PPD Flashcards
Give 3 considerations in the Ethics of resource allocation
1) Cost-benefit analyses, using QALYs
2) Opportunity cost
3) Public/media perception
Describe the libertarian (JSM), egalitarian and utilitarian (maximising) principles in resource allocation
Libertarian - weight
Egalitarian - equal opportunity, equal access
Utilitarian - maximum utility, greatest pleasure and least harm
Define sustainability. Give 3 types of sustainability issues in the NHS
Defn: meeting the needs of the present without compromising the needs of the future
1) Economic - ageing population
2) Environmental - antibiotic resistance, pollution
3) Clinical waste - over…intervention/prescription/investigation
Human Rights Act - issues related to:
a) Art. 2 (right to life)
b) Art. 3 (to refuse dehumanising treatments)
c) Art. 8 (respect for family life)
d) Art. 12 (found a family)
a) Abortion, euthanasia
b) Withdrawal, patient choice
c) Confidentiality
d) IVF
DOLS:
a) Only valid in what 2 settings
b) Assessment involves capacity and what else?
c) For patients of what age
d) For what treatment
a) Hosp. Care home
b) Best interests, consulting family
c) over 18
d) anything that will involve them being deprived of liberties and staying under close supervision in a care setting (for people without capacity)
Common law:
a) Vs statutory law
b) Confidentiality breaches allowed in what 3 instances?
a) Common - precedent; statutory - legislated
b) Patient consents, public interest, required by law
Give 5 ways in which HCPs or PHE may effect health behaviours/patient choice (scale)
Educate/inform, enable, advise, incentivise/ disincentivise, restrict choice
Expected utility = ?
Likelihood x Value
Define sick role in terms of:
a) Rights
b) Obligations
Rights:
The sick person is exempt from normal social roles
The sick person is not responsible for their condition
Obligations:
The sick person should try to get well
The sick person should seek technically competent help and cooperate with the medical professional
Give 4 cognitive biases/heuristics
Availability, representativeness, anchoring/adjustment, affect heuristic
Human error models:
a) Person approach = ?
b) Systems approach = ?
c) Active failures
d) Latent conditions
e) High reliability organisations
a) Treat errors as moral issues (just world hypothesis)
b) Errors are unavoidable. We cannot change human condition; we can change working conditions.
c) Unsafe acts
d) Resident pathogens predisposing to failure
e) Adopt systems approach and prepare for failures
GMC duties of a doctor:
a) Make the…?
b) Act how?
c) 3 pillars
a) Care of your patient your first concern
b) Honestly, openly, with integrity
c) Knowledge, skills, performance
Jim Reason’s Swiss Cheese Model
a) How it works
b) Example - Wayne Jowett and rule of 2s
a) Holes in defences align - allow failure
b) intrathecal vincristine - 2 doctors, 2 days, 2 places, 2 pharmacy deliveries - all failed
Bucket model of error
a) What are the 3 buckets?
b) 3 examples for each
c) Preparedness - 3 points
a) Self, context, task
b) poor knowledge/skills/experience/energy levels; distracted, stressful situation, poor organisation on ward; many steps, difficult task
c) Accept that errors are unavoidable, have contingency plans, care of patient > professional courtesy
Neglect - 3 types
Medical, personal, nutritional (Mid Staffs)
Negligence:
a) Define
b) 4 things patients must prove
c) 2 tests for whether there was a breach - explain
d) Awards for 3 things
a) Legal term for civil case where awards paid to patient on balance of probabilities
b) Duty of care; breach in this duty; harm; harm due to breachbree
c) Bolam - reasonable group of Drs would have done the same; Bolitho - this group would be reasonable to do so
d) Loss of income, care costs, pain & suffering
Intended actions - mistakes vs violations
Mistakes (accidental), violations (knowingly broke protocol)
Never events:
a) Most common. Other surgical
b) Medical, obstetric, mental health
c) Published on ….?
d) Define!
e) Who needs to be notified for a never event?
a) Retained items. Wrong implant
b) Medication wrong/too high dose/wrong route; PPH death; suicide
c) NHS Improvement
d) Never Events are serious incidents that are entirely preventable so should not occur if procedures are followed correctly
e) Strategic executive information system (StEIS)
and the National reporting and learning system (NRLS)
Martin Bromiley’s story:
a) Case
b) 3 errors
a) Tonsillectomy - “Can’t intubate, can’t ventilate” - death (should have been trached)
b) Teamwork - no communication, hierarchical, no leader; loss of situational awareness for time and severity
Shared mental model:
a) Describe
b) 3 key features
c) Example in healthcare (communication)
a) Shared understanding of roles, and strategy
b) Problem/solution, roles in team, strategy
c) SBAR
3 leadership styles
Transactional, transformational, laissez-faire
Theory of planned behaviour.
a) 3 initial stages resulting in intention, then behaviour
Attitude, perceived control, subjective norm
Duty of candour - when is it statutory
When harm arises
Heinrich’s safety triangle: 5 stages
Unsafe acts, near misses, minor injury, time loss injury, fatality
Cases: (what could have been done differently)
a) Meningococcal child
b) Breast cancer referral
c) Warfarin old lady
a) Feverish child - proper screen, proper triage
b) BRCA positive in history, proper referral, AM message followed up
c) Don’t alternate dosage, take INR to check stable
RCGP social media highway code:
a) Benefits and risks of social media
b) Relationship to GMC guidance
a) Benefits - interactions, education, networking; Risks - loss of personal freedom, inappropriate behaviour
b) Nothing should weaken the patient’s trust in HCPs
Public health
a) 3 goals
b) Consider what? (not individuals)
a) Health care delivery, health protection and health improvement
b) Population perspective
Rule of rescue
Rule of rescue: ‘a perceived duty to save endangered life where possible’
Will be protected by the Good Samaritan rule
DNACPR decisions.
a) Discussion
a) Must be discussed with patients and families unless they have explicitly said they don’t want to discuss it
