Answer:

Do not confuse Ethics with Professionalism; they are 2 separate things.

ETHICS:

The two very important things in this station are, understanding the basic concepts and paraphrasing answers using CORRECT words.

The basic themes covered are;

Consent

Capacity

Confidentiality

Complaints

Abuse

Consent, Capacity and Confidentiality (This covers major chunk of the ethical station and the most commonly asked questions as well)

Whenever a question is asked always to think;

Does my patient have capacity or not? (That is what you do in real life as well)

There will be many distractors in the question that will try to mislead you from this. So be careful.

The questions can be phrased as;

  1. Daughter shouting on nurses and want to speak to you now! Go and calm her down
  2. Son is very upset and wants an update
  3. Take a consent from the family about a procedure
  4. Wife called you on the phone for an update
  5. Son is a consultant whose dad is admitted and called you to know more about him
  6. Patient is very upset and try to leave the ward

Always question yourself in the station, do they (judges) want me to assess capacity here.

Know since you reached this point and have made up your mind that they want to talk about capacity, proceed like this;

“I will approach the ward, understand the situation and take an update from the nurses about what is going on. I will calm the family down and without giving any information will see the patient first to gain his consent. I will do so by talking to the patient and evaluate if he can understand me, weigh up the information and retain it to reach a decisive conclusion. These are basic principles of Mental Capacity Act” – You are literally supposed to say all of this to give them clear idea about your understanding of the capacity, how it is evaluated, and it is part of which act.

Now after this you will establish either your patient is capacitated or not and you will continue your answer accordingly.

  1. If your patient is CAPACITATED, then it is simple. It is his decision whether he allows you or not to speak to somebody else. If he allows, always prefer to speak in his presence.
  1. If your patient is INCAPACITATED, then you need to know the next steps and how to proceed;

First of all state that “I will always assume my patient has capacity unless evaluated declared as per the principles of mental capacity act”

The principles of MCA are;

  1. Assume a person has the capacity to make decision unless proven otherwise
  2. Help them make their own decisions
  3. Accept the decision even how unwise it is
  4. Always make decision in their best interest
  5. Treatment provided should be the least restrictive option

Now you must note down that first 3 principles are for capacitated person and last 2 for incapacitated person, some judges love to ask this question and the above 5 principles. Know them by heart.

If by this moment you have established that your patient lacks capacity then ask the following questions to yourself and paraphrase as such if asked in the interview station;

  1. Is capacity likely to improve or fluctuate
  2. Can decision be delayed till the capacity returns
  3. If not then do the patient has an advanced directive in place regarding his/her treatment
  4. If not then IMCA should be appointed

At this point judges might ask you what is IMCA;

IMCA stands for Independent Mental Capacity Advocate, he or she is the person who then hold the power to make decisions on behalf of the patient

If the treatment is urgent and cannot wait for all of the above paperwork to happen then of course you will make decision in the best interest of the patient after discussing with the team around you.

Always close your answer by saying; I will do all my decisions keeping in my mind the 4 basic principles of ethics and they are;

  1. Autonomy
  2. Justice
  3. Beneficence
  4. Non-maleficence

Please go through the link here:

https://www.nhs.uk/conditions/social-care-and-support-guide/making-decisions-for-someone-else/mental-capacity-act/

https://www.nhs.uk/conditions/consent-to-treatment/capacity/

PROFESSIONALISM:

The major topics covered under the context of professionalism are

Documentation (Probity)

Social networking

Complaining/Escalation

Remember that professionalism is focused on how you deal with your colleagues and not the patients.

Ethics Questions:

Answer:

I will go to the ward and speak to the nurses trying to understand what is going on and why the son is unhappy. After understanding the situation, I would like to speak to my patient first and see if he is alright. While speaking to him, I would like to gain his consent explaining him that his son would like to speak to me about his condition. If he gives me permission, only then will I have a conversation about him with his son. While having the conversation, I will also judge if he understands what I am saying , able to retain as well as weigh up the information given to make a decision. This will confirm that the gentleman has capacity.

Now I understand from the scenario that he is an elderly gentleman on palliative chemotherapy for lung cancer but currently admitted with pneumonia and can consent in his full capacity. If I have permission from the patient, I would like to speak to the son in a quiet room and I will hand over the bleep to my colleague in the meantime. I would also like to be accompanied by senior nursing staff as well. I will ask the son about his queries and answer them accordingly.

 At this point judge tells you; Son is terribly upset that my dad is left to die and would prefer him to be taken home, how are you going to proceed.

I will show empathy and will explain that I do understand his condition is palliative but currently he is on treatment for pneumonia which can be improved with antibiotics and that is the reason we are keeping him in the hospital. I would prefer him to stay so we can understand his progress by following up his blood investigations. Once he is showing us signs of improvement, we will be able to discharge him home safely.

 Judge tells you that son is still insistent to take him, then what are you going to do about it?

I will reiterate nicely what I would prefer, however if he still insists then I must say that this decision lies with his father since he is fully capacitated and if he insists to go home then only can I make further decisions.

 Judge says that father want to leave as well, how are you going to proceed then?

In that situation, I know it is an unwise decision, but I will respect it following the principles of MCA and let him leave after signing the discharge against medical advice form and discussing that with my senior. I will make sure he goes home with complete course of his antibiotics and other medications. Also, I will request his GP to follow up his blood investigations in community as well.

 

Key points: Consent taken, Capacity (quick assessment), MCA principles (unwise decision)

Professionalism Questions:

Answer:

The first step that I will do is immediately call/get in touch with the theatre and let them know that the wrong patient has been transferred to them and hence to abort the procedure. I will apologise for this mistake and let them know that I would investigate this further to know the reason. I will also then rebook the correct patient for the procedure.

I will approach the patient who has been transferred and apologise to him for the discomfort. I will make an enquiry into what has happened and why the wrong patient has been transferred. I will also update my nursing colleagues and the nurse in charge. I would have to datix this incident and I will make sure that I complete the duty of candour to my both patients.

Key points: Patient safety concern, Datix, Duty of candour

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