SJT Flashcards
If patient is undergoing tests and is found to be pregnant and husband is in waiting room - what is the most important consideration you have?
consent
who does the GMC recommend resolving conflicts with in the first instance?
the person in question
if unsure whether patient is abusing pain meds like codeine, what is best mx plan?
limited 7 day supply then review if can’t be certain of abuse
how to address colleague who isn’t pulling their weight?
address this with them in the first instance
then raise with clinical supervisor
then look at why it is an issue - are you too busy with your rota
you notice a drug error (eg pt has too much warfarin tablets): what 3 things to do?
make sure correct dose given
raise with nurse dispensing
apologise for mistake
why never prescribe or give a tablet to give a partner/family member you don’t know/never met?
allergies to meds
accepting gifts: GMC states:
do not ask for or accept from pts, colleagues, or others any inducement/gift/hospitality that may be seen to affect the way you prescribe for/treat/refer/organsie care for pts
gift limit usually:
£10
GMC recommend the following when things go wrong:
offering an apology to the patient, putting the situation right (in this case, repeating the sample) and explaining what has happened and the short and long-term implications of the mistake.
duty of candour (4):
Tell the patient when something has gone wrong
Apologise to the patient (or carer or family member where appropriate)
Offer an appropriate resolution
Explain the potential short and long-term effects of the error
is saying sorry legal admission of liability?
no
never prescribed a rare drug before: who to seek advice from? (no guideline on intranet)
senior medical colleague
pharmacy
BNF
can f1s request scans and imaging out of hours?
not without consultant signing off, no
maintaining trust (domain) - key points:
Show respect for patients
Treat patients and colleagues fairly and without discrimination
Act with honesty and integrity
drug error: key thing to do:
cross it out and prescribe appropriate alternative
yellow card forms (drugs): what are they used for?
to report suspected adverse drug reactions to the BNF (particularly regarding drugs new to the market). These are not used for reporting prescribing errors
how do you cooperate with complaints procedures?
respond fully, promptly, and honestly to complaints.
if late, and bottom two choices are do nothing and hope no one notices vs ask f1 colleagues to lie and say you are busy, what is worse?
do not ask colleagues to lie as unproffesional in 2 aspects, not just one
GMC guidance: doctor’s health:
you should not rely on your own judgement of the risk posed by your health to your patients
consult your GP / occ health
breaking bad news to family - what to do with bleep?
give to reg on call keep but only respond to emergencies/arrests keep and respond to all calls give to staff nurse leave at nurses station
conidentiality: situation when you can breach it eg husband has HIV no plans to tell partner
remember you have to break confidentiality, so all options that have this should be prioritised
You are a foundation year one doctor on a Care of the Elderly ward. You have noticed that Gladys, an 80-year-old lady who is recovering from a hip fracture, has not been eating her meals. She has severe dementia and has not been able to understand and retain other information during her admission.
senior nurses first consultant review dietician review (after consultant review) then suggest to her to eat more do nothing
with safeguarding issues - what is key things to do:
contact child protection officer/safeguarding lead first
as best to not be only person who knows what’s going on
good practice to inform the parent what you are going to do
better to tell senior than tell nobody
with procedures eg LP you havent done before ->
PATIENT SAFETY first
willingness to learn
honesty, candour - admit to consultant and pt before you haven’t done one
get someone who has done one to do it before you
havent eaten in ages - light headed - what is worst scenario -
keeping on working - pt safety!!!!
can discahrge safely?
not without some sort of experienced senior review
?NAI in child - first thing to do -
admit child for proper assessment and potential skeletal survey
if you can deal with situation, what shouldn’t you do?
delegate
if pt is doing something harmless to others but illegal eg importing alcohol - what is question testing?
boundaries of dr - not your place to comment/act on illegalities
who can you contact if in ED and suspected nai?
senior dr or nurse in department
admit to paeds
get paeds on call team involved
colleague doesn’t have code for abg machine and abg needs doing urgently - what don’t you do?
give them your code - do not put yourself at risk
You are a foundation year 2 (FY2) doctor currently on a placement in general practice. A patient, Ian, 36, brings his child, Charlie, 4, to see you with a burn on his hand, due to him touching a hot radiator. On examination the burn appears mild, however on general inspection you notice Charlie looks very thin, malnourished and has dirty clothing on. On further questioning, Ian reveals he was asleep following binging on alcohol at home. Ian and Charlie live together alone, as Charlie’s mother died last year. Ian reveals that since her death he has struggled at home and has started consuming considerably more alcohol, but he is planning on reducing his consumption. ??
contact snr GP contact social services find out how much alcohol he takes call police give leaflets on AA
You are a F2 working in the Respiratory Unit. You insert a cannula in a patient for IV antibiotics and you flush it with 10mls of 0.9% saline given to you by a nurse. Whilst you are disposing of the equipment, you realise that the saline is out of date and expired in July 2015. What do you immediately do? (3)
check for adverse fx
apologise
clinical incident form
who transfuses the actual blood?
nurses
You are an F1 on call for medicine. A nurse asks you take a sample for a cross match from a patient who needs a transfusion and is difficult to bleed. The patient has a haematological malignancy and has become anaemic but is stable and well.
You take the blood and send it to the laboratory. You then realise that you labelled the sample with the wrong patient’s details.
B. Phone the laboratory to inform them of the mistake
D. Inform the nurses on the ward of the mistake
C. Document the mistake in both patient’s notes
E. Send another cross match
A. Do nothing as the patient has a previous correct cross match on the system
which act MHA or MCA can patients be forced to take medicine for physical illness?
MCA
consultant is rude to you - consistently making life harder, don’t want to come in - who do you go to?
cons also your clinical supervisor
1st - reg - can reconcile without escalating hopefully 2nd - ed supervisor 3rd - FP school - report 4th - nothing 5th - gossip
GMC: effective communication 4 principles
Listen to patients and answer any questions honestly
Ensure that information is delivered in a manner that can be understood. Identify and apply practical measures to overcome any communication and language barriers
Provide support and information to patients’ relatives or carers in a considerate manner
Doctors on duty need to be easily reachable by their patients and colleagues for any advice or support
GMC partnership with patients 4 principles:
Empower patients with the information required for patients to make decisions with regards to their care. This includes information on the clinical conditions, treatment options and the relevant risks and uncertainties
Ensure that patients are aware of the progress of their care
The roles and responsibilities of each member of the team need to be made clear to the patients
Patient confidentiality needs to be maintained, even after the patient is deceased
off licence prescribing:
refuse
discuss current NICE EVIDENCE
review current tx
when complaint made against you - who are most important people to contact?
consultant and defence union
