Ethics 2 - Making Mistakes

Question 1

What are the 4 domains?

Answer 1

The standards expected of a doctor:

1. Knowledge, skills and performance
2. Safety and quality
3. Communication, partnership and teamwork
4. Maintaining trust

Question 2

List the 6 reasons Sokol and Bergson state for mistakes being made.

Answer 2

Stress
Fatigue
Covering (for colleagues)
Professional culture
Independent decision making (alone)
Fear admitting uncertainty

Question 3

Where do mistakes morally differ?

Answer 3

Between whether a mistake is avoidable or unavoidable

Question 4

From where did the Duty of Candour originate?

Answer 4

The Francis Report

Question 5

What is the (medical) Duty of Candour?

Answer 5

A statutory obligation which states that doctors and nurses have to be open and honest with patients about mistakes

Question 6

What does the Duty of Candour state in reference to an organisation apologising?

Answer 6

An apology is a statement of sorrow or regret in respect of the unintended or unexpected incident which does not of itself amount to an admission of negligence or the breach of a statutory obligation

Question 7

What are 3 possible scenarios that could be put into action following a mistake being made by a medical professional?

Answer 7

Legal action - negligence
NHS Complaints Procedure
GMC

Question 8

As a professional, what are the 4 things you must do following a mistake being made, as stated in the professional Duty of Candour?

Answer 8

Tell
Apologise
Offer support
Explain consequences

Question 9

Describe a little bit about what the Bolam test involves.

Answer 9

If a skilled group of medical professionals agree with how the accused doctor acted in a given situation, then he is said to have done the right thing

Question 10

What does the Bolitho amendment to the Bolam test state?

Answer 10

That basically, the accused doctor can’t go around persuading his colleagues to agree with his stance - must be capable of withstanding LOGICAL ANALYSIS

Question 11

What is the stance given on experience?

Answer 11

There is no preferential treatment given to junior doctors or those who are less experienced

Question 12

What are the 3 questions doctors must ask themselves before administering treatment?

Answer 12

Do they know the risks?
Do they know about the alternatives?
Have I take reasonable car to ensure the patient knows this?

Question 13

When legally claiming against the medical profession, what must the claimant be able to prove?

Answer 13

Owed a duty of care
Duty was breached
Breach caused injuries, which in turn are not too remote - causation & proximity

Question 14

List the 3 stages of the NHS Scotland complaints procedure.

Answer 14

1. Local resolution
2. Scottish Public Services Ombudsman
   (3. ) Judicial review

Question 15

What type of correctional approach is preferred?

Answer 15

Systems based approach rather than a person centred approach

Question 16

How does the systems based approach work?

Answer 16

Considers the environment and seeks to minimise the opportunity for errors to occur

Question 17

How has medicine sought to
address some of the failures in
the current system?

Answer 17

Dedicated centres
Requirement to retrain
Data collections of incidents
Checklists
Protocols & guidelines
Improved instrument design

Question 18

What are the problematic areas that Bowman highlight?

Answer 18

Everyone makes mistakes - does that make the incompetent?
Medicine is not an exact science
A ‘norm of non-criticism’
Whistle blowing is not easy

Question 19

Who (if you like) founded the Duty of Candour?

Answer 19

Robert Francis 2013

Question 20

What is the limitation with taking a legal action negligence approach?

Answer 20

Not an effective way to learn from errors as outcome bias exists
Culpability does not depend on blameworthiness, but on consequences

Question 21

What are the 2 types of approaches considered when learning from errors and where does the focus lie in each approach?

Answer 21

Person-centred approach
- focus on individual
Systems-centred approach
- focus on environment