Medical ethics, reflection, GMC Flashcards
What is feedback
Information about a persons performance which encourages the learner to accept, reflect and learn from it.
Feed back BOOST model
Balanced Observed Objective Specific Timely (ASAP)
Value of multi-discipline team
Higher patient satisfaction, care and communication, with less stress for the healthcare staff. Each staff contributes specialist knowledge.
The four principal approach to bioethics
Autonomy- duty to allow for informed consent
Benevolence- duty to promote wellbeing
Non-malevolence- duty to avoid hate
Justice- duty of fairness.
Utilitarianism
The morally right thing to do is to produce the greatest amount of happiness in the greatest number, type of consequentialism
Problems of utlitarianism
The happiness of some should be more important then the happiness of others (criminals). If a good consequence is caused by a bad intention how can it still be good? Utilitarianism is impartial, everyone’s happiness is worth the same whether it’s our children or a stranger.
Deontology
Ethical decisions are good if they are made on the basis of rules which are our duty to follow. Intentions matter
Deontology problems
Sometimes it is necessary to go against certain rules in order to bring about the right consequences. For example, lying to make someone feel better
Virtue ethics
The focus is on the character of the moral agent
Virtue ethics problem
Difficult to tell virtue from vice
Care ethics
Ethical theories should emerge from caring relationships, careful attention to specific situations is required
Care ethics problems
How do we know what counts as care and why should we value ‘caring.’ Instead of focusing on specific situations we should focus on general rules.
Valid arguments
The conclusion is derived from the premise, just because something is valid does not mean its ethical as we may wish to reject the premise
Necessary and sufficient conditions
just because it is necessary for you to have a certain quality to fit into a category does not mean that it is sufficient. There may be other qualities that you have to have
Reflection
Careful consideration of things that have happened in the past, either positive or negative. You then try to learn from the event
Three stage model of reflection
What- the thought process when a particular action was taken
So what- why was the experience important
And now what- what can I learn from and do differently next time
Experiential learning cycle
Concrete experience- a new experience or situation is encounters, or a reinterpretation of an existing experience.
Reflective observation of the new experience- important to reflect inconsistencies between experience and understanding.
Abstract conceptualisation reflection- gives rise to new idea, or a modification of one.
Active experimentation- the learner applies their ideas to see what happens
Key elements of profesionalism
Expertise (technical knowledge), ethics (ethical principles and values such as honesty, respectfulness and reliability) and service (notion of calling)
The duties of a doctor defined by the GMC
1) Knowledge, skills and performance (up to date, work within competence)
2) safety and quality
3) communication, partnership and teamwork
4) maintaining trust
Role of GMC
Promoting and maintaining the health and safety of the public by ensuring proper standards in medicine as well as ensuring the conduct of medical professionals
Fitness to practise and studying medicine
Failure to demonstrate good fitness to practise as stated in the learning agreement will mean you cant progress to the next stage of learning
Factors that may influence fitness to practise
Criminal convictions, substance abuse, mental health issues, putting the patient at risk, laziness
Professional identity
The degree to which an individual aligns themselves with their profession. Your personal identity is when your existing identity undergoes the process of socialisation. Conscious reflection from role models and experience is better then unconscious acquisitions.
How can socialisation to form PI take place
Learning environment, reflecting from role models and mentors, formal teaching, self-assessment and reflecting from clinical and non-clinical experience. Can also be from the attitude of patients, peers, health care professionals and the public.
Fitness to practise and GMC
Its about ensuring patient safety and making sure your behaviour reflects well on the profession. You must follow the general medical council policy or you may face a medical school FTP panel
Bio-psycho-social model importance
Evaluating all factors leading to illness and patienthood and not just the biological factors. Including society and culture. Explains the emotional reaction we have to physical symptoms. Why someone thinks they are ill whilst someone else thinks its not a big deal
What’s included in the bio-psycho-social model
Biological-genetic factors
Psychological- loneliness, self-esteem, power and control
Social- poverty, access to recourses, living conditions, discrimination
Mongenic mutation
Affects one gene and follows a known pattern of inheritance
Multifactorial disorder inheritance
Don’t follow a known pattern of inheritance, just have risk factors.
What to do in an examination
Explain in advance what you are going to do, making sure they understand, let them know if there will be pain or discomfort. Get consent and repeatedly ask for it. Stop the examination if the patients ask. Thank the patient at the end. Keep discussion relevant.
Calgary-Cambridge framework
Initiating the session Gathering information Physical examination Explanation and planning Closing the session
Benefits of good communicatiob
1) Accurate diagnosis: (hidden agenda, people may hide why they are there) good history
2) Concordance with treatment plan: agrees with the plan and isn’t just doing what the doctor says. Is in line with their wishes
3) Promoting healthy lifestyle
4) Direct therapeutic benefits
5) Patient satisfaction
6) Patient safety- reduction of errors
7) Reduction in complaints and litigation
Communication challenges facing health care
1) technology e.g. medical apps.
2) ageing population with increased fragility
3) increased socio-cultural diversity
4) meeting individuals different communication needs
5) patients expect more involvement
Discuss the variety of contexts in which communication takes place in health care
Gathering information, Building rapport and empaths, seeking consent, conducting a sensitive examination, making a diagnosis, Explaining procedures, giving results, making a shared decisions, building a therapeutic relationship, referring to specialist, negotiating management plans, keeping good notes.
