ethical q Flashcards
Interview questions on difficult scenarios dealing format ?
Seek information: Before you can do anything, you have to understand the nature of the problem. This may involve discussing the matter with the individual concerned or with other colleagues, if appropriate.
Patient Safety: Once you have assessed the situation, you must make sure the patients are protected. If the person is an immediate threat, then you must remove them from the clinical area, or tell them to stop doing whatever they are doing. You may ask to speak with them privately, or in the worst case call for help to have them removed.
Initiative: Is there anything that you can do by yourself that will help resolve the problem?
Escalate: If the situation is too serious for you to deal with, then you must involve other colleagues at appropriate levels. If it is regarding a colleague, speak with the supervising consultant. If it is regarding a consultant, speak with the clinical director. If it is still not resolved, you may need to escalate further to the medical director, the chief executive, or even the GMC.
Support: There are reasons why someone chooses to behave the way they did. As an individual, they may need support to deal with the problem. Your team will also need support if one person is down.
What will you do if a consultant comes in drunk?
A patient mentions to you that on two occasions they have smelt alcohol on your consultant’s breath during clinic in the past few weeks. What do you do?
My first concern would be the safety of the patient.
Patient safety- I will talk to my colleague/consultant and send him home.
(if difficult enlist help of another consultant or clinical director). I will review all the patients seen by him and complete the ward round. I will also recall all the patients discharged by him. I will ensure that appropriate cover is arranged for him, if needed.
DATIX incident report
Duty of care to colleague- I will arrange a taxi for him to go home and check on later to ensure he has reached home safely. I will discuss with him and try and help. You could suggest occupational health referral. Insist that his behavior was not appropriate.
Duty of care to the hospital- Keep accurate records and inform your consultant or clinical director.
You can discuss your concerns with National Clinical Assessment Service (NCAS).If you think the action taken has been insufficient, contact the GMC.
How would you react if one of your female junior colleagues refused to treat a patient who is a known rapist?
GMC guidance-If carrying out a particular procedure or giving advice about it conflicts with your religious or moral beliefs, and this conflict might affect the treatment or advice you provide, you must explain this to the patient and tell them they have the right to see another doctor. You must be satisfied that the patient has sufficient information to enable them to exercise that right. If it is not practical for a patient to arrange to see another doctor, you must ensure that arrangements are made for another suitably qualified colleague to take over your role.
You see a patient verbally abuse a nurse. What is your response?
Firstly ensure that the patient’s behavior is not due to his/her underlying medical condition.
If it is willful, explain to the patient that the behavior is unacceptable and explain the expected standards of behaviour, which must be observed in the future.
If the patient persists he should be given a formal warning.
If the behavior is repetitive, he may be removed from the trust premises by the hospital security. However, his care should not be hampered and the responsible clinician should make adequate arrangements for transfer of his care.
Mary is clinically depressed and takes a lethal overdose. She leaves written instructions asking not to be resuscitated. If you arrived at Mary’s side in time to do so, would you resuscitate her?
Living wills (advance directives) are valid in English Law. However, an advance directive must be written by a person who has mental capacity. We do not know if Mary had psychotic depression. Nor do we know if she understood the consequences of her refusal of future treatment.
The legal defence of ‘necessity’ would cover any treatment (including resuscitation) which was necessary to protect Mary’s life, and which could not reasonably be delayed.
one of your peers arrives constantly late for work in the morning. What do you do?
For minor concerns an informal approach may be all that is needed. a discussion aimed at improving their performance or conduct, may be sufficient to resolve the issue.
this provides the opportunity for both parties to agree the way forward without the use of formal disciplinary procedures.
Even if an informal approach is taken, the outcome of the discussion and agreement reached should be communicated to the practitioner in writing and notes kept of all meetings held.
Your consultant does not provide adequate training and adopts a condescending attitude towards you because of your apparent lack of knowledge. How do you react?
Your SHO mentions that another SHO is complaining about the fact that their consultant does not provide adequate teaching. How do you respond?
There may be reasons for the consultant’s behavior for e.g. health or work related reasons. Discuss it with him and see whether you could arrive at an acceptable training solution. The problem may be with the trainee too. If there are still concerns discuss it with the college tutor or the clinical director.
One of your colleagues seems to be suffering from stress. What do you do?
Discuss it with your colleague if you can and suggest self referral to occupational health. If they are not willing to cooperate and if you suspect it is compromising patient care- then discuss further with your clinical director
What is your opinion about accepting gifts?
accepting gifts is not prohibited, provided that the gift is not seen as an inducement.
In practice this can be difficult to demonstrate, so it is probably unwise to accept any gift of significant value.
is also a matter of judgement, of course, but it is unlikely that the code was intended to apply to the nurse who receives a box of chocolates from a grateful patient.
What do you think about euthanasia?
An ethical justification for euthanasia is that it permits the ultimate expression of the patient’s right of autonomy. However, in the UK at the current time ending a patient’s life may constitute murder.
Passive euthanasia - any form of treatment that might extend a person’s life is withdrawn, eg a life support machine is turned off, or a feeding tube is removed. This is legally allowed in the UK
The law forbids active euthanasia and assisted suicide for several reasons:
Medical knowledge is limited and it is presumptuous for a doctor to determine the moment a person dies.
it can undermine human life
What do you think about euthanasia?
An ethical justification for euthanasia is that it permits the ultimate expression of the patient’s right of autonomy. However, in the UK at the current time ending a patient’s life may constitute murder.
Passive euthanasia - any form of treatment that might extend a person’s life is withdrawn, eg a life support machine is turned off, or a feeding tube is removed. This is legally allowed in the UK
The law forbids active euthanasia and assisted suicide for several reasons:
Medical knowledge is limited and it is presumptuous for a doctor to determine the moment a person dies.
it can undermine human life
slippery slope to legalised murder.
What do you think about presumed consent for organ donation?
Although 90% of the UK population is in favour of organ donation, only 24% has signed the Organ Donation Register. Currently, when a person’s wishes are not known relatives are asked to decide about donation, in the most difficult circumstances, when they are recently bereaved. Not surprisingly, a large number of families—around 40%—opt for the default position, which is not to donate
BMA have supported a system of presumed consent. The system of presumed consent may increase the organ availability but would still retain a role for relatives, opting out would be easy and accessible.
Mechanisms must be in place to ensure all members of the public are informed of their choices and can register an objection quickly and easily
After death, relatives would be informed that the deceased person had not opted out of donation and, unless they object—either because they know of an unregistered objection by the person or because it would cause major distress to the close relatives—the donation would proceed.
delivering bad news
s - setting up and arrange privacy
p - pereception- asses with open question ,about the patgients knoweldge so fo with their illness
i - invite - the patient for a discussion -what would they like to know
k - provide information in concise chunks
e - emotions - recognise and empathize with the patients emotions
s -srategy - set out a medical pan of action
one of your junior colleagues is placing patients at risk. How do you react?
The patient’s safety is paramount. So notify immediately his supervising consultant.
A patient mentions that, during an examination, one of your colleagues examined her breasts. Although the patient is not aware that such behavior was inappropriate in that context, you are. How do you respond?
?
