SJT Flashcards
Who is the first person you contact if someone else has made a prescription error?
Person who wrote up the prescription.
If an allied healthcare professional has informed you of something e.g. an error made by your consultant, should you ask them to call the consultant themselves or should you pass on the information?
You should generally pass on the information yourself, as the HCP has already contacted a member of the team i.e you.
If you need to change the management plan for a patient, for whatever reason, should you do it immediately or contact a senior?
If you need to change the management plan for a patient you need to communicate this to the senior members of the team (i.e. consultant.)
If a patient does not want to go home, but was declared MFFD can you keep them in hospital? What should you consider before discharging?
Can’t just keep them in hospital, if it seems as though their medical situation has changed you should review them, and consider involving seniors before discharging.
What are the factors to consider when a question involves working late consistently?
If working late consistently and you are tired all the time, or you r wellbeing is suffering this is a concern for patient safety, should be top concern.
You also have a right to finish on time, as per contract and they consider this important.
What is a more pressing patient care concern, a possibly incorrect prescription or a patient beckoning to speak to you?
The medication review is more pressing than the patient beckoning (still important though)
What’s more pressing, a pt beckoning, a learning opportunity (theatres) or a nurse who is concerned about the functioning of another doctor?
Pt beckoning most important - PT CARE FIRST.
Learning opportunity is more important than the nurse, unless her concerns are urgent.
Should you spend time with patients, so they have someone to talk to if they are lonely?
This is only appropriate if you do not have more pressing jobs to do, it can be done by others.
If you don’t know the protocol for prescribing Abx, who/where should you get help from, in order of preference.
Hospital intranet should have the info, or may have printed out soemwhere on ward.
Senior colleagues next port of call (your team first (reg) then could try others including microbiology team.
BNF is next, good but doesn’t take into account local policy
National guidance is LAST resort
DO NOT ask a nurse
Is it an F1s responsibility to break bad news?
No, should ask senior to do it.
Who are the most appropriate people to alert regarding an infection control issue with an F1 colleague?
Should always speak to colleague first
Nurse in charge of ward has a big role in ensuring infection control.
Your Spr isn’t too appropriate
Infection control team only if this is a repeated offence, with serious issues
If you have made a medical mistake what are the things you should do?
FIRST ensure patient does not come to harm
Inform your team
Apologise and inform patient if they are in a position to understand what happened/in their best interests.
Can explain cause of mistake.
You can seek advice from peer (but should be senior before F1 colleague)
What is more important when a team is not functioning well with you, documenting what is happening or steps to improve the situation?
Documenting is LESS important than any steps you can take to improve the situation.
If you feel like your educational needs are not being met in your job what is a good thing to ask your consultant to get them met?
Spend time in theatre/clinics
Apart from spending time in theatre/clinics (most important) how else can you seek to improve your educational aspect of your job (if you spend all you tie doing one activity)?
Can ask to help F1 colleagues, as long as you aren’t jeopardising own team.
Is taking on a role in the junior doctors committee beneficial to your learning? What time can you put towards doing it?
NOT beneficial to your clinical learning, needs to be done in your OWN time.
What is more appropriate, handing over task to a nurse or to your colleague?
Nurse is much less reliable, and should not be done.
If a patient is discussing their concerns with care with a relative is it important to discuss their concerns with the relative?
Not really very important if you can discuss the concerns with the patient, and try to sort the problem first.
If a colleague is not accepting your handover (which is appropriate) what should you do?
First of all need to try to solve problem, need to be assertive with colleague, and tell em to do their work.
Should NOT rely on nurses to handover info
Should NOT stay on ward in own time unless emergency.
What can/should you do if a pt speaks another language?
Best thing - if available - is another doctor who speaks that language (?HCP)
Can use NHS language services too, not quite as good as another doctor who is there, takes a while etc.
Should get senior advice, make your team aware
DO NOT try to communicate yourself if you do not speak the language.
Should you offer a pt the offer to self-discharge if it is taking a long time?
Not really, it is risky, maybe only if emergency sit.
Should you discharge a patient yourself as an F1?
Nope never.
Can you facilitate a discharge through the phone?
Yes, but it’s not ideal, should try to get senior help first.
What is the general rule for procedures you can’t do?
- Tell senior you can’t do it
- Get senior help, tackle it as is safest.
- Observe a senior
- Be observed (not really appropriate)
Last is anything that compromises pt care, such as not doing it or doing it alone.
What is better in a prescription query (senior) contacting a pharmacist or waiting for senior to get back in a few hours (before prescription due)?
Contacting a pharmacist is better than waiting for senior
best to contact the senior immediately of course.
What is better in a prescription query (senior ?mistake) a. leaving the prescription be or b. changign the prescription to something you know is safe and standard?
Changing it is better than leaving it. Always put options that tackle the problem higher up.
If you have made a communication error to a pt, what are the steps you should take?
Pt care is first, sort problem and care first if this is offered
Apologise first of no pt care issue.
Can explain what happened.
Offer complaint procedure after these steps.
Is it better, in a communication/medical mistake to explain what happened and why or offer complaint procedure?
Better to explain what happened before offering complaint procedure.
Colleague has left you with work, which was their responsibility and fucked off for their own learning (theatre/clinic) what are appropriate steps to take, in order?
Always address immediate problem, and pt care, so try to bring them back
Try to address the problem for the future
After addressing problem for future, include other appropriate actions such as writing list of jobs for them to do.
Do not refer to line manager with a single incident.
If a nurse/HCP is worried about a patient, who the stem suggests is not critically ill (but not 100%) what is the most important rule/action to bear in mind?
Best to get more information about the patient and their state before doing anything else, e.g. ask for obs.
If an F1 colleague is not completing their clinical role adequately and this is happening repeatedly, who is the best person to talk to?
Always talk to colleague first
after that if they are repeatedly not completing their role then you can talk to CLINICAL supervisor
Educational is not relevant (they do pastoral and educational needs)
If you have been informed by another (F1) colleague that an F1 is acting inappropriately what are the best steps for YOU to take?
You are not directly involved here, and it is your colleagues responsibility to talk to them first.
Advise colleague to seek advice from educational supervisor THEN F1 colleague
Don’t report them to a senior if it is an isolated occasion.
Pt is unwell with condition that you are confident to manage, nurse is not confident in you and wants you to get your reg, what should you do?
Pt care is first, you should initiate treatment first
You should then consider reassuring the nurse, you can do this by calling the reg, this is probably helpful anyway and appropriate.
You can then explain that you are confident in managing the condition, and have before.
Should not compromise care by going elsewhere to find reg, or professional relationship with the nurse.
If a pt deteriorates and you are very new, not confident, what can you do to help with the situation?
Get some help from nursing staff
then you should probably escalate within your team.
If there is a disagreement in the team with the consultant decision what actions should you take?
Always seek to solve problem first, and put pt care first, should discuss this with the consultant, then suggest the disagreer discusses with consultant
Ultimately should do what consultant says but always discuss first.
If a pt does not seem to understand what they have consented for what should you do/who should you discuss with first?
Pretty big medico-legal problem - Consultant should know first when there is a big issue even if the reg consented (can tell them after consultant)
There is a query over consultant prescribing who is more important to talk to, another (uninvolved doc) or the nurse who will be dispensing the meds?
The nurse is more important to speak to.
With what issues is it most appropriate to speak to colleagues?
Professional issues most appropriate, F1 colleagues or educational supervisor.
Whats worse in GMC eyes, texting a colleague or informing a nurse?
Texting is worse, they really don’t like it.
If you need info/help then should you ask consultant to come back to ward?
Not really - should inconvenience them as little as possible - call them.
What is more important when you need to discuss a patient with wider team (palliative, in hosp), the MDT or the GP?
MDT is initially more important that the GP.
If there is a query as to the conduct of a colleague who should you speak to, in order?
The colleague first, of course
Then educational supervisor
Then colleagues
If a sentence uses the word complain, should you use it as an option?
Probably not, sounds unproductive and unprofessional
You are at home and need to hand over important urgent info to colleague, what steps should you take?
Contact your team first, F1 then up the chain to reg, depends on info, but if about tasks then not consultant
Then contact an F1 colleague not on your team
Then go in yourself (using your own time not really appropriate).
COns wants PM on pt, family don’t really. What is more important, your own learning (e.g. asking consultant) or gettign senior help to solve issue?
Solving issue comes up higher than your own learning.
When is it a good idea to have a chaperone?
Intimate exam
Pt/relative very upset
If a pt or relative is upset about something, should you wait for senior help before talking to them?
No, if they are very upset, you should talk to them first.
If a nurse/HCP has a problem with the medical decision of another F1 who should you speak to first?
Always the F1 who has made the decision first.
If there is a conflict of medical decision between you and another doc, who can you contact, if unsure?
Should contact other doc first
Should contact YOUR reg if you are unsure about anything.
Who has responsibility for infection control?
EVERYONE, however nurse in charge of ward has special interest, and obvs infection control.
What’s more important possible conflict with a HCP or you leaving slightly later than expected?
Conflict is more important to consider
When leaving a message/task list/handover for a colleague, what is the best way to do this (colleague is late)?
Best to hand over in person
Then could handover to senior (reg)
Then write in the notes
Then it is not appropriate to leave a list on a desk or whatever
What is more appropriate when meds are contraindicated, to write them up (but not start date) or to not write them up?
ALWAYS better to not prescribe, or change to safe levels than it is to prescribe them.
When there is a query over contraindicated meds, who is better to seek advice from, senior colleague (not in team) or pharmacist?
Senior colleague
Nurse repeatedly behaving inappropriately to you, you have already spoken to her, who is best to talk to?
NOT her in this case, as already tried, but would be if you have not.
Your consultant or foundation programme director if you are sure action needs to be taken.
Then it would be good to talk to colleagues (?ed supervisor)
Should NOT inform nurse in charge, this is your consultants job.
If a patient threatens physical violence who should yo always call?
Call security
Should you ask other members of staff to confront violent pts?
No, never.
Should you suggest to a patient that they won’t be treated if they are being disturning to pts?
No, never threaten right to treatment.
If a pt is being violent/disruptive/inappropriate what steps should you take?
Call security,
Ask staff to comfort other pts, or ensure they are comforted yourself.
Should inform patient that they are being inappropriate and it is not tolerated.
If a colleague is having trouble coping with the job what can you do?
Offer to spend time with them, and discuss
Should advise them to talk to senior members of the team, you should offer to go with.
Seek to solve the problem, not appropriate to take time off, see GP, help her or ask team to help.
If you are really busy and you have a colleague who is evidently not, what actions can you take? What shouldn’t you do?
Should ask for help from team member
Should make seniors in team aware you are really busy, can ask for help from them
Should NOT work late to complete tasks if it is not a medical emergency
Can you ask students to assist you?
You can if it will be beneficial to their learning, but not routine tasks like bloods and not used to support you in your job.
If you have an issue with working times/your workload, who should you discuss with, in what order?
You should first discuss with your team before raising things formally, e.g. departmental meeting.
Can you hand over non-emergency tasks to the on-call team?
No, they are not for emergency tasks.
If an isolated medical mistake has been made, not quite clear who was responsible between medical and nursing team what actions should you take?
- Make efforts to tackle the issue, e.g. inform nursing team
- Gather information on the event e.g. check the information was communicated
- Don’t immediately jump to telling people
- Documenting is last priority.
If a patient does not speak english and you really need to get things across should you do drawings or attempt to communicate?
No should never attempt to communicate this way.
If a patient does not speak English and you really need to communicate something to them, what’s your first priority?
Getting a translator.
Before escalating, what should you consider?
Patient safety first
Patient communication
Gather relevant info.
If a consultant is expecting too much of you in terms of completed tasks, what actions can you take?
Reassure consultant that you have been doing what you’re supposed to, telling them what you have done, and saying you will do your best to do the rest
If a question uses the words confront, should you do this?
It’s unlikely if it is isolated incident. Maybe if repeated thing or patient safety in danger.
Should you confront a doctor if they have a ‘reputation’ and seem to be doing the same with you?
Do not take actions on ‘reputation’ or heresay.
If a patient is unsure of how well they are/if they getting better what actions should you take?
Always good to review the patient again, even if it has been done recently.
If a colleague is struggling and dyslexic, what actions should you take?
Should bring to senior, as patient care issue.
NOT good to to offer to help him with work, does not deal with the problem.
DONT jump to escalating the problem
If you have a personal health problem that is affecting your work performance what should/(n’t) you do?
You shouldn’t use annual leave/arrange cover/chaneg shifts the trust will/should sort this out for you.
Talk to clinical supervisor, alert colleagues and see your GP.
Colleague has come in drunk, has done this before. What should you do?
Seek to talk to colleague in first instance
Tell him to go home, patient safety
Seek advice
- Don’t need to inform consultant immediately as he has gone home.
You have a pastoral care concern what actions should you take?
Educational supervisor and colleagues
Seek to solve whatever the problem is
You have made a prescribing mistake (pt has received wrong abx), no harm has come, what actions?
Need to inform consultant
Need to inform pt (presumably because she has been taking something that is wrong)
Need to solve the issue - change the prescription.
If there is a disagreement in patient care, what should you do?
Talk to whoever has disagreed and sort problem.
Seek advice from senior colleague
Concerns about colleagues performance, what should you do?
Speak to colleague first
Try to find out if patient care is being compromised and if it is solve this problem
Seek advice from senior colleague
Nurse did not accept your handover of a task, what should you do?
Try to ensure pt care, find someone who will
Should seek to solve - information gathering
DONT work later than necessary
What is the difference between clinical and operational tasks? What is more important?
Pt care is clinical (e.g. reviewing patients)
Operational is tasks like paperwork
Clinical is more important
Who can/should speak to patients over the phone
Nurses usually do this, HCAs can and you can also, but not priority.
F1 colleague behaving unprofessionally (advertising services privately), what should you do?
Sort the problem, tell them to stop (non-confrontational)
Can talk to educational supervisor
DONT seek to solve colleagues problems.
Cons behaved inappropriately in front of pt and nurses on WR to colleague. Actions?
Talk to Cons, in non-confrontational manner, away from bedside
Can talk to educational supervisor (if problem is within team)?
Colleague does NOT need to speak to cons alone
Colleague may have made prescription mistake, what are your actions?
Pt care first - try to correct
If any part of you is unsure - information gather
Discuss with the team if there have been near misses - pt care
DONT need to inform the pt if they haven’t taken the meds yet
Pt is confused, has punched nurse, threatened other pts, wants to go home.
CALL SECURITY
Talk to pt calmly
Should look after nurse (you are responsible for other staff too)
DONT jump to sedating and restraining pts
Doesn’t have insight, don’t need to inform him his behaviour is inappropriate
What doctors need to apply the principles of GMC good medical practice?
Any doctor whether they hold a licence or not, whatever field of medicine, and whether or not they routinely see patients.
What do you need to be able to prescribe according to good medical practice?
Adequate knowledge of patients health, and need to be satisfied the medication serves the patients’ needs.
Whom should you avoid prescribing to?
Anyone with whom you have a close personal relationship.
What should clinical records include?
- Relevant clinical findings
- Decisions made and who is making those decisions
- The info given to patients
- Any drugs prescribed, any investigation or treatment
- Who is making the record and when
Which organisations do you have to respond to requests about health?
Organisations monitoring public health
What should you do, in accordance with good medical practice, if you suspect a colleague may not be fit to practice?
Must ask for advice from a colleague, defence body or the GMC.
If you may have a serious condition that you may be able to pass on to others, what must you do?
You must consult a suitably qualified colleague, must not rely on your own assessment of the risk to patients.
When your role in a patients’ care has ended, how can you ensure that their medical care is being continued?
Check it has been taken over by a named clinician or team.
When pts need to make decisions about their care what information must you share with them?
Info on their condition, it’s progression and options for treatment including risks of those.
Info on the progress of their care, your role and responsibilities in the team.
Who is responsible for each aspect of patient care, and how that info is shared within teams.
If a pt has died is their info still confidential?
Yes.
If you conscientiously object to a procedure what must you inform patients?
Explain that you conscientiously object
Tell them of their right to see another doctor
Can’t express disapproval of the patients lifestyle, choices or beliefs.
Can you pursue a sexual or improper relationship with a pt? What about someone close to them?
You can’t use your professional position to, in GMC guidance.
If things go wrong what steps must you take?
Put things right if you can
Apologise
Explain fully and promptly what has happened and the likely effects.
If a pts medical condition may put you at risk can you deny treatment?
No, you must take all steps to protect your own health first however. OR make suitable alternative arrangements
If a colleagues behaviour does not comply with guidance what must you do?
Challenge them.
Ask advice from a defence body, or GMC or colleague.
If still concerned then report them.
How must you respond to complaints?
Prompt, fully and honestly
In what situation can you end your working relationship with a patient?
The breakdown of TRUST means you can no longer provide good clinical care.
If someone asks for you GMC number/registered name, must you give it to them?
Yes
When signing forms, reports or other documents (presumably for pts) What must you do?
Make sure they are not false or misleading in any way:
- Take reasonable steps to check info is correct
- DO NOT deliberately leave out info.
What contact with the law must you inform the GMC of?
Any caution, or criticism in an official enquiry
Charged with or found guilty of a criminal offence
Another professional body has had fitness to practice procedures with you
Suspended from medical post, or restrictions placed.
If a kid (12) does not want life saving treatment anymore, what is your position as a doctor?
You should consult colleagues, parents to discuss the implications of refusing treatment, and the benefits
Their views should be used to form an assessment of whether continuing treatment without his consent may be in his best interests
Can use a counsellor.
Should doctors tell young patients about their condition if asked by a kid who can understand?
Can’t withhold information if they can understand, unless they have asked not to be told or if it would cause them serious harm to be told.
What three basic things do you need for consent to a procedure to be vaid (i.e. if a pt doesn’t want to hear about it in detail)?
What the objective is
What is involved
What the main risks are.
If a pt has signed a consent form but still has questions about their treatment, is that consent valid?
No, the doctor providing the intervention must be satisfied that the consent is valid, and the pt has all the information they need, with no more questions or reservations.
Who’s responsibility is it to get consent, can consent be delegated?
It is the responsibility of the doctor who is performing the intervention, it can be delegated provided that:
a. is suitably trained and qualified
b. has sufficient knowledge of the proposed investigation or treatment, and understands the risks involved
c. understands, and agrees to act in accordance with, the guidance in this booklet
If a pt with learning disabilities (and little speech) comes into surgery with her mother who is doing the speaking, can you ask the mother for consent?
Not in the first instance, you can ask her if she has lasting power of attorney, but if not you need to ask the pt (can use the mother to communicate).
You need to start from the assumption she has capacity and work from there, if you don’t think she does, you can act in her best wishes.
If you are unsure about a pt’s capacity, what must you do?
a Consult nursing staff or others involved in the patient’s care, or those close to the patient, who may be aware of the patient’s usual ability to make decisions and their particular communication needs
b. Consult colleagues with relevant specialist experience, such as psychiatrists, neurologists, or speech and language therapists
If still unsure, can seek legal advice
In what situation can you disclose domestic violence to the authorities?
With the patients consent
If there are others such as vulnerable adults or children at risk.
When can you not pursue sexual relationships with FORMER patients?
Can’t if they were vulnerable at the point of your care
If you are in doubt about whether to share information about a parent, what should you do?
Seek advice from senior colleague/Child protection officer/Caldicott guardian
If a relative comes to you to discuss one of your pts, what can/can’t you do?
You can listen to their concerns - consider how the patient may feel, however.
You can’t disclose any information about your patient
If you need to act on the information you need to ask for permission to disclose where the information came from, if you don’t have permission, you need to weigh up whether breaching confidentiality is in the patient’s interest.
If someone fails to tell the DVLA about a condition that stops them driving should you tell them?
You must make every effort to persuade the patient to, if they do not, then you must tell the DVLA (should inform pt first)
Can you share information about a patient with their relative if their capacity is impaired?
If their capacity is impaired it is reasonable to assume they’d like their relatives to know their general condition and progress.
What should you do in terms of communicating with patients who may have a disability to do this?
You should make reasonable adjustments to do so, you may have to put more time aside, use visual aids etc. establish how well they can communicate and whether you need an interpreter. You must still gain the same consent as anyone else, checking their understanding and addressing any concerns.
If someone comes in with a knife/gunshot wound, that is suspect, but they are adamant it wasn’t anyone else and they don’t want you to inform the police, what should you do?
If someone comes in with a knife wound that you suspect might be a result of an attack you MUST inform the police, you only need to tell them that there is someone with a knife wound, don’t need to state their name.
The police will want to talk to the suspect, you should encourage them to do so, but can’t force them.
You must make a judgement about whether it will prevent harm to someone else, or will prevent a serious crime as to whether you can disclose information without a patient’s consent.
When is disclosure without consent appropriate?
When someone other than the adult is at risk of serious harm
When disclosure may prevent a serious crime from occuring
What can you say to the media if questioned?
You can state what normal practice is but you can’t reveal any patient details
Buying patients gifts, okay?
No not really.
Should you phone a consultant on their mobile?
If they have left then definitely not
If they haven’t… then it also probably isn’t great
If a patients’ capacity is fluctuant what should you do in terms of consent?
Try to maximise their capacity:
a. Discuss treatment options in a place and at a time when the patient is best able to understand and retain the information
b. Ask the patient if there is anything that would help them remember information, or make it easier to make a decision; such as bringing a relative, partner, friend, carer or advocate to consultations, or having written or audio information about their condition or the proposed investigation or treatment
c. Speak to those close to the patient and to other healthcare staff about the best ways of communicating with the patient, taking account of confidentiality issues.
If a pt refuses to share info with other HCP can you break that?
You can only break it if you judge the risk to not telling them is higher than the benefit to maintaining pt trust
What side effects and adverse effects do you need to inform a pt if about to take a new medication?
Need to explain serious side effects and common side effects/outcomes.
When can you prescribe off licence? Can an F1 do this?
If you are satisfied that an alternative, licensed medicine would not meet the patient’s needs.
An F1 wouldn’t do this without senior guidance.
