Truth Telling Flashcards

Question

when looking at lies of omission, what is it important to consider?

Answer 1

The nocebo effect: is said to occur when negative expectations of the patient regarding a treatment cause the treatment to have a more negative effect than it otherwise would have. what benefit would it bee to tell a patient all the side effects if they have little chance of happening?

Answer 2

Veracity - the first principle. Truth has inherent value that a lie does not. To ‘outweigh’ truth, you need multiple other factors, sufficient to outweigh this - you need to have no other option - deception is acceptable ONLY as a last resort - the other options are also wrong, and would lead to greater harm

Answer 3

“Probity means being honest and trustworthy, and acting with integrity: this is at the heart of medical professionalism.” NHS England (Guide for Appraisers)

Answer 4

integrity : from integer, Latin - intact, whole - As a moral agent, you are undivided - you will follow the same principles in all situations - You do not deviate in other company, or other circumstance, or where it is disadvantageous to you personally In a medical context, integrity can be seen as making the care of the patient the first concern ... in all situations, even when it is not advantageous to you Self-interest (such as what would advance your own career, or make your life easier, or mean you get to leave work on time today...) must come second to the patient’s interests

Answer 5

the duty of being open and honest

Answer 6

“The volunteering of all relevant information to persons who have or may have been harmed by the provision of services, whether or not the information has been requested and whether or not a complaint or a report about that provision has been made.”

Answer 7

A report produced into the Mid Staffordshire scandal It is thought that between 2005- 2009, 400 - 1200 excess deaths occurred at Stafford Hospital due to inadequate care. Robert Francis led a number of investigations and published a series of reports into what went wrong at the Mid Staffordshire NHS Trust As a result an investigation was launched and a publicity campaign by relatives of deceased patients who died due to inadequate care.

Answer 8

The first Francis Inquiry gathered evidence about what care was like at the hospital. Interviews were taken from patients, relatives and members of staff. They found out: - missed or late pain medication - verbal abuse of patients by staff - patients unwashed for up to a month food and drink left out of patients reach - poor hygiene – relatives were picking up used bandages and dressings which were disposed of on the floor and had to clean toilets themselves - patients requests for help with toileting ignored, leaving them in soiled sheets sometimes for hours - Calls for help unanswered, patients left in states of undress - Lack of compassion: while many staff did their best, others showed a disturbing lack of compassion towards their patients.

Answer 9

Chronically understaffed wards Receptionists with no medical training triaging in A&E Inadequate training of staff Junior doctors left to manage alone overnight

Answer 10

"A chronic shortage of staff, particularly nursing staff, was largely responsible for the substandard care" Staff were cut to meet ﬁnancial targets to become a Foundation Trust. Complaints were ignored - Financial targets became more important than patient care. There was a complaints procedure that was superﬁcially followed but none of the recommendations were ever implemented Complaints were treated as isolated issues and not joining dots to get a full picture A culture of fear, bullying and intimidation at the hospital between management and staff 🡪staff did not feel able to speak up

Answer 11

No one, at any point, has suggested that the doctors or nurses at the Trust were any less competent than anywhere else Most complaints were about basic personal care - washing, feeding, hydration Staff must have seen this happening - it went unchallenged

Answer 12

Physical needs unmet Dehydration - poor healing, poor immune function --> decrease chance of surviving their condition Emotional /social needs unmet - stress response altered neuroendocrine function, poor immune function, impaired wound healing --> reducing chance of survival

Answer 13

The ethics have been removed from this system so everything else falls apart. It was unethical not only how patients were treated but staff as well. Because of no collaboration staff were really overstretched and there was really low moral 🡪 all leading to bad patient care (unsuccessful system)

Answer 14

if you make reports e.g. to a manger you may be punished. There is not trust and so no collaboration.

Answer 15

Eventually the increased mortality flagged up in broader NHS systems Julie Bailey, whose mother died in Stafford Hospital, launched a campaign group ‘Cure the NHS’ to publicise failings at the Trust It became a national scandal and led to significant changes throughout the NHS in term of how we deal with whistle blowing

Answer 16

One outcome from the Mid Staffordshire scandal was the Duty of Candour be honest with your patients about mistakes or errors that have happened in their care Duty of Candour: “The volunteering of all relevant information to persons who have or may have been harmed by the provision of services, whether or not the information has been requested and whether or not a complaint or a report about that provision has been made.”

Answer 17

Regulation 20 in the Health and Social Care Act 2008 states Organisations have a duty to : Inform people about the incident provide reasonable support provide truthful information provide an apology

Answer 18

Healthcare professionals must: tell the patient (or the patient’s advocate, carer or family) when something has gone wrong apologise offer an appropriate remedy or support to put matters right (if possible) explain fully to the patient the short- and long-term effects of what has happened.

Answer 19

“Freedom to Speak Up’ - a further review into changing the culture of the NHS Nationwide, over 30% of those who had raised a concern throughout the NHS felt unsafe afterwards e.g. lost jobs, negative performance reviews. “victimisation or fear of speaking up has no place in a well-run, humane and patient centred service”