health in doctors and dentists

Answer 8

• Poor patient care
o Anger, inability to be compassionate, burnout
o Fatigue, errors
• More time off work
• Sick leave, early retirement, suicide
• Reduction in morale of work force
• Poorly functioning teams
• Impact on families

Question 9

barriers to seeking help in doctors and dentists, mental: work related

Answer 9

difficulty taking time off

heavy workload

Question 10

barriers to seeking help in doctors and dentists, mental: fear and shame

Answer 10

fear of lack of confidentiality (punitive response)
fear of stigma
concerns about professional future

Question 11

barriers to seeking help in doctors and dentists, mental: lack of knowledge about what to do

Answer 11

insufficient knowledge about services

experience of how other colleagues have been treated

Question 12

In order to prevent and aid in the early intervention of poor mental health, medical and dental curriculums should implement

Answer 12

an ability to develop self-awareness, resilience, lifelong learning

Question 13

prevention/early intervention strategies: individuals

Answer 13

reduce stigma
change the culture
support 
mentor
coach
opportunities for continuing education

Question 14

prevention/early intervention strategies: organisational

Answer 14

involve doctors/dentists at all levels
workplace stress management strategies
trust initiatives
HEE initiatives
college initiatives - startwell and PSS (RCPsych), first five (RCGP)

Question 15

how does self-awareness enhances resilience?

Answer 15

recognising your own trait patterns

Question 16

what is resilience?

Answer 16

ability to withstand and bounce back from adversity. Resilient people have the ability to focus on and address the core issues and to find productive solutions. It helps the individual to compartmentalise in order to maintain an acceptable QoL.

Question 17

capacity for resilience is influenced by 4 character traits:

Answer 17

1. self-directedness
2. co-operativeness
3. harm avoidance
4. persistence

Question 18

capacity for resilience: self directedness

Answer 18

evident in people who are conscientious, resourceful and goal-orientated
accept responsibility for their mistakes, learn from them and move on

Question 19

capacity for resilience: co-operativeness

Answer 19

accept opinions and behaviours of colleagues even if different from their own
don’t lose sight of their own principles but work to achieve the best outcome for everyone

Question 20

capacity for resilience: harm avoidance

Answer 20

doctors/dentits with with low harm avoidance are more decisive and less anxious
they can accept uncertainty and a degree of risk

Question 21

capacity for resilience: persistence

Answer 21

maintenance of behaviour with stamina despite frustration, fatigue or discourageemnt
high persistence associated with perfectionism which leads to burnout or depression

Question 22

predictors of resilience

Answer 22

personal factors
organisational factors
socio-cultural factors

Question 23

predictors of resilience: personal

Answer 23

personality
previous adversities
coping strategies

Question 24

predictors of resilience: organisational

Answer 24

workload

hours

Question 25

predictors of resilience: socio-cultural

Answer 25

culture within medicine/dentistry
rise of blame and claim culture of litigation
didactic teaching

Question 26

factors consistently related to resilience:

Answer 26

female
work-life balance
laughing
beliefs
self-reflection
professional identity

Question 27

equality act 2010: protected characteristics

Answer 27

age
disability
gender reassignment
marriage and civil partnership
pregnancy and maternity
race
religion or belief
sex
sexual orientation

Question 28

successful negligence claim

Answer 28

Successful negligence claim:
• Failure in Ones Duty of Care
o (Falling below the standard)
• ‘Foreseeable’ damage must result
o ‘Causation’
o Wilsher v Essex Health Authority

Question 29

negligence: bolam v friern hospital management committee

Answer 29

the treatment proposed is recognised as proper by responsible medical opinion

Question 30

negligence: bolitho vs hackney health authority

Answer 30

Lord Brown-Wilkinson held that recognising a ‘responsible body of medical opinion’ required the ‘body’ to apply their minds to the risks versus benefits in any particular case

Question 31

negligence: hunter v hanley

Answer 31

o Must be a recognised procedure
o Must not have followed that procedure
o No reasonable doctor (dentist) would have done what the defendant did