Truth Telling, Duty Of Candour & Raising Concerns Flashcards
What reasons are their to act appropriately with patients?
Moral duties
Legal duties
Regulatory duties (CQC)
Professional duties (e.g. GMC duties of a doctor)
Why is honesty important in everyday life?
- Significant part of relationships built upon trust
- Respecting people + autonomy
- Expectation of honesty
In what everyday situations may it seem acceptable to not be completely honest?
- Protect ourselves
- Protect others
- Avoid upsetting someone
What does the principle of respect for autonomy require of us?
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
What are the different conceptions of truth telling?
- Do not lie
- Respond truthfully when asked a question
- Provide all info relevant to patient w/o prompting
Why is there a underlying ethical duty to be honest and open with patients?
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
What other ways can doctors show dishonesty towards patients other than by directly lying?
- Failure to disclose info
- Failure to FULLY disclose info
- Misleading a patient
What is therapeutic privilege?
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.
What are the problems with therapeutic privilege?
- 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?
What is the professional duty of candour?
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.
At what point should you be open and honest with patients?
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
What do patients need to know when things go wrong?
All you know + believe about a situation:
- What went wrong
- Why it went wrong
- Possible consequences for patient
- Explain where there are still uncertainties
How should you apologise to a patient?
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
What is statutory/organisational duty of candour?
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.
How is the statutory/organisation duty of candour set out?
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
Define what it means to make a mistake but not harm the patient.
An error or system failure that reaches the patient but does not result in patient harm i.e. a near miss.
Define what it means to make a mistake and cause low harm to patient.
Any patient safety incident that required extra observation or minor treatment (e.g. first aid, additional therapy or medication) + caused minimal harm.
Define what it means to make a mistake and cause significant harm to patient.
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.
What is the statutory duty of candour consequence if a mistake is made that does not harm the patient?
Incident used for learning + no need for disclosure
What is the statutory duty of candour consequence if a mistake is made that causes the patient low harm?
Disclosure required under the PROFESSIONAL duty of candour + incident should be reported to NRLS
What is the statutory duty of candour consequence if a mistake is made that causes the patient significant harm?
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
What duty do doctors have to raise concerns?
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
What principles is the duty to raise concerns mainly based on?
Patient safety + quality of care
How should concerns be raised?
- Raise it with manager/senior (e.g. consultant, clinical/medical director or practice partner)
- If concern is about that person go to clinical governance lead
- Documents concerns
