52 Questions
What must a doctor establish before prescribing medicines from a distance?
The patient's current medical conditions and history
Why should doctors think carefully about prescribing via email or telephone?
It could seriously compromise the standard of care provided to patients
What should be documented in a patient's notes regarding end-of-life decisions?
Any decision to withhold or withdraw life-prolonging treatment and why
What should doctors consider before complying with requests to prescribe drugs for relatives in another country?
The possibility of liability arising and seek information from the patient's own doctor
What is an essential responsibility of doctors when prescribing from a distance?
Ensuring there is sufficient justification to prescribe the medicines or treatment proposed
Why is it important for doctors to make a clear, accurate, and legible record of all medicines prescribed?
To ensure transparency, accountability, and safe medical practice
What should be done prior to withdrawing or withholding treatment, nutrition, and hydration?
A senior clinician should talk to the patient
Why does palliative care offer relief from pain and distressing symptoms?
Because it focuses on improving quality of life for patients with incurable conditions
What are the risks associated with prescribing in cases where the patient is unknown to the doctor?
Serious safety risks due to lack of opportunity for examination and limited monitoring/follow-up arrangements
What is the responsibility of doctors when prescribing unlicensed medicines?
They take on greater responsibilities
When should oral nutrition and hydration be maintained for patients?
As long as the patient is able to tolerate it
What is the responsibility of doctors when signing a prescription?
Accept clinical and legal responsibility
What should doctors consider when prescribing medication?
Sufficient knowledge and experience
When should doctors prescribe sufficient drugs for discharged patients?
For at least a 7-day period for inpatients and a 14-day period for outpatients.
What is the responsibility of doctors regarding off-label prescriptions?
Should not prescribe off-label without full agreement between transferring doctors and GPs.
When can doctors prescribe lifestyle drugs?
When clinically appropriate and the benefits outweigh the risks.
What happens to decisions for incapacitated patients?
Decisions are made based on their best interests or what would benefit them.
What happens when doctors prescribe unfamiliar drugs?
Should avoid prescribing unfamiliar drugs without full agreement between transferring doctors and GPs.
What is an important aspect of end-of-life care according to the text?
Affording patients dignity and privacy
What is emphasized about communication in end-of-life care?
Compassion, sensitivity, and honest communication are essential
When should difficult decisions to withhold or withdraw life-prolonging treatment arise?
If treatment can no longer provide sustained benefit to the patient
What does advance care planning indicate according to the text?
Whether treatment should be withheld or withdrawn
What is vital in providing effective end-of-life care?
Effective communication within the health team
What should health professionals be sensitive to according to the text?
Patients' cultural and religious backgrounds
What is important in helping people close to dying patients come to terms with the situation?
Care provided to dying patients includes helping people close to them come to terms with the situation.
What should be recognized in end-of-life care according to the text?
It is important to recognize when death is approaching and help people prepare for it.
What must be clearly communicated regarding withholding life-prolonging treatment?
Reasons for not providing life-prolonging treatment must be clearly communicated.
What should patients maintain control over according to the text?
Patients should maintain control over as many aspects of their care as possible, including by advance planning if they wish.
Prescribing from a distance can seriously compromise the standard of care provided to patients.
True
Doctors are obliged to comply with requests from patients to prescribe drugs for relatives in another country.
False
Palliative care provides support only for the patient, not the family.
False
Doctors should document any decision to withhold or withdraw life-prolonging treatment in the patient's notes.
True
Doctors are not required to establish the patient's current medical conditions before prescribing from a distance.
False
Prescribing by email or over the telephone does not pose any serious safety risks.
False
Doctors must ensure that there is sufficient justification to prescribe the medicines or treatment proposed and discuss other treatment options with the patient where appropriate.
True
Prior to withdrawing or withholding treatment, nutrition and hydration, a senior clinician should talk to the patient.
True
True or false: Patients should not be afforded dignity and privacy at the end of life?
False
True or false: Advance care planning may not indicate whether treatment should be withheld or withdrawn?
False
True or false: Health professionals should not be sensitive to patients' cultural and religious backgrounds in end-of-life care?
False
True or false: Withholding treatment, nutrition, and hydration should not involve difficult decisions for health professionals?
False
Patients have the right to refuse treatment, and treatment can be provided against their valid refusal.
False
Decisions for incapacitated patients are made based on their best interests or what would benefit them.
True
Oral nutrition and hydration should be maintained as long as the patient is able to tolerate it, but can be forced on unwilling or refusing patients.
False
Dying patients should be given opportunities to discuss where they want to die and plan aspects of their care.
True
Advance decisions made by patients to refuse some forms of active treatment can be overruled if they retain mental capacity.
False
Doctors accept clinical and legal responsibility when they sign a prescription.
True
Doctors should only prescribe medication if they have sufficient knowledge and experience, and should avoid conflicts of interest.
True
Doctors can prescribe unlicensed medicines, but take on greater responsibilities when doing so.
True
Legal responsibility for prescribing rests with the doctor who signs the prescription, but responsibilities may be shared between hospital consultants and GPs.
True
Sufficient drugs should be prescribed and dispensed when a patient is discharged from hospital to last for at least a 7-day period for inpatients and a 14-day period for outpatients.
True
Doctors should not prescribe off-label or prescribe unfamiliar drugs without full agreement between transferring doctors and GPs.
True
Doctors have an ethical duty to use the most economic and efficacious treatment available within the NHS and should not prescribe larger doses or issue prescriptions without clinical review.
True
Study Notes
-
Patients have the right to refuse treatment, and treatment cannot be provided against their valid refusal.
-
Decisions for incapacitated patients are made based on their best interests or what would benefit them.
-
Oral nutrition and hydration should be maintained as long as the patient is able to tolerate it, but cannot be forced on unwilling or refusing patients.
-
Dying patients should be given opportunities to discuss where they want to die and plan aspects of their care.
-
Advance decisions made by patients to refuse some forms of active treatment can be overruled if they retain mental capacity.
-
Doctors accept clinical and legal responsibility when they sign a prescription.
-
Doctors should only prescribe medication if they have sufficient knowledge and experience, and should avoid conflicts of interest.
-
Doctors can prescribe unlicensed medicines, but take on greater responsibilities when doing so.
-
Legal responsibility for prescribing rests with the doctor who signs the prescription, but responsibilities may be shared between hospital consultants and GPs.
-
Sufficient drugs should be prescribed and dispensed when a patient is discharged from hospital to last for at least a 7-day period for inpatients and a 14-day period for outpatients.
-
Doctors should not prescribe off-label or prescribe unfamiliar drugs without full agreement between transferring doctors and GPs.
-
Doctors have an ethical duty to use the most economic and efficacious treatment available within the NHS and should not prescribe larger doses or issue prescriptions without clinical review.
-
Doctors should not prescribe lifestyle drugs unless clinically appropriate and the benefits outweigh the risks.
-
Patients have the right to refuse treatment, and treatment cannot be provided against their valid refusal.
-
Decisions for incapacitated patients are made based on their best interests or what would benefit them.
-
Oral nutrition and hydration should be maintained as long as the patient is able to tolerate it, but cannot be forced on unwilling or refusing patients.
-
Dying patients should be given opportunities to discuss where they want to die and plan aspects of their care.
-
Advance decisions made by patients to refuse some forms of active treatment can be overruled if they retain mental capacity.
-
Doctors accept clinical and legal responsibility when they sign a prescription.
-
Doctors should only prescribe medication if they have sufficient knowledge and experience, and should avoid conflicts of interest.
-
Doctors can prescribe unlicensed medicines, but take on greater responsibilities when doing so.
-
Legal responsibility for prescribing rests with the doctor who signs the prescription, but responsibilities may be shared between hospital consultants and GPs.
-
Sufficient drugs should be prescribed and dispensed when a patient is discharged from hospital to last for at least a 7-day period for inpatients and a 14-day period for outpatients.
-
Doctors should not prescribe off-label or prescribe unfamiliar drugs without full agreement between transferring doctors and GPs.
-
Doctors have an ethical duty to use the most economic and efficacious treatment available within the NHS and should not prescribe larger doses or issue prescriptions without clinical review.
-
Doctors should not prescribe lifestyle drugs unless clinically appropriate and the benefits outweigh the risks.
Learn about the goals and principles of providing care to patients at the end of life, including maintaining dignity, respecting privacy, honoring cultural and religious backgrounds, and supporting advance planning.
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