Professionalism Flashcards
What abilities does someone need in order to have capacity?
1) Understand the information given to them.
2) Retain the information.
3) Weigh up/ use the information.
4) Communicate their decision.
What are the three aspects of valid consent?
1) Informed.
2) Capacity.
3) Voluntary.
What information does a patient need in order to give informed consent to treatment?
Any potential benefits.
Any potential risks.
Any alternative treatments.
Name a measure of income inequality that can be used to compare a local population with others.
Gini coefficient.
What did the Black Report hypothesise were the possible determinants of health inequalities?
Artefact-healthy people move up the classes.
Natural selection (poor health pushes people into poverty).
Poverty causes ill health.
Life style differences.
Name some government initiatives that aim to reduce child poverty?
Increased child benefit. Increased minimum wage. Strategy to reduce teenage pregnancy. Childcare tax credits, and free childcare for working parents. National fruit scheme.
Why did child poverty indicators increase in the 1980s?
Increased unemployment, and more families without a member in unemployment. Lower pay. More single parent families. Cuts in expenditure in some services. More indirect taxation.
What 4 factors are used when making an evidence-based decision?
1) Evidence from research (and NICE guidelines).
2) Clinical expertise.
3) Available resources.
4) Patient preference.
What is opportunity cost?
The services/treatment that could be provided to a different patient using the money you are spending on your patient. Need to distribute resources fairly to reduce health inequality.
Where would you find evidence-based information to help make a decision?
NICE guidelines. Evidence-based journals. Cochrane library. Search on Medline or Embase. GP Update. Clinical guidelines. Individual journal articles.
What phrase is given to the cost of prescribing the drug in terms of the benefit lost from money that could be spent on other drugs or health services?
Opportunity cost.
Name three measures of the benefits of a drug.
Mortality rate.
Morbidity.
Quality of life measures.
What are the benefits of the NICE guidelines?
They are evidence-based.
They take into account the cost-effectiveness of a drug/treatment, as well as the clinical effectiveness (take into account the additional benefits of treatment compared to the additional costs).
There is a formal process of public consultation in the guideline development.
They reduce health inequality, so similar patients are treated equally across the UK.
What are the 4 ethical principles?
Autonomy.
Justice.
Beneficence.
Non-maleficence.
What is the decision making model used by more junior health professionals?
Hypothetico-deductive model.
What are the three theories of ethical decision making?
1) Deontological (actions are either right or wrong).
2) Consequential (is the consequences that justify actions).
3) Virtue (what decision would a virtuous person make).
What factors need to be considered when GPs implement opportunistic prevention in consultations?
Patient’s receptiveness.
Planning how much time can be allocated within the consultation.
Avoidance of preaching/victim blaming.
Respect for patient’s views.
Check that the health visitors are giving the same (evidence-based) information.
Planning how to involve practice nurse if no time left in GP consultation.
Planning how to reinforce message with posters/leaflets in waiting room.
Planning how to deal with complaints/distress.
List the three kinds of exception to the duty to always keep medical information confidential.
1) There is a public interest in you breaching confidentiality, other people will be at risk of harm if you don’t.
2) There is a court order (statute) saying you have to break confidentiality.
3) The patient had capacity and has given you consent to share the information.
How does confidentiality differ from privacy?
Confidentiality is a pledge or agreement which is implicit in the professional relationship, privacy is a qualified human right.
Name some statutes obliging physicians not to disclose confidential information about the patient.
Public Health (control of diseases) Act 1984.
Abortion Act 1967.
Births and Deaths Registration Act 1953.
Road Traffic Act 1988.
Human Fertilisation and Embryology Act 1990.
NHS Venereal Diseases Regulations 1974.
Prevention of Terrorism Act 1989.
If you have decided to breach confidentiality, name one thing the GMC says you must do first.
Inform the patient.
Describe the 4 requirements for a patient to enter the Sick Role.
1) They must want to get better as soon as possible.
2) They should seek advice from a medical professional and cooperate with the doctor.
3) They may be expected to shed some normal activities and responsibilities (e.g employment and household tasks).
4) They are regarded as being in need of care, and unable to get better by his or her own decisions and will.
Describe the 4 requirements of a doctor, laid out in the Sick Role.
1) They must apply a high degree of skill and knowledge to the problems of illness.
2) They must act for the welfare of the patient and community, rather than for their own self-interest or desire or money or advancement.
3) They must be objective and emotionally detached (don’t judge the patient’s behaviour in terms of personal values system, or become emotionally involved with them).
4) They must be guided by the rules of professional practice.
Describe the 3 rights afforded to doctors by fulfilling the Sick Role.
1) Granted the right to physically examine patients, and to enquire into intimate areas of their physical and personal life.
2) Granted considerable autonomy in professional practice.
3) Occupy a position of authority in relation to patients.
What is the Prospect theory of decision making?
There are two phases in decision making.
Phase 1 = framing and editing (preliminary analysis of problem, influenced by context and wording)
Phase 2 = framed prospects evaluated, prospect with highest value selected (influenced by people’s different values)
What types of evidence can be used in clinical situations?
Available resources. NICE guidelines. Evidence from research. Patient preference. Clinical expertise.
What is the difference between expressed and implied consent?
Expressed consent can be verbal or written. Implied consent can be something like raising an arm to have blood taken, and is trickier as it is easier to misinterpret.
When do you need consent from a patient?
Before examining, treating, or caring for a patient.
Before taking part in research or teaching.
Before screening.
Before disclosing confidential information.
Why is consent important?
To maintain the patient’s trust in doctors and uphold the doctor-patient relationship.
To respect patient autonomy.
To avoid causing psychological/physical harm by treating without consent.
To acknowledge that patient’s know what is in their best interests.
To fulfil the professional requirement by the GMC, as part of the duty of a doctor.
To fulfil the legal requirement and avoid claims of battery and negligence.
What is battery?
Touching a person without his/her consent, even if no harm results.
What are the three criteria of negligence?
There is a duty of care owed to the patient
The duty of care has been breached
Breach has led to harm of the patient
What is the difference between Statute Law, Common/Case Law, Public Law, Private Law?
Statute Law = acts of Parliament
Common/Case Law = judgements/precedents from courts e.g GMC guidance
Public Law = criminal law (the state is the prosecutor)
Private Law = between private relationships (e.g hospital and patient)
What is the term for how much information is required to be given to a patient?
Reasonable Patient Standard (how much would a reasonable patient want, relevant to decision making).
What is the age above which capacity is presumed?
16.
What is Gillick competence?
Children under 16 who have consent can consent to treatment without their parents giving consent, but can’t refuse treatment.
Name some situations where you wouldn’t have to obtain consent.
In an emergency, when giving life-saving treatment to people sectioned under the mental health act, when patient’s lack capacity and it is in their best interests, under the Public Health act when patient has infectious disease (can be detained, not treated), disclosure of confidential information if non-disclosure puts others at risk.
What types of uncertainty are there in medical decisions?
People are different and so react to the same situation in different ways
Technical uncertainty - inadequate information for accurate diagnosis or estimation of treatment effects
Personal uncertainty - don’t know what the patient wants
Conceptual uncertainty - difficulty applying your knowledge (e.g guidelines) to specific patient
What are the benefits of evidence-based decision making?
Clinical care is improved by ensuring patients receive the most appropriate treatment, proven by research.
There is increased efficiency of health care services.
There is reduced variation in practice among health care professionals.
How is evidence based medicine implemented?
Evidence based clinical guidelines provided by NICE.
Summaries of evidence provided for practitioners.
Access provided to reviews of research.
Practitioners evaluate research for themselves.
