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CSP 3 > Truth Telling > Flashcards

Truth Telling Flashcards

1
Q

What is the most commonly abused substance in the UK?

A

Alcohol

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2
Q

What negative behaviour is alcohol associated with? (3)

A

criminal behaviour, violence and road accidents

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3
Q

How many medical and surgical admissions are for problems related to alcohol?

A

1/3

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4
Q

What is the chemical definition of alcohol?

A

Any substance that contains a hydroxyl group attached to a carbon atom [C-OH].
Usually refers to ethanol.

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5
Q

When does blood alcohol level peak?

A

30-90 minutes on empty stomach

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6
Q

What does peak blood alcohol level depend on?

A

rate of absorption, prior level, duration and rate of consumption, strength (20% causes greatest peak), type of drink, sex (higher in women), body weight, food in the stomach, physiological factors (genes, blood supply, conditions increasing gastric emptying)…

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7
Q

How is alcohol eliminated?

A

The liver detoxifies 95%

90% of the rest is excreted by the kidney, and the last 10% eliminated in the breath and sweat.

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8
Q

What is the rate of elimination of alcohol?

A

12-25mg/100ml of blood/h

About 1 unit an hour for 70kg man

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9
Q

Effects of alcohol on behaviour at <50mg/100ml?

A

Talkative, driving skills deteriorate.

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10
Q

Effects of alcohol on behaviour at 50-100mg/100ml?

A

Dizzy, slurred speech, loss of coordination

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11
Q

Effects of alcohol on behaviour at 100-150mg/100ml?

A

Staggering gait, disorientation

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12
Q

Effects of alcohol on behaviour at 150-200mg/100ml?

A

Nausea, non-cooperative, loss of inhibition

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13
Q

Effects of alcohol on behaviour at 200-300mg/100ml?

A

Vomiting, stupor, incontinence

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14
Q

Effects of alcohol at 300-400mg/100ml?

A

Coma, impaired respiration, loss of reflexes

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15
Q

Effects of alcohol at >400mg/100ml?

A

Death

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16
Q

How many people are killed each year in the UK as a result of drinking and driving?
How many % of all road accidents does alcohol account for?

A

> 1000

10%

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17
Q

At the legal limit, how are the chances of a serious accident increased?

A

Twice normal

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18
Q

At twice the legal limit, how are the chances of a serious accident increased?

A

20x greater

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19
Q

Driving under the influence can lead to prosecution under what act?

A

Road Traffic Act 1988

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20
Q

What does the Road Traffic Act 1988 set out? (3)

A

A person who fails to provide a specimen when required to do so is guilty of an offence.
It is an offence to drive a motor vehicle
whilst impaired through alcohol or drugs. [3 pieces of
evidence are required: evidence from arresting officer +
medical evidence + toxicological evidence (but prosecutioncan proceed with only two)].
It is an offence to drive a motor vehicle with more than the legal limits of alcohol.

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21
Q

What are the legal limits of alcohol in…
Breath?
Blood?
Urine?

A 
Breath = 35mcg/100ml 
Blood = 80mg/100ml 
Urine = 107mg/100 ml
22
Q

How long is an ordinary license valid?

A

Up to the age of 70 (then it must be renewed every 3 years)

23
Q

What is the driver obliged to inform the DVLA of?

A

Any potential or actual medical disability that may affect his driving.

24
Q

As a doctor, what should you do if a patient refuses to inform the DVLA and you have concerns?

A

Inform the patient that he has a legal duty to inform the DVLA.
If the patient refuses to accept the diagnosis or the associated risks, suggest a second opinion. Advise the patient not to drive until it is obtained.
If the patient continues to drive, try to persuade him not to do so, possibly by involving the next of kin.
If the patient still drives, tell him that the DVLA will be informed.
Discuss the matter with his defence organisation.
Give the medical information to the Medical Adviser at the DVLA.
Write to the patient, informing him that you have done so.

25
Q

What drugs affect fitness to drive?

A

Prescribed drugs - tranquillisers; antiepileptics; antidepressants; antipsychotics; antihistamines; analgesics; anaesthetics.
Illicit drugs - opiates; cannabis, LSD; alcohol.

26
Q

What neurological conditions affect fitness to drive?

A

Epilepsy - need to be fit-free > 1 y
Narcolepsy - yearly medical review
CNS Disease, e.g. Parkinson, MS
CVA, TIA - stop to 4 w, then start if no disability
Vertigo, Meniere’s - stop until symptoms controlled
Brain benign tumour - Stop for 1 y, then 3 y review
Serious head injury - Stop 6 w – 1 y
Syncope - Stop until identified & controlled
Dementia - Stop until assessment
Opiates - Stop for 1 y screening
Cannabis - Stop for 6 w screening

27
Q

Define confidentiality.

A

An agreement that gives the confider the right to expect discretion from the confidant as well as guardianship of the information received.

28
Q

What is confidential information?

A

Any information disclosed to the professional about the patient before or after death, which has a nature of confidence, or seen by the patient as having such a nature.
NOT medical information only.
PATIENT IDENTIFIABLE INFORMATION

29
Q

Who has a duty of confidentiality?

A

EVERYONE - esp anyone receiving personal information in the context of care or research

30
Q

When does the duty of confidentiality cease to exist?

A

If there are good reasons for breach of the duty, if no representatives can give consent or refuse disclosure…

31
Q

Who has a right to confidentiality?

A

All patients - Gillick-competent minors have the same rights as adults.

32
Q

How should confidential data be protected?

A

Do not discuss about, or talk to, patients in public
areas.
Store, transfer and dispose of confidential info carefully.
Record-holders are only trusts for NHS, GPs, private clinics.
Retain health records 8 y min. (25 for maternity/obstetric records).
Never disclose more than needed.
Disclose necessary information only to relevant and authorised bodies.

33
Q

Why do we have a duty of confidentiality?

A

The rational argument:
* No confidentiality – no trust. No trust - no
information. No information – no care, no business.
* Improper breach of confidentiality might lead to
unpleasant legal/professional consequences to the
confidant.
The ethical argument:
Privacy and confidentiality are preconditions of
autonomy. Insofar as autonomy ought to be
respected, confidentiality ought to be kept.

34
Q

The duty of confidentiality is protected by law and professional codes - what are they?

A

A general common law (civil proceedings for breach of
implied contract).
Statutory law - Human Rights Act 1998, Art.8 (criminal proceedings).
GMC and UKCC Code of professional Conduct for nurses, and the Ambulance Service Code of Ethics and Professional Conduct of paramedics.
Patient’s Charter

35
Q

What are the remedies for Improper Breach of Confidentiality? (3)

A

Disciplinary proceedings – up to and including being struck off.
Civil proceedings – having to pay compensation. The patient may claim damages.
Criminal proceedings – may occur in the future.

36
Q

When can the duty be relaxed?

A

The patient gives explicit consent to disclose identifiable information e.g. for teaching, for research etc.
The patient gives implied consent to disclose information to relatives.
The patient must be informed of the purpose and
consequences of disclosure, and to whom information is
disclosed.
The patient may refuse and refusal must be respected, unless there are good reasons for breach of confidentiality.
Professionals receiving info must understand that it is
confidential.
If breach of the duty is in the patient’s best interest OR society’s best interest.
When the professional has dual responsibility (e.g.
working in prison, members of the armed forces,
company staff, insurance). Legally speaking, duty to
institution comes before duty to patient.
In case of serious crime or assault on professional - disclose info to police.
Courts of law can compel the disclosure of medical or
other info.
Tax inspectors can compel disclosure of financial
info only.

37
Q

What are the four statutory duties?

A

Abortions must be notified to the Chief Medical Officer (Abortion Act, 1991).
Known/suspected drug addicts must be notified to the Home Office (Misuse of Drugs Act, 1971, 1985).
Births and deaths must be notified (NHS Regulations 1982).
Certain infections diseases are notifiable (Public Health Act, 1984).

38
Q

Is AIDS a notifiable disease?

A

NO

39
Q

Regarding HIV+ doctors, when may the doctor’s status be disclosed without their consent?

A

Only in the most exceptional circumstances, where the release of a doctor’s name is essential for the protection of patients

40
Q

Doctors were traditionally reluctant to give their patients truthful information about diagnosis/treatment/prognosis.
How is this justified?

A

Patients are often ignorant and cannot really understand professional information.
Certain information might harm the patient’s health status.
Information about bad prognosis might imply the doctor’s failure. Breaking bad news is always unpleasant.
Not enough time
Knowledge = Power, and Monopoly on Knowledge = Absolute Power.
Causes loss of professional autonomy, de professionalisation, decline of social status.

41
Q

Doctors were traditionally reluctant to give their patients truthful information about diagnosis/treatment/prognosis.
Arguments against.

A

Patients often expect you to disclose
information to them.
The law and professional guidelines require that you give sufficient information, and only truthful information.
Now considered morally AND clinically good as well.

42
Q

Why tell the truth?

A

Clinical benefit: promotes trust, induces truth telling by the patient, contributes to compliance.
Moral importance: Truthful information is a
necessary precondition of autonomy and moral
action.
Legal importance: concealment of information may lead to charges of negligence.

43
Q

When might it be justified to withhold the truth from a patient?

A

If evidence that disclosure will cause real and predictable harm, e.g. info that might make a depressed patient suicidal

If the patient states an informed preference not to be told the truth.

44
Q

Is it justifiable to deceive a patient with a placebo?

A

In general, the deceptive use of placebos is not deemed to be ethically justified.

45
Q

Define utilitarianism

A

maximise utility/happiness/preference of the majority

46
Q

Define consequentialism

A

morality of an action judged according to expected

outcome

47
Q

Define a rights based approach

A

people have rights, and rights trump preferences:

48
Q

Which information should be given?

A

• Identity of doctor/student.
• Diagnosis and prognosis in case of non-intervention v.
intervention.
• Purpose and nature of recommended treatment.
• Expected benefits and harms of treatment.
• Potential conflict of interests.
• Alternative options, if available or affordable.
• Assurance of confidentiality and disclosure of its scope
• Any other information the patient may wish to obtain:
Encourage further questions and answer them.

49
Q

Which information may be discretionarily avoided?

A

• Any information the patient does not wish to have.
• Information about alternative options, if patients
cannot afford them (???).
• Information about negligible risks (???).
• Information about rationing considerations (???).
• Information about professional competence and
identity of surgeon (in the public system only).
• Information about futile treatments.

50
Q

What is The Bolam test? v. The Prudent Patient test

A

Assuming the patient wants to be informed, the
amount of information that must be offered about
risks or about anything else is:
– Which – at least – a responsible body of medical opinion would endorse as reasonable.

51
Q

What is the prudent patient test?

A

Assuming the patient wants to be informed, the
amount of information that must be offered about
risks or about anything else is:
– which – at most – a reasonable person in the position of the patient would need to know to make an informed choice.

52
Q

Do relatives have a right to be informed about a patient?

A

NO, whether adult or child

The duty to inform them depends on the rights of the patient to confidentiality and the clinical needs of the patient.

CSP 3 (13 decks)

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