Making Mistakes

Question 1

What are the 6 reasons why basic errors happen?

Answer 1

Stress, fatigue, covering for colleagues, professional culture, feeling like decisions must be made alone and inability to admit uncertainty

Question 2

What are the four domains in the duties of a doctor

Answer 2

Knowledge, skill and performance, Safety and quality, communication, partnership and teamwork, and finally maintaining trust

Question 3

Why is it difficult to admit errors in medicine?

Answer 3

Consequences, question around if error means incompetence, whistle blowing is not without risk, medicine is not an exact science, and the argument that there is a norm of non-criticism.

Question 4

Why can whistle-blowing be difficult in medicine?

Answer 4

Only 33% of doctors who had blown the whistle said colleagues didn’t supported them, 18% felt isolated as a result, 12% suffered mental health issues and 14% moved location or job.

Question 5

Describe the ducty of candour bill introduced in 2015

Answer 5

• It places the duty of candour on health and social care organisations as this creates a legal requirement for these organisations to inform patient when they have been harmed as a result of the care/treatment they have received.
• It established criminal offence of ill-treatment or wilful neglect in health and social care settings.

Question 6

What are the 4 steps involved in the professional duty of candour

Answer 6

• Tell patient when something has gone wrong.
• Apologise to patient.
• Offer appropriate remedy or support to put matters right if possible.
• Explain fully to patient the short and long term effects of what’s happened. (where appropriate if unable to speak to patient then should speak to family/advocate/carer)

Question 7

What might happen in response to errors or inadequate care?

Answer 7

Negligence (legal approach) where patient might take legal action. NHS complaints procedure where patient may make complaint and GMC disciplinary action or removal from register

Question 8

What are the three elements that comprise an action in negligence?

Answer 8

They claiment must establish that:

• They were owed a duty of care by defendant.
• The defended breached duty of care by failing to provide reasonable care and,
• That the breached care of duty caused claimant’s injuries and those injuries are not too remote.

Question 9

Define the bolam test

Answer 9

A doctor is not guilty of negligence if they acted in accordance with a practice widely accepted as proper by responsible body of practitioners.

Question 10

Define the Bolitho test

Answer 10

Modified bolam to add: The professional opinion must be capable of withstanding logical analysis.

Question 11

What three questions arose due to the impact of the Montgomary case

Answer 11

Does the patient know the risks of the proposed treatment? Does the patient know about the reasonable alternatives to this treatment? Have I taken care to ensure patient actually knows this?

Question 12

Describe the difference to person-centred and systems-based approach to addressing medical errors

Answer 12

Person-centred - focuses on the individual doctor where as systems-based considers the environment and seeks to minimise opportunities for error.

Question 13

What are human factors?

Answer 13

A way of improving clinical performance via understanding the effects of teamwork, tasks, equipment, workspace, culture and organisation on human behaviour

Question 14

What are some ways of reducing errors via a systems-based approach?

Answer 14

Dedicated centres for less common procedures, Requirement to retrain, data collection of incidents, improved instrument design, protocols and guidelines and checklists