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:

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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