Ethics Flashcards
What are the 4 duties of a doctor (or domains of good medical practice) according to the GMC?
- Knowledge, skills and performance
- Safety and quality
- Communication, partnership and teamwork
- Maintaining trust
What are the key elements of Domain 1 - Knowledge, skills and performance (GMC good medical practice)
- Develop and maintain your professional performance
Incl. Keep knowledge and skills up to date
Take steps to monitor and improve the quality of your work - Apply knowledge and experience to practice
Incl. Provide a good standard of care to pts
Provide effective treatments based on the best available evidence
Recognise and work within the limits of your competence
Consult with/refer to another practitioner when appropriate
Respect the pts right to seek a second opinion - Record your work clearly, accurately and legibly
Incl. Clear, accurate, legible, contemporaneous records
Consider data protection requirements
What are the key elements of Domain 2 - Safety and quality (GMC good medical practice)
- Contribute to and comply with systems to protect patients
Incl. take part in regular review and audit - Respond to risks to safety
Incl. promote blame-free open culture
Take prompt action if pt safety, dignity or comfort is being compromised
Offer help in emergencies arising in clinical/community setting if safe & appropriate to do so - Protect patients and colleagues from any risk posed by your health
What are the key elements of Domain 3 - Communication, partnership and teamwork (GMC good medical practice)
- Communicate effectively
Incl. Listen to pts, take account of their views and respond honestly to their questions
Give pts the information they need /want to know in a way they can understand - Work collaboratively with colleagues to maintain or improve patient care
Incl. Treat colleagues fairly and with respect - Teaching, training, supporting and assessing
Incl. Support colleagues who are having problems but remember pt safety comes first at all times - Continuity and coordination of care
Incl. Share all relevant information with colleagues involved in your pts care e.g. handover/transfer - Establish and maintain partnerships with patients
Incl. Be polite and considerate,
Treat as individuals and respect their dignity
Share information they need to help them make decisions about their care
Treat pts fairly and with respect whatever their choices or beliefs
Respect their right to confidentiality
Support pts and empower them to improve and maintain their own health
What are the key elements of Domain 4 - Maintaining trust (GMC good medical practice)
- Show respect for patients
Incl. Be open and honest with pts if things go wrong - Treat patients and colleagues fairly and without discrimination
Incl. Give priority to pts based on clinical need
Do not deny treatment to pts because their medical condition may put you at risk
Do not allow personal views to affect you professional relationships or judgements
Do not allow a pts complaint to adversely affect the care you provide and only end a a professional relationship if breakdown of trust means you can no longer provide good clinical care to that pt. - Act with honesty and integrity
Incl be honest about your experience, qualifications and role
Be honest and trustworthy in all communication with pts and colleagues and other professionals
Do not engage in false advertising
Be honest about any criminal/fitness to practice investigations or restrictions placed on practice
Be honest in financial/commercial dealings with pts/organisations etc
Be honest if faced with conflicts of interest
Scenario:
Mother states that 5yr old child being teased for prominent ears and wants him to have surgery.
Divorced from husband and doesn’t want to involve child’s father.
GMC guidance re. acting in interests of children
- should always act in the best interests of the child
- identifying best interests not always easy
- in general should consider:
childs view
views of both parents or those with parental responsibility (divorce or separation does not affect parental responsibility)
views of others close to the child eg. impact of bullying at school
cultural and religious views of the child/parents
Social, psychological and emotional aspects
views of healthcare professionals involved in providing care to the child
which option will least restrict the child’s future options - doctors should aim to facilitate resolution of conflicts of interest between parents
- sometimes can also be conflicts of interest between child protection and/or confidentiality
- doctors should allow parents access to their child’s medical provided child gives consent (or is not against the child’s best interests if child lacks capacity to consent)
BUt information about any 3rd parties should not be disclosed without their consent.
Scenario:
Child has metastatic malignant melanoma and has parents don’t want to tell him his diagnosis or details of his illness.
GMC guidance on effective communication in young patients
- Doctors should be open and honest to all pts incl children
- BUT should be careful not to overburden young children who might not understand the details of their illness
- Consider views and wishes of parents and others close to child
- BUT ultimately need to act in the best interests of the child
- Should make an assessment of child’s capacity in first instance
- Aim to find out what the child wants to know, what issues are important to them and what opinions/fears they have
- Then work with childs parents to provide him with information to a level appropriate for his age/maturity and at an appropriate time and pace
- Child’s capacity/best interests may need to be reassessed under changing circumstances
Scenario:
Child refusing medical treatment
GMC guidance
- Respect the child’s views
- Consider the reasons for the childs refusal of treatment
- Seek the help of parents/colleagues to discuss the implications of the decision and benefits of treatment
- Address child’s concerns
- Consult with parents and other professionals to form assessment of the child’s best interests
- Consider involving a counsellor to speak to child
NB Parents can consent when a child lacks capacity to consent BUT cannot override the consent of a competent child to undergo treatment that is deemed in their best interests.
Becomes more difficult when competent child refuses treatment
- seek legal advice
Scenario:
Pt given penicillin when records show pt has had a previous bad reaction to it
GMC guidance re. clinical errors
- Be open and honest
- Explain fully and promptly what has happened
- Apologise for error
(NB. NHS litigation authority does not consider an apology an admission of liability) - Put matters right (if possible) and/or explain to pt what will be likely to happen re. short/long term consequences and best treatment/further management
Scenario:
Colleague turns up to work smelling of alcohol
GMC guidance on fitness to practice
- GMC advises should support colleagues in difficulty BUT pts are 1st priority
- Take immediate steps to ensure pts are protected
- Can obtain confidential ethical advice from GMC/MDU to help come to a decision re further action in individual case - NOT same as reporting colleague to GMC
Usually:
- Remove colleague immediately from clinical setting
- Discuss concerns with colleague in supportive/non-confrontational manner
- Report incident to doctors employers as can often be appropriately handled locally
- In v. serious cases may need to formally report to GMC
Scenario:
Pt turns up to see you in private sector for cosmetic surgery but doesn’t want GP to know as GP wouldn’t support her decision
GMC guidance on providing good clinical care and sharing information with colleagues
- Ensure professional judgement
- Need to satisfy yourself that procedure serves pts needs i.e physical and/or psychological benefits of procedure would outweigh any potential harm
- Need to satisfy yourself that you have all relevant information about pts history incl. any potential risk factors/comorbidities as should only prescribe medications/treatment if have adequate knowledge of pts current health and it is compatible with other treatment pt is receiving
- Try to encourage pt to disclose their plans to GP
N.B. If proceed without disclosing to GP then would become responsible for ALL necessary aftercare.
Scenario:
Pt wishes to make you or your clinic a beneficiary of their will
GMC guidance
- Doctors must not encourage or accept any gift or hospitality which might affect (or be seen to affect) their professional judgement, whether the gift benefits them directly or indirectly
- May undermine patient and public trust and encourage other pts to offer gifts in hope of preferential treatment
- Applies even if the benefit would apply after pts death
Advertising in private practice
GMC guidance
- does not prohibit doctors from advertising their services provided the information is honest, factual and does not exploit a pts lack of medical knowledge
- information should be verifiable and not make unjustifiable claims about the quality or outcome of their services
Advertising Standards Authority
What is the Keogh report?
Following the PIP scandal DOH convened an expert group to develop advice on PIP implants
BUT exposed wider concerns about overall regulation of cosmetic practice.
Existing regulatory framework was found to be outdated and did not provide enough protection esp re. ever growing non-surgical sector
Secretary of State for Health commissioned Sir Bruce Keogh to set up review committee to develop recommendations on safety and regulation of cosmetic practice
Report published in 2013
Recommendations identified need for regulatory framework encompassing whole cosmetic sector
Focused on 3 main areas:
1. High quality care
2. Informed and empowered public
3. Accessible resolution and redress
What are the 3 main recommendations of the Keogh report on cosmetic practice?
- High quality care
- practitioners should have appropriate skills and training
- products should be safe
- premises should be suitable - Informed and empowered public
- patients should be given clear unbiased information
- information should be easily accessible
- patients should be helped to make informed decisions
- management of expectations is a fundamental part of consent - Accessible resolution and redress
- practitioners should provide continuity of care in event of complications/substandard outcomes
- patients should have access to guidance and assistance in dispute resolution
- insurance schemes should be in place to provide support and reassurance
