OSCE Book - Law and ethics Flashcards
You have to obtain consent from a 23 year old man with learning difficulties for an examination under anaesthetic and extractions as necessary. He lives in a residential home and has attended with his carer.
A - How will you obtain consent for this procedure
No one can give consent on behalf of an adult is incompetent. (Competence is defined as the ability to perform a task, which in this case is to make a decision.) You will therefore need to obtain consent from the patient in question. The severity of his learning difficulties will determine how and what the patient understands. If the patietn does have some degree of understanding, you will need to explain the procedure in a way that he understands.
You have to obtain consent from a 23 year old man with learning difficulties for an examination under anaesthetic and extractions as necessary. He lives in a residential home and has attended with his carer.
B - What does the law say about who may give consent fro procedures?
If the patient cannot understand, it is obvious that treatment may need to be gicen which is in the best intrests of the patient, and his inability to consent to the treatment should not prevent treatment from being given. Only such treatment that is in the best interest of the patient should be carried out. In these situations information should be sought from relatives and carers of the patient, and it is useful to have an agreement of those close to the patient to carry out treatment although this is not consent.
You have to obtain consent from a 23 year old man with learning difficulties for an examination under anaesthetic and extractions as necessary. He lives in a residential home and has attended with his carer.
C - What types of consent are there?
Cosent may be “express”, in which case the patient explicityly agrees to treatment and it may be oral or written.
The GDC requires that written consent is gained for the administration of sedation or GA, but may hospitals consent forms are used fro all surgical procedures. In certain situations it may be advisable for two doctors/dentists to sign a consent form for treatment in the patients best interests.
‘Implied consent’ is when you assume from the patients conduct that they have consented - sitting in the dental chair, for example is taken to mean that the patient consents to an examination.
You are a senior partner in a dental practice. One of the practice dental nurses has come to talk to you. She is upset as she overheard a patient treated at the practice complaining in the waiting room that she thought her practicioner has been negligent.
A - Please explain what negligence is, and what must be proved for a case to ensure with respect to dental care.
Negligence is failure to exercise reasonable care in ones professional capacity. This obviously depends on what reasonable care means, but so long as the dentist can show that they acted in line with what most of his or her colleagues would have done it is unlikely that they would be held negligent.
For negligence to be proved it must be showed that the dentist had a duty of care to the patient, and that there was a breach of that duty and that this resulted in damage to the patient.
You are a senior partner in a dental practice. One of the practice dental nurses has come to talk to you. She is upset as she overheard a patient treated at the practice complaining in the waiting room that she thought her practicioner has been negligent.
B - Also explain what the difference is between contributory negligence and vicarious liability.
Contributory negligence is when the patient has contributed to the damage, such as when they have not followed the dentists instructions.
Vicarious liability is when the employer is held responsible for the actions of anyone in their employment (dental nurses etc) although that employee will aslo be held responsible for their own actions
You are a dentist in a new GDP. Please explain how you NHS complaints system should be set up.
Points to cover
1. Each practice must have a complaints procedure, with one person being in charge of admin
2. The practice complaints procedure must be available to patients
3. All records relating to complaints must be kept, but should not be stored in the patients notes
4. Patients have 6 months from the time of incident to complain or 6 months from the time they noticed the problem, provided this is less than 6 months after the incident
5. On recieving a complaintm a written acknowledgement must be made within 2 working days
6. Following investigation of the complaint, a written response should be sent to the patient within 10 working days of the orginal complaint.
7. If the patient is not satisfied with the outome they can ask the local primary care trust to look into the matter.
Possible outcomes followinf this are:
- The complaint is referred back to the practice
- Conciliation
- Independent reveiw panel of convener and two independent members
- Healthcare comission
- Advising the patient to contact the health services ombudsman
- No further action
You are a dentist in a practice who wishes to employ a dental hygienist. What documents would youwish to see to enable them to work in your practice.
A dentist may legally designate almost all non-surgical management of periodontal disease to a dental hygienist or dual qualified therapist, provided they are registered
As an employer you would want to have seen the following documents
- GDC annual practicing certificate
- Current membership of dental defence organisation to allow for imdemnity against claims of professional negligence
- Any post -qualification certification allowinf the hygienist to carry out radiographs, LA etc
- BLS in last 12months
- Hep B immunisation
- CPD evidence
- Evidence of no criminal record
An 11 year old girl, Chloe attends the GDP with her aunt. She is on holiday staying with her aunt and cousins and they have been trampolining earlier in the day. Unfortunately Chloe fell off and has fractured her 21. You have requested a telephone number to contact chloes mum but her aunt wants to know why you need to do this as she is here with chloe.
Please explain to chloes aunt what the issues are surrounding consent for examination and treatment of chloe?
- Explain that chloe is a minor and the currently accepted age of consent is 16 years old in the UK. Provided the individual has capacity( ie intelligence, maturity and understanding). If they do not then the age is 18. However there is an issue of “Gillick competence” this is where a minor can consent, provided they have capacity. Also, the proposed treatment must be in the best interest of the patient and every resonable effort should be made to involve the parents or legal guardian. Chloe is still very young to consent fro complex dental treatment by herself (although she probs would be able to consent for an examination) so every effort should be made to contact the parental responsiblity for chloe. If contact cannot be made it is an absolute emergency that treatment:
- Must not be denied to chloe
- Must be in her best interests - It may also be an advantageous to involve another colleague in the practice to confirm that treatment was absolutely necessary and was in chloes best interests
- The treament should be explained and agreed by her aunt
- If possible only reversible treatment rather than anything such as an extraction should be carried out and further treatment only given when parental consent is given
- Ask chloes aunt if she has any questions
A - What is an audit?
Audit is a systematic examination of current practice to assess how well an institution or practitioner is performing against set standards. It is a method for systematically reflecting on, reviewing and improving practice. Areas of deficiency can be identified and remedied.
B - Why is an audit done?
The main purpose of an audit is it increase the quality of services/care provided to users (patients). It identifies and promotes good practice, and can lead to improvement in service delivery and outcome for users. An audit helps provide information about the effectiveness of the service and provides an oppurtunity for training ane educations. it also helps ensure efficiency by ensuring better use of resources.
C - Fill in blanks
Audit cycle
A - Set standard
B - Collect data
C - Identify cahnges to be made
