Truth Telling, Duty Of Candour & Raising Concerns

Question 1

What reasons are their to act appropriately with patients?

Answer 1

Moral duties
Legal duties
Regulatory duties (CQC)
Professional duties (e.g. GMC duties of a doctor)

Question 2

Why is honesty important in everyday life?

Answer 2

• Significant part of relationships built upon trust
• Respecting people + autonomy
• Expectation of honesty

Question 3

In what everyday situations may it seem acceptable to not be completely honest?

Answer 3

• Protect ourselves
• Protect others
• Avoid upsetting someone

Question 4

What does the principle of respect for autonomy require of us?

Answer 4

Sharing of info

Openness at all stages of contact with patient so they need information about:

• Diagnosis/prognosis
• Necessary for informed consent
• On progress
• When things go wrong

Question 5

What are the different conceptions of truth telling?

Answer 5

• Do not lie
• Respond truthfully when asked a question
• Provide all info relevant to patient w/o prompting

Question 6

Why is there a underlying ethical duty to be honest and open with patients?

Answer 6

Dr-Pt relationship built upon trust; patients expect this + failing to do so will compromise relationship

Crucial to respecting patient autonomy; need info to make informed decisions

Question 7

What other ways can doctors show dishonesty towards patients other than by directly lying?

Answer 7

• Failure to disclose info
• Failure to FULLY disclose info
• Misleading a patient

Question 8

What is therapeutic privilege?

Answer 8

The situation where telling a patient clinical information may cause them harm so there is an ethical argument in favour of withholding information during the consent process in the patients benefit.

Question 9

What are the problems with therapeutic privilege?

Answer 9

• Who is best positioned to determine what is best for patients?
• Does undermining autonomy harm a patient?
• What if something goes wrong directly related to the withheld information?

Question 10

What is the professional duty of candour?

Answer 10

Every healthcare professional must be open + honest with patients when something goes wrong with their treatment or care causes, or has the potential to cause, harm or distress. As a doctor, you must be open + honest with patients, colleagues + employers.

Question 11

At what point should you be open and honest with patients?

Answer 11

Start before things go wrong; fully inform patient about care including risks + benefits

Continue if something goes wrong; if it causes them harm/distress now or perhaps will in the future

Question 12

What do patients need to know when things go wrong?

Answer 12

All you know + believe about a situation:

• What went wrong
• Why it went wrong
• Possible consequences for patient
• Explain where there are still uncertainties

Question 13

How should you apologise to a patient?

Answer 13

In a meaningful in genuine way say sorry + tell them:

• What happened
• What can be done to deal with harm caused
• What will be done to prevent someone else being harmed in the future

Question 14

What is statutory/organisational duty of candour?

Answer 14

Healthcare organisations have a duty to support staff to report adverse incidents + be open/honest with patients if something goes wrong. This is separate to professional duty of candour that individual doctors have.

Question 15

How is the statutory/organisation duty of candour set out?

Answer 15

Statutory institutional duty set out in statute therefore its a legal requirement - Health & Social Care Act 2008: Regulation 20 (2014)

Formal process triggered by incident resulting in harm to patient, action based on:

• Level of harm
• Cause + effect

Question 16

Define what it means to make a mistake but not harm the patient.

Answer 16

An error or system failure that reaches the patient but does not result in patient harm i.e. a near miss.

Question 17

Define what it means to make a mistake and cause low harm to patient.

Answer 17

Any patient safety incident that required extra observation or minor treatment (e.g. first aid, additional therapy or medication) + caused minimal harm.

Question 18

Define what it means to make a mistake and cause significant harm to patient.

Answer 18

Corresponds with NRLS ‘moderate’, ‘severe’ + ‘death’, and with incidents notifiable to CQC with harm explicitly defined to include ‘prolonged psychological harm’ in line with CQC reporting practice.

Question 19

What is the statutory duty of candour consequence if a mistake is made that does not harm the patient?

Answer 19

Incident used for learning + no need for disclosure

Question 20

What is the statutory duty of candour consequence if a mistake is made that causes the patient low harm?

Answer 20

Disclosure required under the PROFESSIONAL duty of candour + incident should be reported to NRLS

Question 21

What is the statutory duty of candour consequence if a mistake is made that causes the patient significant harm?

Answer 21

Disclosure would be required under both the PROFESSIONAL + STATUTORY/ORGANISATIONAL duties of candour, with proportionate regulatory consequences for a failure to disclose harm of this kind

Question 22

What duty do doctors have to raise concerns?

Answer 22

Raise concerns where believed that patient’s safety/care is being compromised by the practice of colleagues or systems, policies + procedures in organisations they work

Encourage + support a culture where staff can raise concerns openly + safely

Question 23

What principles is the duty to raise concerns mainly based on?

Answer 23

Patient safety + quality of care

Question 24

How should concerns be raised?

Answer 24

1. Raise it with manager/senior (e.g. consultant, clinical/medical director or practice partner)
2. If concern is about that person go to clinical governance lead
3. Documents concerns

Question 25

Who should doctors in training raise their concerns too?

Answer 25

Named person in deanery or clinical supervisor

Question 26

Why are processes of raising concerns in the workplace often different?

Answer 26

Each institution has its own process

Question 27

What important considerations come into play when raising a concern in the workplace?

Answer 27

• Duty to patient’s interests + protection put first above personal/professional loyalties to colleagues
• Legal protection against victimisation/dismissal for individuals who reveal info to raise concern + expose malpractice in workplace
• Do not need to wait for proof if its brought up genuinely even if its a mistake

Question 28

What duties to we have as medical students?

Answer 28

• Follow GMC guidance
• Be open + honest with patients at all times
• Ensure patients have provided appropriate consent for your involvement in care/for them to be involved in your training
• Follow whistle blowing policy of Trust
• Speak to personal tutor or phase lead if concerned about colleague’s behaviour e.g. clinician, member of medical school staff or student