Pass Medicine Flashcards
What is an advance directive
Individual preferences with respect to medical Rx
Written when person is of sound mind
Must refer to Rx in specific circumstances
Cannot demand Rx
Advance directive = binding unless
Decision withdrawn
Power to make decision conferred to another person e.g. POA
Patient has acted in a way thats inconsistent with directive
Patient able to decide for themselves
Circumstances or Rx specified do not exist or have changed
What is POA
Allows person to make decisions if someone loses capacity
Health and welfare
Property and finance
Who do you register with
Office of public guardian
When are you entitled to careers allowance
16+ 35+ hours caring Lived in country 2 out of last 3 years and normally live here Not in full time education Earn no more than 110 a week
What is means tested
Carer’s allowance
110 after tax / care / pension
What are the types of consent
Informed
Expressed
Implied
When does someone have capacity
Able to Understand and retain info Believes info to be true Able to weight up information to make a decision Communicate decision
Who can consent for minors
Gillick competent
Biological mother
When can father consent
If named on birth certificate or if married and biological
What are 4 types of consent form
1 = competent but consciousness impaired e.g. GA 2 = adult consent for child who's consciousness impaired 3 = consciousness NOT impaired 4 = adults who lack capacity
What are the 5 principles of adults with incapacity
Must assume to have capacity
Take steps to ensure decision can be made
If decision unwise doesn’t mean lack capacity
Must be done in patients best interest
Least restrictive
What should you do to take in best interests
See if decision can wait till regain capacity
Encourage and optimise participation
Think of past and present wishes
Views of other
What can a compliant be
Verbal Informal Formal to doctor Complaint to managing body Complaint to GMC
What must controlled drugs have on prescription
Name and address
Form, strength and preparation
Total quantity or number of dosage units to supply
Dose
Prescribers name, signature, address and date
Schedule 1
Cannabis
Schedule 2
Diamorphine / morphine
Amphetamine
Cocaine
Schedule 3
Barbiturates
Buprenorphine
Midazolam
Gabapentin / pregabalin
Schedule 4
Benzodiazepine (except midalazam) Zopiclone Androgenic and anabolic steroid HCG Somatotrophin
Schedule 5
Codeine
Oromorph
What are controlled in BNF
Schedule 2+3
How long are prescriptions valid for
28 days
When do controlled prescriptions not apply
Schedule 4 + 5
How is cremation form filled
2+ doctors identify case of death
Patients own GP or doctor looking after them
+ independent doctor with 5+ years registration
Discuss are
What is not acceptable cause of death
Old age if <80
Natural causes
Organ failure if can’t specify why it failed
What happens with death certificate
Family take it to local registrar who decides if needs reported
Gives certificate of burial or cremation + registration
What are notifiable deaths
Unexpected No doctor in last 14 days Within 24 hours of hospital Accidents Suicide Industrial injury Result of neglect During an operation or recovery Poison including illicit drugs Still birth Prisoner or police custody Service disability pensioner
Who decides if CPR goes ahead
Senior clinical if no POA or advance directive
Views of relative, best interest + chance of recovery
What is duty of candour
Must be honest when something goes wrong Tell patient Apologise Offer resolution Explain short and long term effects
When must you not drive and notify DVLA psychiatric
Severe depression affecting memory / concentration / sucidial thoughts Acute psychosis Hypomania or mania Schizophrenia Severe disability
What may you be able to drive but must notify DVLA
Pervasive development diosrdr ADHD Dementia Mild learning disability Personality disorder
When do you not need to inform DVLA
Mild cognitive impairment
When must you notify DVLA in regards with vision
Visual field defect
Monocular vision - can still drive if acuity and field normal in other eye
GMC advice gifts
DO not accept if affect way prescribe, treat or refer
GMC doctors health
Do not rely on own judgement of risk
Assess by appropriate professional
Seek and follow advise
GMC partnership and teamwork
Respect skills
Treat fair and with respect
Communicate with colleague
Talk to person involved first
GMC must report criminal proceeding if
Found guilty
Charged
Admit to criminal offence
Accept option of paying penalty for ASBO
Cannabis warning
Registration restricted by another medical body
Conduct directly contributed to organisation entering prosecution agreement
GNC teaching
Must be willing to take on mentoring role
Contribute to teaching
What do you do if problem arises
Begin escalating up
Colleague involved then SHO before registrar before consultant
Speak to clinical supervisor
When do you end professional relationships
If breakdown of trusts means cannot provide good care
Includes violent/. theft / sexual advance
NOT due to a complaint
How do you end
Tell patient considering ending it Do what you can to restore Discuss with experienced colleague Must not discriminate Make sure patient is told what is happening and why
GMC trust
Show respect
Treat fair and no discrimination
Act with honesty and integrity
Social media
If identify as doctor identify by name
Treating colleagues
Avoid prescribing for yourself or anyone with close relationships
Responsible clinician
Respect wishes of any patient who objects to info being shared unless in public interest
If patient objects to disclosure that is essential for safe care explain you cannot refer
Accountabiliy
If delegating to junior doctor consultant is not accountable for decisions but accountable to ensure junior member is trained and experienced
Chaperone
YUP
Confidentiality
YUP
