Cadmore media player playing video Ethical Scenarios for Postgraduate Orthopaedic Exams
Video Player
Accessibility
Using forms mode, you can utilize keyboard shortcuts to make usability more efficient.
Space bar will play and pause the video. Pressing escape will close all displays and pressing it again will jump to the end of the player.
You can press A to open the Keyboard Shortcut Dialog which also provides an audio description of the player and all of its features.
Language
1x
Play Speed
Adjust Volume
Transcript
Search
Result Count
of
Click to jump to result
Search
Re-center
Segments
Result Count
of
Click to jump to result
Search
Name:
Ethical Scenarios for Postgraduate Orthopaedic Exams
Description:
Ethical Scenarios for Postgraduate Orthopaedic Exams
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/f92fcc67-754d-4831-b16c-1e0e8f3317d7/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H46M30S
Embed URL:
https://stream.cadmore.media/player/f92fcc67-754d-4831-b16c-1e0e8f3317d7
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/f92fcc67-754d-4831-b16c-1e0e8f3317d7/Ethical scenarios for Postgraduate Orthopaedic Exams.mp4?sv=2019-02-02&sr=c&sig=sHnEuGBqkiHF1N0TGh0xxBX0KZ02QJ2WHts%2Bpfzhjx8%3D&st=2024-11-24T02%3A12%3A22Z&se=2024-11-24T04%3A17%3A22Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Good evening, everyone, welcome to this Wednesday's teaching FRCS teaching from the mentor group. Sorry, you can hear some echo, but there's been a technical problem. And that's why some delay decision tonight is ethical considerations for the FRC exam.
The presenter is Muhammad EMOM. He is one of the members. He is a consultant surgeon from Norfolk and Norwich. We have other mentors in the group Abdullah, Tasha's and also Amjad, who recently was with us. Tonight? tonight. I please interactive on the chat group or raise the handsome guy next to the name.
Everyone who attends can have cleaner CPD certificate. Please get in touch with me. And over to you, Mohammad. Thank you very much for us and welcome everyone. So I'm going to I think this is a very important topic. It's ethical. You know, nowadays, recently there has been always one of the ethical scenarios that comes in the exam.
And the problem is with this scenarios, this is important because it reflects your attitude and behavior. However, the difficulty mainly it is in the sort of code mainly that there are no books or no hard consensus on how to answer this, but mainly it's common sense, and it's all about the end. It's all about guidance. So I'm going to go through most of these ethical dilemmas, and I've collected this of support during my preparation for the exam years ago.
And also it is crucial you will be asked these questions in most scenarios. One of the most common scenarios that I'm pretty sure you've been asked during your different interviews is a drunk colleague or colleague who's using or someone who or a patient mentions to you. On two occasions they have smelled alcohol on your consultant stress during a clinic or someone coming to you and telling you that someone is abusing drugs or stuff like that.
And in these scenarios, there is much worse and there are buzzwords and you have to use this first word. And as with everything else, we do patients first. So I would tell a colleague or a colleague who use illegal drugs. My first concern would always be the safety of the patient. However, I have a duty of care to my colleague and the hospital too. And that's it.
You know, you passed this scenario. If you just said these two sentences, you have a duty of care to your two patients. Always our first concern is patient safety and duty to our colleagues and the patient and the hospital itself. Patient safety, you would talk to your consultant colleague and send them home. Of course, if you take on consultants, as is everything else in the exam, you will enlist the help of another consultant or a clinical director if you need to.
And then patient safety. You review all patients seen by the consultant. Complete the word. You can recall patients with charts by him. Ask them to come back and see them again. Review there's no and all that stuff and then a duty of care to your colleague because at the end of the day, this is your colleague and you know, GMC with, you know, it's common sense.
You have to make sure that your colleague would arrive home safely. So you can arrange for a taxi for them to go home, check with them later to ensure that they've reached home safely. It will discuss with them and try to help find, you know, like you can suggest occupational health referral and says that this behavior was always appropriate. And that's the problem with this scenario is there is no medicine and there is no way it's actually all about.
Common sense and guidance. And finally, the duty of care to your hospital by keeping accurate records and inform your consultant through your clinical director because you're a consultant. It's mainly you have to protect patients from risk of harm posed by another consultant colleague conduct performance for ill health. If so, and the safety of patients will always come first at all times.
You can read as much as you want during this scenario, and then you can discuss other concerns later on. Another ethical problem is like inappropriate behavior, like consultant making inappropriate sexual remarks to another colleague stealing hospital property. So what are you going to do? So generally speaking, I'm not sure if you know that or not. You know, usually if you have concerns about a consultant, some colleagues in regard to behavior or performance, you can always say these are different pathways.
You can report your concerns to clinical or medical director. You can discuss your concerns with the National Clinical assessment center. And so the service and CAA s Kessler and you can always report your concerns. GMC started quite nice to go over it again because it's very, very important. You touched on the topic of difficulty and colleague, colleague and difficulty, and that could come into so many scenarios, so many different scenarios.
But you explained the main three pillars our answer should be based on. And once that examiners hear these pillars duty of care to the patient, to the colleague and to the hospital, once you touch on these three, you your this question. So if you could go through that again for us and from the beginning with your slides, please? Yes so basically, again, this is an important topic about ethical considerations in the exam.
And the main problem of these ethical scenarios is that they will come frequently nowadays. It's almost guaranteed you'll have a scenario of an ethical problem in your exam, and it's not mentioned in our book. We didn't study it before. You know, we all read it, we had to import it, but it wasn't written. It's all about guidance, and the GMC website will have the guidance.
One of these ethical dilemmas is actually, you know, if you have a colleague with a behavioral problem like you smelled alcohol on your consultant, colleague, a colleague, you suspect someone is taking illicit drugs, a patient tensions during an examination, one of your colleagues smelled of alcohol. This so difficult colleagues or colleagues in difficulty is a common scenario.
And to deal with a drunk colleague, for instance, to start with this one because this is the commonest scenario is almost always patient, comes first. You cannot start this scenario without saying this buzzword. My first concern would be the safety of the patient. However, you have a duty of care towards your colleague himself and the hospital, too. So first, you have to talk to your consultant colleague and make sure they are supporting.
So that's what we call damage control. So if difficult, you have to enlist the help of another senior consultant, colleague or the clinical director. And then you have to make sure that you demonstrate that you care about patient safety by saying that you review all the patients that seen by him or her complete the word around. Recall all patients seen by your colleagues and that they ensure the appropriate cover is arranged for them if needed, because their colleague might be on call.
And that might be the next question. The other thing is actually under also. A common sense is a duty of care to your colleague himself. You should arrange for a taxi for them to go home, check on them later, ensure they reach home safely and then demonstrate that you have a long term plan and long sightedness or the vision you discuss with them and try to help you adjust referring them for occupational health.
And they said at all time that this behavior isn't appropriate. And finally, a duty of care to the hospital itself. The duty of care of hospital is just by keeping accurate records. What incident form and full and then duty to your colleague and the hospital, right? A difficult colleague. As I said, the first concern always in every of these ethical scenarios is patient safety.
That utmost importance. And then you have a duty of care to your colleague himself and the hospital. So can you see that now? Patient safety is discussed with your colleague. Make sure they arrive home safely. And all that stuff was discussed earlier and the recalled patients charged by your colleague ensure that appropriate cover is arranged whenever possible.
Second thing here in this slide your duty of care to your colleague arranging a way to go home, make sure they arrive home early. Insist that this behavior wasn't appropriate, and this is a buzzword that you should make sure you make your examiners hear and discuss with them and try to help and adjust referral to an occupational health for the hospital. Mainly, it's all about keeping accurate records and inform your consultant or clinical director about the incident and make sure it is following.
If your colleague is doing inappropriate behavior, generally speaking with a sexual health, sexual attitude, bad sexual attitude, the system, all this stuff. If you suspect problems from your colleagues, if you have contained of or concerns and you have to protect patients from risk of harm goes by another colleague, conduct performance or health, the safety of patients would confirm the safety of your colleagues comes first here in this scenario.
I also it's same importance. And then if you have concerns, there are always ways to report your concerns. So basically, you have to make sure you take these necessary few options. You have to make sure you report your concerns and your colleague and/or clinical director mainly or the medical director if there is a consultant involved.
You have to. You can also discuss your concerns with the National Clinical assessment service, which is which gives advice in regards to any concerns, and they give advice to employers, patients or others. And you can always report their concerns to the GMC. And then there are three main. Uh, aspects here first, the individual health and other factors related to the individual himself.
So this slide. I've summarized some of the topics that can be covered, so you have to make sure that your colleague is. This change in behavior is not due to a physical or mental illness. Maybe it is depressed or she's depressed, or it might be also alcohol. And if there is a major life event going on that have led to this inappropriate behavior and you know, having this guidance in your mind while dealing with all these concerns would always help.
Secondly, you should know you should. If you have concerns and knowledge or skills of behavior, then you have to dig deep. You there might be a deficiency in education or infection or problems with competence. All these questions, you should ask. Covering the three main aspects of good clinical practice for the GMC. Finally, it is the job is the changes in behavior related to work factors.
Is there a problem with technological advances, with work environments, with difficulties? Is there any major organizational changes to these are different points you can talk about if you're having concerns, if you are having a significant concern. So always one question you might be asked and I was asked that before. What is the significant concern?
Because the definition of a significant concern is mainly a concern and regard to behavior, health, attitude and knowledge that might affect patients or staff safety and should be reported. For example, if you're worried about poor clinical performance, if you're worried that your colleague is ill treating patients, if there is unacceptable behavior like harassment or discrimination, if there is other if he or she is reaching sexual or other patients on control.
If there is for a poor teamwork that compromise patient care if you have any other concerns like fraud or criminal offenses, offenses and that's actually, you know this, this is never exhaustive and there might be other areas that you can take any route. You can, you know, if you follow these principles, as I said here. So basically, you discuss individual health and other factors, knowledge, skills and behavior and the job, and you cover most of them and it's always patients comes first and as well in other scenarios, staff safety comes also first.
Another scenario is that you might have if you've been asked, how would you react if one of your female junior colleagues, if they one consultant and your registrar, refused to treat a patient because it's a known rapist and this is, you know, that's what I'm fighting here. So you should mention the word guidance. Basically, if you're carrying out a particular procedure or giving us advice about it and conflict with your religious or moral beliefs, this conflict might affect the treatment or advice you provide.
You should explain that to the patient and tells them that they have a right to see another doctor. So patient safety first. As usual, however, you must be satisfied that the patient has sufficient information to enable them to exercise that right. So if it's not practical for the patient to arrange for another doctor, you must ensure that these arrangements are made for another suitably qualified colleague to take over the role of your junior colleague.
Because all patients are entitled to care, either there are serial killers or rapists, they are all entitled to the same quality of care and treatment meetings. The clinical need. However, the staff have also rights. So if they are carrying a particular exercise that conflicting with the religious or moral beliefs, but at all times, patient safety will always come first.
If in this scenario, here also the other concern that she might refuse to treat the patient because medical, his medical or mental condition might put at risk if a patient pulls the rest to your colleague health or safety or yourself, you should take all available steps to minimize the risk before providing treatment or making suitable alternative arrangements for that treatment. So it's basically to summarize here, you should say the guidance is clear and it's published on the GMC website.
You should mention that this is a conflict. Conflict with the religious or moral beliefs should be respected. However, patient safety and care comes at the core of everything we do, and if there are any concerns or risks, then you can always make sure all available options and alternatives are in place. Another topic, which can be important as well is racism. So how would you react if a patient refused to be treated by you if one of your junior doctors because a foreigner?
So there is a protocol here, and there is a guidance here that, you know, just look at this slide. It's really important you first have to ensure that this patient behavior is not due to his or her underlying medical condition is that if something knot is said by someone with dementia, that's it. You have to kill. You have to continue treating them because the patient is not willful.
However, if the patient is willful, then you have to start with an informal Warning. Tell them that their behavior is not acceptable. If if the patient suggests, then you should give a formal Warning. And if the behavior is repetitive, then the patient should be removed from the premises by hospital security. So you should make sure the behavior is due to underlying medical condition, followed by informal Warning, then formal Warning and then removal from the premises.
However, and you always have, however, the care should not be harmful, and the responsible clinician should make sure that adequate arrangements for the transfer are in place. Most trusts have policies regarding dealing with violent, abusive or racist patients, and most trusts will display them everywhere. As you are aware and most trust in the NHS, if not all, have a zero tolerance policy towards abusive patients, and care may be withdrawn from persistent offenders.
But as such, but at all times, make sure you have arrangements for him or her to receive treatment appropriately. So another scenario here, you know, I'm just trying to go through all common scenarios that you might not find a good solution for elsewhere. If you have someone who there, you know you're working as a trauma consultant, Tom Cole, and you have someone who takes a lethal overdose.
Some of the bridge and coming with multiple trauma, and she leaves written instructions that. She doesn't want to be resuscitated or he so. How would how would you deal with her? So basically remember the four basic principles of medical ethics. This you can use the most of these scenarios. The principle of autonomy, which individual, which means that individuals have the right to be self-governing.
The principle of nonviolence since the patient should be on the principle of beneficence, the benefit of the patient should be promoted at all times and the principle of justice, which is equality and equal, should be considered equally in. You can cite this in most whenever possible in this scenario. So living wills or advanced directives are valid in the English law.
However, an advance directive must be written by a person who actually are competent and has the mental capacity. So if in this patient x, if she had psychotic depression, she wouldn't understand the consequences of her refusal of future treatment and then she should manage. Who is it? So in this scenario, you must have discussed with the psychiatrist as well to gain further guidance and define the dilemma if you can discuss it with a senior colleague or check trust protocol.
All these things you can say. So what about performance concerns and in regards to performance concerns like? Your consultants tell you something that you think is a consultant in the trauma in trauma meetings and decisions that you find inappropriate and lack of minimal competency or one of you constantly arrived late for work.
These are also performance concerns in these concerns. Don't assume that your consultant is wrong. Always discussed, or you could solve what is wrong. Discuss with them. Find why they make that decision. Why they find that decision interesting. And tells them that you would like to learn from the thinking behind that decision. If you're not satisfied, and that would be the next question from the examiner, then you suspect that less than perfect care has been provided.
You're duty bound to raise your concerns with your consultant. If you find it difficult, then discuss it with a clinical director or the medical director. If you have, if there is minor consent of minor performance concerns like a colleague arriving late or you find. That your colleague seems to be suffering from stress. All this can be done informally and you can discuss with them, listen to them, get their feedback and understand what is behind the poor performing doctor.
Someone whose competence, conduct or behavior pose a potential risk to the patient safety of the effective running of your clinical team, so a problem should be also addressed. Also remember the three main points we talked about is the individual himself. The job itself, the attitude problem or the knowledge, skills and attitude problem. So here you have to find a diagnosis is true.
Confirm the diagnosis. If it is your junior, then you have to make the correct observation. Have feedback from previous supervisors and then have an intervention by, you know, these are all things to diagnose and confirm the diagnosis and then do the intervention by communication of clear expectation, enhance teaching, arrange for care or mental support.
Reduce the clinical workload. And have more protected time for your colleagues. So there is no right answer for these scenarios. And also one good place to find more ethical considerations. If you're looking for one is actually the GMC website itself, because in the GMC website, you will find that the. You will find few clinical scenarios, and I think they are very helpful if you would like to know more about it.
The other important topics that we can discuss as well, I would like you to take a look on this few questions which would be content. And it's an important, important topic to discuss as well. Consent for four procedures you do. That's one important question that you can be asked and special with the current problems going on in the NHS consent thing is always an important topic that asks a lot.
So I would answer the first question by saying. Uh, that. I work in close partnership with my patients. I consider an important part of the process of discussion and decision making. I discuss with my patients the current situation. I answer all the questions. You know, you have to discuss other treatment options and the benefits may common uncommon and rare risks and share with them the detail of information as much as they want.
And then if there are complexity of proposed investigations on treatment, you should also discuss that. And always say the word GMC guidance, because that's a reference on which you're talking about, the second topic is always a second question. It's an important one as well. So what do you consider to be sufficient level of information for that patient? So initially, the laws are English.
Law has tended to regard the level of information required to be that acceptable to a reasonable body of medical opinion, and that's known as the polemicist. However, after the Montgomery case, and you should check this case, it's not up to me. And I think in Lancaster, the courts have said that they will depart from the approach of the amount of information that's acceptable to a reasonable body, to the amount of information they could find to be appropriate and that's appropriate for consent.
The legal age for consent, for surgical treatment 16 years and over in such cases. There is no legal requirement to obtain consent from the parent or guardian. Usually 16 to 18 is a gray area, but 16 is a legal age. However, if a child is under 16 and if the health professional feels they are capable of understanding the nature and possible consequences of the surgical procedure, you can still consent them.
However, legally, you should also discuss it with the parents and that also known as the plager ruling. And generally speaking, that's mainly was highlighted for contraception advice. Contraceptive advice. So what's the legal position of a child or parental refusal to treatment?
So according to the Fraser ruling, ali-frazier competent child cannot receive the treatment thought to be for his or her best benefit in England and Wales, and then parental consent will be needed. So if a child, if you think that a child, bas status, 16, receives the treatment you think it's in the best interest, then you should gain consent from their parents. It was mainly based on the MMR controversy.
And there is also one common scenario that you can find is about a kid who's like 14 years old, and he's happy to have lots of children who are the parents, and you have a witness who refused to give them blood transfusion and there are guidance on the Royal Society of Hematology is that you can check. So, Mohammad, you got you covered this. Extensively, and you can never cover everything to do with the ethical considerations and ethical scenarios and consent matters, it's quite varied and could be anything but.
As long as you understand the principles, we can come up with the sensible answer. And you you said that very nicely, say, you know, patient's hospital colleague, colleague, safety, patient safety and hospital. Also, always say GMC guidance, according to GMC guidance, for anything to be ethics or concerns related to ethical consent.
Can I say just add one comment regarding the Montgomery cases is quite complex. I looked at it, and the only thing I could get out of it, to be honest, is. Now, you know, is a consent should be patient specific, and by saying that, you know, if you have a patient, for example, you're offering a knee replacement to a patient. And a knee pain and inability to kneel is very important to a plumber, for example, and that's very important to another patient who doesn't kneel at all.
So I think that's an example of how the concern should be patient specific to the needs. So we need to. Now, after Montgomery ruling, we need to understand our patient's life and lifestyle and function very well, actually. So I was concerned, you know, this consenting dilemma. It's a common dilemma, and it is discussed in most meetings. You'll find a lower level meetings and upper level meetings, all these meetings.
So just stick to the principles in the exam. Just say you're aware of the Montgomery URL that you should give as much details as the patient would like to know, as you said, the peaceful consent for this particular problem. Listen to patients and understand their expectations, their aspirations. And then you can then give them the amount of information you want.
How much to summarize ethical considerations. As you said, patients come first. They GMC guidance your duty of care to police your duty of care to hospital, and that will cover to the hospital and that will cover everything. And then when you're discussing someone with problems, you should know and understand and find the diagnosis, confirms the diagnosis and set up an intervention to manage them and then discuss individual problems for this particular.
Police discuss, you know, understand the knowledge, skills, attitude, all of these things that matter and eventually know, understand the job and dig deep to get more about the shop. If you should say this, you know this broad title and you can talk as much as you want underneath them. And as I said, the GMC has some good ethical considerations. This what I am aware, has been asked in the exam before, but not conclusive, of course.
Yeah, Yeah. I mean, I agree with you, these topics have been asked all in the exam before and they commonly retested. I just want to say also, like when they put an ethical dilemma in front of you, always try to differentiate whether it's a major or a minor. One major one is the one that patient safety is affected.
Yeah, minor one is when the patient safety is not affected. Minor one is such as colleague is stressed out or colleague arriving late at work every day. These are concerns, but they are not major ones. So always show the examiners. They understand the patient safety ones are the major ones. Other ones are less major and can be dealt with later on once patients have been sorted.
And also in any ethical dilemma with when a colleague is involved, the first step always, always is talk to the colleague first. Don't jump the colleague and say all straight away. Call the GMC or call my character. Speak to the colleague first because you might be able to immediately help them. They might just not be aware of they are causing problems and always ask them, whatever the problem is, self referral to the occupational health department.
If they give them a chance to do it, if they don't self-refer themselves, if they're stressed out or whatever drinking problem and not offering themselves, that's when you raise it to the higher level. Basically, if a colleague, if you finding out a colleague is doing too many mistakes, what would you do? How would you approach that?
Is it making open muscular applications and no, no, this is also a performance problem to think about the individual health and other factors because they have physical or mental problems. Are they depressed suffering from another mental illness, substance misuse and then goes into the second aspect, which is knowledge, skills and behavior? And then finally, the changes in the job, and if you have serious concerns, you can discuss with others like medical director or the same personnel.
Also, you can actually quantify your concerns by other things of performance, making sure they are they have making sure they don't have an increased complication rate compared with their peers. And then if you have concerns, highlight this concerns. The next question if no one makes an action, then you can always contact the National Clinical assessment service. You can contact the GMC.
So you know, it's always about a hierarchy of things to do. So you always think about the same the individual, the knowledge, skills and behavior and then the job and then take it further. I think what can happen then that you report that issue to the clinical director and the clinical director tells you, OK, Mr emam, can you help us out and get this sorted? But what would you do if a colleague is, is underperforming, let's say, and they are asking you to formulate a plan?
So one one, one way of assessing that if you think your colleague is having an increased the infection rate after his are supposed to listen. So first, they should stop operating because patient safety comes first. That's one thing. So that's one thing should be an action we should have. They should stop whatever they are doing now. And that's usually the decision of the medical director or the clinical director, of course.
And then you do service evaluation, which is a quality improvement project by assessing actually, you know, like because you might have three infections in the last week and he never had he didn't have an infection for the last three years. So what is different is him or is the other is the cases is that problem is exclusive for him to now you do root cause analysis to make sure that actually he's the 1 to blame.
And if I'm worried about his performance. And I have evidence supporting my concerns, then that should be taken to the other level by doing a proper investigation and having a clinical incident and discussing that in the governance meetings. And then decisions should be taken on a higher level, not just meeting them, but also, as I said, with everything else. Patient safety comes first.
Thank you, ma'am. I think that's what I was getting at. Sorry, go ahead. I'm sorry. Yeah, I agree with everything you said, Mohammad. The next level, I would say, is. So the first thing is just to establish whether it is actually true or not. So information gathering exercise and that could be like an audit, so you can start by doing an audit of someone's practice with other people.
Next, find out the cause of it. It might be the consultant. It might be as registrar is junior, the scrub nurse, the theater who is operating in because some hospitals have specific data for specific surgeon. So again, find the root cause of the root cause and for the root cause analysis, while, as you said, protecting patients. So you could say I have a duty to the patient, as you said, which is the paramount, a duty to my colleague, duty to the trust and then a duty to myself by protecting my reputation and a duty for all doctors, by protecting their reputation as well.
By mentioning all these giving this plan, I think the discussion will take you where they want to take it. And I totally those of the land, you know, using all these buzzwords makes you a seven, at least. You know, it's simple. It's not. It's like, you know, and you know, we go to hospitals every day. It's a career for paying the bills, but you know, there are easier careers, but we mainly there for patient safety.
That's the thing. So I think, you know, you always have to highlight this buzzwords like root cause analysis, gathering information, make sure all the things are all precautions are in place. What who to blame, what's a problem and then investigate accordingly. Excellent I think that's what I was trying to highlight. My question?
Service evaluation. Don't always assume it's the colleague quote because it could be other causes for the complications, but because patient safety is paramount here, we have to do a root cause analysis to find out whatever the cause is and eliminate it. If the colleague, if a problem turns out to be a colleague, requires more training, then obviously he could be supervised by a senior colleague. could be mentored.
He could be offered educational courses and things like this. So always show you supporting your colleagues here, protecting patient safety, but also supporting your colleagues. If your colleagues require training in particular areas, we should be supportive to them. And that's also important to show in the exam and in real life that we would be examined. You know, our support for our colleagues, so don't always say or exclude my colleague can never be, you know, go home security, take.
Well, we will support a colleague unless, you know, you know, we leave any more drastic measurement as a last resort. So assessment of capacity is important. Thanks, Amjad. Assessment of capacity of the patient, whether it's elderly or a child. Yeah so the points were the points were whether, you know, if this is the capacity or this kind of dementia, is it related to the injury itself or whether it's something kind of well established?
So then the examiner would take you to which route that he is going to talk to you about? Thank you. Thank you. I think there was one more question to the mentors, Mohammad, if you could. Yeah, so, yeah, good bye. Let's huddersfield, what's my responsibility if my patient is found to be HIV positive and he or she refuses?
It is, you know, we are physicians who are bound by duty of confidentiality to our patients. But this is not absolute because confidentiality here is mainly at the center of maintaining trust and ensuring partnership. However, without causing harm to others. So in this case, yes, in every hospital, most of the hospital there is Jehovah witness liaison kind of committee, and they have this OK.
The issues here is the child is he. Is he Gillich competent or not? If the child is not clearly competent, but you need to highlight this for the examiners or that if the child is getting competent or if the child is not competent. So this is it's all about higher order thinking on your structure and your principles. So, you know, you are aware of the guidance and that's all it's about.
There's a legal responsibility for this person, and it's very fair to ask, who is the person who has guardianship? And that's, I think, the buzz word. Yeah who's the person who's legally the guardian? And if he is in between establishments moving from one family to the other, whatever, then you have the buzz word with the act in the best interest of the patient.
So these are the two buzzwords guardian and best interest. And actually, you know, if the guardian or the legal representative who can take consent, you deal with them as if they are parents. So and you always can, you can always contact the court or a legal representative if you have concerns. But it's all. Yeah, I think that the buzzword here there is.
And the third thing that if they want to give you a seven or eight, I don't know. There is an uncle court representative that you can contact any time of day or night, and they can issue a quick order within 24 hours to legalize whatever you want to do, as long if matters are really, really ambiguous. But then you have to speak to your colleague first clinical supervisor, site supervisor, whatever, and then they will contact that person in front of you on your behalf and you explain the situation and they can issue a court order allowing you to stop or start treatment based on the facts available in the absence of any person who can act as a guardian, for example, a traffic accident.
Both parents are dying to have died and the child is there. The child is there. Yeah, but you know, in this scenario, if you're an emergency situation for children and you know, you're worried the condition is deteriorating or the child might die, you start your treatment without any delay. That is, we cover this topic really very well and we appreciate it very much you.
You came forward to discuss this one because we haven't covered it. And as you heard, we don't cover it in teaching or find very little about it in books. It's one of weak points in our preparation for the FARC. So thank you very much for covering this. Yes, thank you. Thank you for us for moderating, and thank you, everyone, for your experience input in the important topic.
And as I said, you know, this is a topic that usually there is no right answer for. So if you have a format in your mind, you can easily do it. Thank you, mama, that's brilliant. Also, anyone who wants CPD certificate to attend it, I have a list of people who register. You could send me a message and let me know if you want the certificate.
So that's the end of the teaching. I hope you all learned like me and I've found it interesting. Now there will be a viable vibration. Now Dr. Abdullah is going to lead the Viva is using a new approach to help with the clinical component. He's got a very good idea, and I think we need to move forward in our teaching and implement and adopt new ideas all the time.
Segment:0 .
Good evening, everyone, welcome to this Wednesday's teaching FRCS teaching from the mentor group. Sorry, you can hear some echo, but there's been a technical problem. And that's why some delay decision tonight is ethical considerations for the FRC exam.
The presenter is Muhammad EMOM. He is one of the members. He is a consultant surgeon from Norfolk and Norwich. We have other mentors in the group Abdullah, Tasha's and also Amjad, who recently was with us. Tonight? tonight. I please interactive on the chat group or raise the handsome guy next to the name.
Everyone who attends can have cleaner CPD certificate. Please get in touch with me. And over to you, Mohammad. Thank you very much for us and welcome everyone. So I'm going to I think this is a very important topic. It's ethical. You know, nowadays, recently there has been always one of the ethical scenarios that comes in the exam.
And the problem is with this scenarios, this is important because it reflects your attitude and behavior. However, the difficulty mainly it is in the sort of code mainly that there are no books or no hard consensus on how to answer this, but mainly it's common sense, and it's all about the end. It's all about guidance. So I'm going to go through most of these ethical dilemmas, and I've collected this of support during my preparation for the exam years ago.
And also it is crucial you will be asked these questions in most scenarios. One of the most common scenarios that I'm pretty sure you've been asked during your different interviews is a drunk colleague or colleague who's using or someone who or a patient mentions to you. On two occasions they have smelled alcohol on your consultant stress during a clinic or someone coming to you and telling you that someone is abusing drugs or stuff like that.
And in these scenarios, there is much worse and there are buzzwords and you have to use this first word. And as with everything else, we do patients first. So I would tell a colleague or a colleague who use illegal drugs. My first concern would always be the safety of the patient. However, I have a duty of care to my colleague and the hospital too. And that's it.
You know, you passed this scenario. If you just said these two sentences, you have a duty of care to your two patients. Always our first concern is patient safety and duty to our colleagues and the patient and the hospital itself. Patient safety, you would talk to your consultant colleague and send them home. Of course, if you take on consultants, as is everything else in the exam, you will enlist the help of another consultant or a clinical director if you need to.
And then patient safety. You review all patients seen by the consultant. Complete the word. You can recall patients with charts by him. Ask them to come back and see them again. Review there's no and all that stuff and then a duty of care to your colleague because at the end of the day, this is your colleague and you know, GMC with, you know, it's common sense.
You have to make sure that your colleague would arrive home safely. So you can arrange for a taxi for them to go home, check with them later to ensure that they've reached home safely. It will discuss with them and try to help find, you know, like you can suggest occupational health referral and says that this behavior was always appropriate. And that's the problem with this scenario is there is no medicine and there is no way it's actually all about.
Common sense and guidance. And finally, the duty of care to your hospital by keeping accurate records and inform your consultant through your clinical director because you're a consultant. It's mainly you have to protect patients from risk of harm posed by another consultant colleague conduct performance for ill health. If so, and the safety of patients will always come first at all times.
You can read as much as you want during this scenario, and then you can discuss other concerns later on. Another ethical problem is like inappropriate behavior, like consultant making inappropriate sexual remarks to another colleague stealing hospital property. So what are you going to do? So generally speaking, I'm not sure if you know that or not. You know, usually if you have concerns about a consultant, some colleagues in regard to behavior or performance, you can always say these are different pathways.
You can report your concerns to clinical or medical director. You can discuss your concerns with the National Clinical assessment center. And so the service and CAA s Kessler and you can always report your concerns. GMC started quite nice to go over it again because it's very, very important. You touched on the topic of difficulty and colleague, colleague and difficulty, and that could come into so many scenarios, so many different scenarios.
But you explained the main three pillars our answer should be based on. And once that examiners hear these pillars duty of care to the patient, to the colleague and to the hospital, once you touch on these three, you your this question. So if you could go through that again for us and from the beginning with your slides, please? Yes so basically, again, this is an important topic about ethical considerations in the exam.
And the main problem of these ethical scenarios is that they will come frequently nowadays. It's almost guaranteed you'll have a scenario of an ethical problem in your exam, and it's not mentioned in our book. We didn't study it before. You know, we all read it, we had to import it, but it wasn't written. It's all about guidance, and the GMC website will have the guidance.
One of these ethical dilemmas is actually, you know, if you have a colleague with a behavioral problem like you smelled alcohol on your consultant, colleague, a colleague, you suspect someone is taking illicit drugs, a patient tensions during an examination, one of your colleagues smelled of alcohol. This so difficult colleagues or colleagues in difficulty is a common scenario.
And to deal with a drunk colleague, for instance, to start with this one because this is the commonest scenario is almost always patient, comes first. You cannot start this scenario without saying this buzzword. My first concern would be the safety of the patient. However, you have a duty of care towards your colleague himself and the hospital, too. So first, you have to talk to your consultant colleague and make sure they are supporting.
So that's what we call damage control. So if difficult, you have to enlist the help of another senior consultant, colleague or the clinical director. And then you have to make sure that you demonstrate that you care about patient safety by saying that you review all the patients that seen by him or her complete the word around. Recall all patients seen by your colleagues and that they ensure the appropriate cover is arranged for them if needed, because their colleague might be on call.
And that might be the next question. The other thing is actually under also. A common sense is a duty of care to your colleague himself. You should arrange for a taxi for them to go home, check on them later, ensure they reach home safely and then demonstrate that you have a long term plan and long sightedness or the vision you discuss with them and try to help you adjust referring them for occupational health.
And they said at all time that this behavior isn't appropriate. And finally, a duty of care to the hospital itself. The duty of care of hospital is just by keeping accurate records. What incident form and full and then duty to your colleague and the hospital, right? A difficult colleague. As I said, the first concern always in every of these ethical scenarios is patient safety.
That utmost importance. And then you have a duty of care to your colleague himself and the hospital. So can you see that now? Patient safety is discussed with your colleague. Make sure they arrive home safely. And all that stuff was discussed earlier and the recalled patients charged by your colleague ensure that appropriate cover is arranged whenever possible.
Second thing here in this slide your duty of care to your colleague arranging a way to go home, make sure they arrive home early. Insist that this behavior wasn't appropriate, and this is a buzzword that you should make sure you make your examiners hear and discuss with them and try to help and adjust referral to an occupational health for the hospital. Mainly, it's all about keeping accurate records and inform your consultant or clinical director about the incident and make sure it is following.
If your colleague is doing inappropriate behavior, generally speaking with a sexual health, sexual attitude, bad sexual attitude, the system, all this stuff. If you suspect problems from your colleagues, if you have contained of or concerns and you have to protect patients from risk of harm goes by another colleague, conduct performance or health, the safety of patients would confirm the safety of your colleagues comes first here in this scenario.
I also it's same importance. And then if you have concerns, there are always ways to report your concerns. So basically, you have to make sure you take these necessary few options. You have to make sure you report your concerns and your colleague and/or clinical director mainly or the medical director if there is a consultant involved.
You have to. You can also discuss your concerns with the National Clinical assessment service, which is which gives advice in regards to any concerns, and they give advice to employers, patients or others. And you can always report their concerns to the GMC. And then there are three main. Uh, aspects here first, the individual health and other factors related to the individual himself.
So this slide. I've summarized some of the topics that can be covered, so you have to make sure that your colleague is. This change in behavior is not due to a physical or mental illness. Maybe it is depressed or she's depressed, or it might be also alcohol. And if there is a major life event going on that have led to this inappropriate behavior and you know, having this guidance in your mind while dealing with all these concerns would always help.
Secondly, you should know you should. If you have concerns and knowledge or skills of behavior, then you have to dig deep. You there might be a deficiency in education or infection or problems with competence. All these questions, you should ask. Covering the three main aspects of good clinical practice for the GMC. Finally, it is the job is the changes in behavior related to work factors.
Is there a problem with technological advances, with work environments, with difficulties? Is there any major organizational changes to these are different points you can talk about if you're having concerns, if you are having a significant concern. So always one question you might be asked and I was asked that before. What is the significant concern?
Because the definition of a significant concern is mainly a concern and regard to behavior, health, attitude and knowledge that might affect patients or staff safety and should be reported. For example, if you're worried about poor clinical performance, if you're worried that your colleague is ill treating patients, if there is unacceptable behavior like harassment or discrimination, if there is other if he or she is reaching sexual or other patients on control.
If there is for a poor teamwork that compromise patient care if you have any other concerns like fraud or criminal offenses, offenses and that's actually, you know this, this is never exhaustive and there might be other areas that you can take any route. You can, you know, if you follow these principles, as I said here. So basically, you discuss individual health and other factors, knowledge, skills and behavior and the job, and you cover most of them and it's always patients comes first and as well in other scenarios, staff safety comes also first.
Another scenario is that you might have if you've been asked, how would you react if one of your female junior colleagues, if they one consultant and your registrar, refused to treat a patient because it's a known rapist and this is, you know, that's what I'm fighting here. So you should mention the word guidance. Basically, if you're carrying out a particular procedure or giving us advice about it and conflict with your religious or moral beliefs, this conflict might affect the treatment or advice you provide.
You should explain that to the patient and tells them that they have a right to see another doctor. So patient safety first. As usual, however, you must be satisfied that the patient has sufficient information to enable them to exercise that right. So if it's not practical for the patient to arrange for another doctor, you must ensure that these arrangements are made for another suitably qualified colleague to take over the role of your junior colleague.
Because all patients are entitled to care, either there are serial killers or rapists, they are all entitled to the same quality of care and treatment meetings. The clinical need. However, the staff have also rights. So if they are carrying a particular exercise that conflicting with the religious or moral beliefs, but at all times, patient safety will always come first.
If in this scenario, here also the other concern that she might refuse to treat the patient because medical, his medical or mental condition might put at risk if a patient pulls the rest to your colleague health or safety or yourself, you should take all available steps to minimize the risk before providing treatment or making suitable alternative arrangements for that treatment. So it's basically to summarize here, you should say the guidance is clear and it's published on the GMC website.
You should mention that this is a conflict. Conflict with the religious or moral beliefs should be respected. However, patient safety and care comes at the core of everything we do, and if there are any concerns or risks, then you can always make sure all available options and alternatives are in place. Another topic, which can be important as well is racism. So how would you react if a patient refused to be treated by you if one of your junior doctors because a foreigner?
So there is a protocol here, and there is a guidance here that, you know, just look at this slide. It's really important you first have to ensure that this patient behavior is not due to his or her underlying medical condition is that if something knot is said by someone with dementia, that's it. You have to kill. You have to continue treating them because the patient is not willful.
However, if the patient is willful, then you have to start with an informal Warning. Tell them that their behavior is not acceptable. If if the patient suggests, then you should give a formal Warning. And if the behavior is repetitive, then the patient should be removed from the premises by hospital security. So you should make sure the behavior is due to underlying medical condition, followed by informal Warning, then formal Warning and then removal from the premises.
However, and you always have, however, the care should not be harmful, and the responsible clinician should make sure that adequate arrangements for the transfer are in place. Most trusts have policies regarding dealing with violent, abusive or racist patients, and most trusts will display them everywhere. As you are aware and most trust in the NHS, if not all, have a zero tolerance policy towards abusive patients, and care may be withdrawn from persistent offenders.
But as such, but at all times, make sure you have arrangements for him or her to receive treatment appropriately. So another scenario here, you know, I'm just trying to go through all common scenarios that you might not find a good solution for elsewhere. If you have someone who there, you know you're working as a trauma consultant, Tom Cole, and you have someone who takes a lethal overdose.
Some of the bridge and coming with multiple trauma, and she leaves written instructions that. She doesn't want to be resuscitated or he so. How would how would you deal with her? So basically remember the four basic principles of medical ethics. This you can use the most of these scenarios. The principle of autonomy, which individual, which means that individuals have the right to be self-governing.
The principle of nonviolence since the patient should be on the principle of beneficence, the benefit of the patient should be promoted at all times and the principle of justice, which is equality and equal, should be considered equally in. You can cite this in most whenever possible in this scenario. So living wills or advanced directives are valid in the English law.
However, an advance directive must be written by a person who actually are competent and has the mental capacity. So if in this patient x, if she had psychotic depression, she wouldn't understand the consequences of her refusal of future treatment and then she should manage. Who is it? So in this scenario, you must have discussed with the psychiatrist as well to gain further guidance and define the dilemma if you can discuss it with a senior colleague or check trust protocol.
All these things you can say. So what about performance concerns and in regards to performance concerns like? Your consultants tell you something that you think is a consultant in the trauma in trauma meetings and decisions that you find inappropriate and lack of minimal competency or one of you constantly arrived late for work.
These are also performance concerns in these concerns. Don't assume that your consultant is wrong. Always discussed, or you could solve what is wrong. Discuss with them. Find why they make that decision. Why they find that decision interesting. And tells them that you would like to learn from the thinking behind that decision. If you're not satisfied, and that would be the next question from the examiner, then you suspect that less than perfect care has been provided.
You're duty bound to raise your concerns with your consultant. If you find it difficult, then discuss it with a clinical director or the medical director. If you have, if there is minor consent of minor performance concerns like a colleague arriving late or you find. That your colleague seems to be suffering from stress. All this can be done informally and you can discuss with them, listen to them, get their feedback and understand what is behind the poor performing doctor.
Someone whose competence, conduct or behavior pose a potential risk to the patient safety of the effective running of your clinical team, so a problem should be also addressed. Also remember the three main points we talked about is the individual himself. The job itself, the attitude problem or the knowledge, skills and attitude problem. So here you have to find a diagnosis is true.
Confirm the diagnosis. If it is your junior, then you have to make the correct observation. Have feedback from previous supervisors and then have an intervention by, you know, these are all things to diagnose and confirm the diagnosis and then do the intervention by communication of clear expectation, enhance teaching, arrange for care or mental support.
Reduce the clinical workload. And have more protected time for your colleagues. So there is no right answer for these scenarios. And also one good place to find more ethical considerations. If you're looking for one is actually the GMC website itself, because in the GMC website, you will find that the. You will find few clinical scenarios, and I think they are very helpful if you would like to know more about it.
The other important topics that we can discuss as well, I would like you to take a look on this few questions which would be content. And it's an important, important topic to discuss as well. Consent for four procedures you do. That's one important question that you can be asked and special with the current problems going on in the NHS consent thing is always an important topic that asks a lot.
So I would answer the first question by saying. Uh, that. I work in close partnership with my patients. I consider an important part of the process of discussion and decision making. I discuss with my patients the current situation. I answer all the questions. You know, you have to discuss other treatment options and the benefits may common uncommon and rare risks and share with them the detail of information as much as they want.
And then if there are complexity of proposed investigations on treatment, you should also discuss that. And always say the word GMC guidance, because that's a reference on which you're talking about, the second topic is always a second question. It's an important one as well. So what do you consider to be sufficient level of information for that patient? So initially, the laws are English.
Law has tended to regard the level of information required to be that acceptable to a reasonable body of medical opinion, and that's known as the polemicist. However, after the Montgomery case, and you should check this case, it's not up to me. And I think in Lancaster, the courts have said that they will depart from the approach of the amount of information that's acceptable to a reasonable body, to the amount of information they could find to be appropriate and that's appropriate for consent.
The legal age for consent, for surgical treatment 16 years and over in such cases. There is no legal requirement to obtain consent from the parent or guardian. Usually 16 to 18 is a gray area, but 16 is a legal age. However, if a child is under 16 and if the health professional feels they are capable of understanding the nature and possible consequences of the surgical procedure, you can still consent them.
However, legally, you should also discuss it with the parents and that also known as the plager ruling. And generally speaking, that's mainly was highlighted for contraception advice. Contraceptive advice. So what's the legal position of a child or parental refusal to treatment?
So according to the Fraser ruling, ali-frazier competent child cannot receive the treatment thought to be for his or her best benefit in England and Wales, and then parental consent will be needed. So if a child, if you think that a child, bas status, 16, receives the treatment you think it's in the best interest, then you should gain consent from their parents. It was mainly based on the MMR controversy.
And there is also one common scenario that you can find is about a kid who's like 14 years old, and he's happy to have lots of children who are the parents, and you have a witness who refused to give them blood transfusion and there are guidance on the Royal Society of Hematology is that you can check. So, Mohammad, you got you covered this. Extensively, and you can never cover everything to do with the ethical considerations and ethical scenarios and consent matters, it's quite varied and could be anything but.
As long as you understand the principles, we can come up with the sensible answer. And you you said that very nicely, say, you know, patient's hospital colleague, colleague, safety, patient safety and hospital. Also, always say GMC guidance, according to GMC guidance, for anything to be ethics or concerns related to ethical consent.
Can I say just add one comment regarding the Montgomery cases is quite complex. I looked at it, and the only thing I could get out of it, to be honest, is. Now, you know, is a consent should be patient specific, and by saying that, you know, if you have a patient, for example, you're offering a knee replacement to a patient. And a knee pain and inability to kneel is very important to a plumber, for example, and that's very important to another patient who doesn't kneel at all.
So I think that's an example of how the concern should be patient specific to the needs. So we need to. Now, after Montgomery ruling, we need to understand our patient's life and lifestyle and function very well, actually. So I was concerned, you know, this consenting dilemma. It's a common dilemma, and it is discussed in most meetings. You'll find a lower level meetings and upper level meetings, all these meetings.
So just stick to the principles in the exam. Just say you're aware of the Montgomery URL that you should give as much details as the patient would like to know, as you said, the peaceful consent for this particular problem. Listen to patients and understand their expectations, their aspirations. And then you can then give them the amount of information you want.
How much to summarize ethical considerations. As you said, patients come first. They GMC guidance your duty of care to police your duty of care to hospital, and that will cover to the hospital and that will cover everything. And then when you're discussing someone with problems, you should know and understand and find the diagnosis, confirms the diagnosis and set up an intervention to manage them and then discuss individual problems for this particular.
Police discuss, you know, understand the knowledge, skills, attitude, all of these things that matter and eventually know, understand the job and dig deep to get more about the shop. If you should say this, you know this broad title and you can talk as much as you want underneath them. And as I said, the GMC has some good ethical considerations. This what I am aware, has been asked in the exam before, but not conclusive, of course.
Yeah, Yeah. I mean, I agree with you, these topics have been asked all in the exam before and they commonly retested. I just want to say also, like when they put an ethical dilemma in front of you, always try to differentiate whether it's a major or a minor. One major one is the one that patient safety is affected.
Yeah, minor one is when the patient safety is not affected. Minor one is such as colleague is stressed out or colleague arriving late at work every day. These are concerns, but they are not major ones. So always show the examiners. They understand the patient safety ones are the major ones. Other ones are less major and can be dealt with later on once patients have been sorted.
And also in any ethical dilemma with when a colleague is involved, the first step always, always is talk to the colleague first. Don't jump the colleague and say all straight away. Call the GMC or call my character. Speak to the colleague first because you might be able to immediately help them. They might just not be aware of they are causing problems and always ask them, whatever the problem is, self referral to the occupational health department.
If they give them a chance to do it, if they don't self-refer themselves, if they're stressed out or whatever drinking problem and not offering themselves, that's when you raise it to the higher level. Basically, if a colleague, if you finding out a colleague is doing too many mistakes, what would you do? How would you approach that?
Is it making open muscular applications and no, no, this is also a performance problem to think about the individual health and other factors because they have physical or mental problems. Are they depressed suffering from another mental illness, substance misuse and then goes into the second aspect, which is knowledge, skills and behavior? And then finally, the changes in the job, and if you have serious concerns, you can discuss with others like medical director or the same personnel.
Also, you can actually quantify your concerns by other things of performance, making sure they are they have making sure they don't have an increased complication rate compared with their peers. And then if you have concerns, highlight this concerns. The next question if no one makes an action, then you can always contact the National Clinical assessment service. You can contact the GMC.
So you know, it's always about a hierarchy of things to do. So you always think about the same the individual, the knowledge, skills and behavior and then the job and then take it further. I think what can happen then that you report that issue to the clinical director and the clinical director tells you, OK, Mr emam, can you help us out and get this sorted? But what would you do if a colleague is, is underperforming, let's say, and they are asking you to formulate a plan?
So one one, one way of assessing that if you think your colleague is having an increased the infection rate after his are supposed to listen. So first, they should stop operating because patient safety comes first. That's one thing. So that's one thing should be an action we should have. They should stop whatever they are doing now. And that's usually the decision of the medical director or the clinical director, of course.
And then you do service evaluation, which is a quality improvement project by assessing actually, you know, like because you might have three infections in the last week and he never had he didn't have an infection for the last three years. So what is different is him or is the other is the cases is that problem is exclusive for him to now you do root cause analysis to make sure that actually he's the 1 to blame.
And if I'm worried about his performance. And I have evidence supporting my concerns, then that should be taken to the other level by doing a proper investigation and having a clinical incident and discussing that in the governance meetings. And then decisions should be taken on a higher level, not just meeting them, but also, as I said, with everything else. Patient safety comes first.
Thank you, ma'am. I think that's what I was getting at. Sorry, go ahead. I'm sorry. Yeah, I agree with everything you said, Mohammad. The next level, I would say, is. So the first thing is just to establish whether it is actually true or not. So information gathering exercise and that could be like an audit, so you can start by doing an audit of someone's practice with other people.
Next, find out the cause of it. It might be the consultant. It might be as registrar is junior, the scrub nurse, the theater who is operating in because some hospitals have specific data for specific surgeon. So again, find the root cause of the root cause and for the root cause analysis, while, as you said, protecting patients. So you could say I have a duty to the patient, as you said, which is the paramount, a duty to my colleague, duty to the trust and then a duty to myself by protecting my reputation and a duty for all doctors, by protecting their reputation as well.
By mentioning all these giving this plan, I think the discussion will take you where they want to take it. And I totally those of the land, you know, using all these buzzwords makes you a seven, at least. You know, it's simple. It's not. It's like, you know, and you know, we go to hospitals every day. It's a career for paying the bills, but you know, there are easier careers, but we mainly there for patient safety.
That's the thing. So I think, you know, you always have to highlight this buzzwords like root cause analysis, gathering information, make sure all the things are all precautions are in place. What who to blame, what's a problem and then investigate accordingly. Excellent I think that's what I was trying to highlight. My question?
Service evaluation. Don't always assume it's the colleague quote because it could be other causes for the complications, but because patient safety is paramount here, we have to do a root cause analysis to find out whatever the cause is and eliminate it. If the colleague, if a problem turns out to be a colleague, requires more training, then obviously he could be supervised by a senior colleague. could be mentored.
He could be offered educational courses and things like this. So always show you supporting your colleagues here, protecting patient safety, but also supporting your colleagues. If your colleagues require training in particular areas, we should be supportive to them. And that's also important to show in the exam and in real life that we would be examined. You know, our support for our colleagues, so don't always say or exclude my colleague can never be, you know, go home security, take.
Well, we will support a colleague unless, you know, you know, we leave any more drastic measurement as a last resort. So assessment of capacity is important. Thanks, Amjad. Assessment of capacity of the patient, whether it's elderly or a child. Yeah so the points were the points were whether, you know, if this is the capacity or this kind of dementia, is it related to the injury itself or whether it's something kind of well established?
So then the examiner would take you to which route that he is going to talk to you about? Thank you. Thank you. I think there was one more question to the mentors, Mohammad, if you could. Yeah, so, yeah, good bye. Let's huddersfield, what's my responsibility if my patient is found to be HIV positive and he or she refuses?
It is, you know, we are physicians who are bound by duty of confidentiality to our patients. But this is not absolute because confidentiality here is mainly at the center of maintaining trust and ensuring partnership. However, without causing harm to others. So in this case, yes, in every hospital, most of the hospital there is Jehovah witness liaison kind of committee, and they have this OK.
The issues here is the child is he. Is he Gillich competent or not? If the child is not clearly competent, but you need to highlight this for the examiners or that if the child is getting competent or if the child is not competent. So this is it's all about higher order thinking on your structure and your principles. So, you know, you are aware of the guidance and that's all it's about.
There's a legal responsibility for this person, and it's very fair to ask, who is the person who has guardianship? And that's, I think, the buzz word. Yeah who's the person who's legally the guardian? And if he is in between establishments moving from one family to the other, whatever, then you have the buzz word with the act in the best interest of the patient.
So these are the two buzzwords guardian and best interest. And actually, you know, if the guardian or the legal representative who can take consent, you deal with them as if they are parents. So and you always can, you can always contact the court or a legal representative if you have concerns. But it's all. Yeah, I think that the buzzword here there is.
And the third thing that if they want to give you a seven or eight, I don't know. There is an uncle court representative that you can contact any time of day or night, and they can issue a quick order within 24 hours to legalize whatever you want to do, as long if matters are really, really ambiguous. But then you have to speak to your colleague first clinical supervisor, site supervisor, whatever, and then they will contact that person in front of you on your behalf and you explain the situation and they can issue a court order allowing you to stop or start treatment based on the facts available in the absence of any person who can act as a guardian, for example, a traffic accident.
Both parents are dying to have died and the child is there. The child is there. Yeah, but you know, in this scenario, if you're an emergency situation for children and you know, you're worried the condition is deteriorating or the child might die, you start your treatment without any delay. That is, we cover this topic really very well and we appreciate it very much you.
You came forward to discuss this one because we haven't covered it. And as you heard, we don't cover it in teaching or find very little about it in books. It's one of weak points in our preparation for the FARC. So thank you very much for covering this. Yes, thank you. Thank you for us for moderating, and thank you, everyone, for your experience input in the important topic.
And as I said, you know, this is a topic that usually there is no right answer for. So if you have a format in your mind, you can easily do it. Thank you, mama, that's brilliant. Also, anyone who wants CPD certificate to attend it, I have a list of people who register. You could send me a message and let me know if you want the certificate.
So that's the end of the teaching. I hope you all learned like me and I've found it interesting. Now there will be a viable vibration. Now Dr. Abdullah is going to lead the Viva is using a new approach to help with the clinical component. He's got a very good idea, and I think we need to move forward in our teaching and implement and adopt new ideas all the time.
Form Title Download
Transcript
Form Title Bookmark
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Share
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Accessibility and Keyboard Shortcuts
The cadmore media player is a professional video and audio player experience designed to deliver media as well as relevant transcript, segmentation, and metadata. On the screen is a traditional html video player with buttons such as play, pause, forward, captioning, language and play speed selection and more. Adjacent to the video player are generally tabs, one of which shows a scrolling transcript of the video and the other shows any segmentation of the media, sometimes referred to as chapters. At the top of the video is a menu bar containing an Explore button and Tools button. The Explore button allows you to dig deeper into the video by opening up an explore dialog which contains tabs for a visual navigation of the video using thumbnails, an about tab which contains rich metadata about the media, a segments tab which contains further information about the video, and a related tab which contains links to other media related to this media. The tools button opens a menu with options for sharing the media on social media, creating bookmarking links, creating embed codes for your website, generating citations, and more.
Keyboard Shortcuts
Keyboard shortcuts only work while you are in forms mode. By entering forms mode, you will be able to quickly access portions of the media player with single key commands.
Spacebar: Play/Pause Toggle
I: Info Menu,
O: Tools Menu
T: Transcript Tab,
S: Segments Tab
F: Forward 15,
R: Rewind 15
L: Languages,
P: Playspeed
M: Mute Toggle,
V: Volume Bar
N: Video Only Toggle,
B: Full Screen Toggle
C: Captions Toggle
Escape: Closes dialogs and menus / Exits Player
Z: Next Transcript Chapter
X: Previous Transcript Chapter
Q: Next Transcript Paragraph
W: Previous Transcript Paragraph
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Embed Size
-
You Size - Responsive
-
We Size - Responsive
-
Picture Overlay Popup
-
400 x 225
-
512 x 288
-
400 x 700
-
768 x 1024
-
1024 x 512
-
1280 x 608
Form Title Cite
No citation provided.
Info
Segments
Related
Thumbnails
Exit Clip Mode
You have requested to see a portion of the video outside of the clip.
Click OK to switch to the full video or click if you would like to stay inside the clip. You can always go back to the clip with Tools and Clip Mode