Professional Dilemma

Question 1

What to do with bleep when breaking bad news during family discussion?

Answer 1

1. Give bleep to senior in same team, they can triage calls
2. If not, leave it with nurse, can interrupt in emergency
3. If not, answer bleeps during, there is patient safety aspect
4. Leaving unattended is bad, patient risk

Question 2

Concerns regarding behaviour of colleague. Escalation

Answer 2

1. Discuss with them directly, may be explanation for what they are doing
2. Inform there senior, they can investigate and may act on your concerns
3. Escalating to training body is poor option, should manage locally first

Question 3

Gifts from patients

Answer 3

You must not encourage patients to give, lend or bequeath money or gifts that will directly or indirectly benefit you.
Gift of substantial value
- Best option to politely decline.
- if you do accept gift, it is important to register gift
If not of substantial value can accept.

Question 4

A patient confides information in you

Answer 4

Listen and reassure patient.
Inform the whole team of the discussion.
Important to not break confidentiality

Question 5

Treating family or friends

Answer 5

Best response is to ask them to seek help from GP or out of hour service.
Avoid assuring and prescribing as you have lack of knowledge of PMH or allergies

Question 6

Patient asking for same-gender doctor for examination

Answer 6

Respecting the patients request is important.
If not available important to explain the situation and being transparent, look to rearrange if appropriate.
Refusing to provide care without exploring alternative options is dismissive.

Question 7

Teamwork, someone is slacking

Answer 7

Speaking to colleague directly if best option.
If not effective can involve senior.
Putting up with it and working around this is frowned upon

Question 8

Duty of candour

Answer 8

Tell the patient when something has gone wrong
Apologise to the patient
Offer an appropriate resolution
Explain the potential short and long term effects of the error

Question 9

Notice a patient taking the wrong medication

Answer 9

Stop them taking the medication
Review the prescription sheets for errors
Speak to the nurse who dispensed the drug

Question 10

Providing information over the phone

Answer 10

Balance risk of inappropriately breaking confidentiality and causing distress to family.
If patient lacks capacity, you should share relevant information.
Unless they indicate otherwise, it is reasonable to assume patients would want those closest to them to be kept informed of condition & prognosis

Question 11

Feeling burnout

Answer 11

Discuss with your CS
Visit your own GP
Alerting local team, foundation programme director

Question 12

Fraser guidelines

Answer 12

A doctor can give contraceptive advice and treatment to girl <16 provided she is deemed gilick competent
- able to understand, weigh up decision and communicate
- Fraser, cannot persuade her to inform her parents, likely to continue without contraceptive treatment, could lead to deterioration in physical/mental health

Question 13

Patient that doesn’t speak English

Answer 13

Use a telephone translation service to get history.
If not, arrange appointment with interpret.
Should avoid using family member as translator
Avoid using google translate, diagrams or body language

Question 14

Busy shift and colleague calls in sick

Answer 14

Phone the consultant and inform them of the situation
Prioritise patients with life-threatening conditions.

Question 15

Consent for treatment.
Patient insists they do not want basic information.

Answer 15

Explain that giving no information may invalidate their consent
Explain to them what the treatment aims, what it will invoke and serious risk.

Question 16

Nurse calls you asking to review another sick patient when you are attending to sick patient

Answer 16

Find out more clinical details over the phone.
If appropriate bleep team member to see patient.
Leaving a patient who is acutely unwell is very inappropriate

Question 17

Relationships with patients

Answer 17

You must not use your professional position to pursue a sexual or improper emotional relationship with at patient.