Podcast
Questions and Answers
A doctor discovers they made a significant error during a surgical procedure, but the patient is currently stable. What would constitute the most ethically complex action in this situation, considering the principles of honesty and open disclosure?
A doctor discovers they made a significant error during a surgical procedure, but the patient is currently stable. What would constitute the most ethically complex action in this situation, considering the principles of honesty and open disclosure?
- Immediately informing the patient and the healthcare facility of the error, initiating a transparent review process. (correct)
- Carefully documenting the incident in the patient's file while avoiding direct communication unless complications arise.
- Consulting with senior colleagues first to determine the best course of action, potentially delaying immediate disclosure.
- Deferring the disclosure until the patient is discharged to avoid causing undue stress.
In the context of medical practice, what is the most critical element that distinguishes 'honesty' from 'open disclosure'?
In the context of medical practice, what is the most critical element that distinguishes 'honesty' from 'open disclosure'?
- Honesty involves conveying facts, while open disclosure includes empathy and support.
- Honesty is about admitting errors, while open disclosure focuses on preventing future incidents.
- Honesty is required by law, while open disclosure is a voluntary commitment.
- Honesty is a personal attribute, while open disclosure is a systematic organizational process. (correct)
How does the concept of a 'social contract' relate to medical professionalism and public trust?
How does the concept of a 'social contract' relate to medical professionalism and public trust?
- It explains expectations that healthcare professionals will adhere to ethical standards in exchange for public trust and autonomy. (correct)
- It outlines the legal obligations of healthcare organizations to provide care.
- It defines the boundaries of acceptable medical interventions in society.
- It details the financial agreements between healthcare providers and patients.
In a healthcare setting, what is the most ethically challenging aspect of maintaining patient confidentiality when using digital communication?
In a healthcare setting, what is the most ethically challenging aspect of maintaining patient confidentiality when using digital communication?
When is a healthcare professional ethically obligated to breach patient confidentiality?
When is a healthcare professional ethically obligated to breach patient confidentiality?
What is the most ethically significant outcome of implementing a 'Duty of Candour' in healthcare organizations?
What is the most ethically significant outcome of implementing a 'Duty of Candour' in healthcare organizations?
Which circumstance most appropriately illustrates the concept of 'moral courage' in raising concerns within a healthcare setting?
Which circumstance most appropriately illustrates the concept of 'moral courage' in raising concerns within a healthcare setting?
What is the most complex challenge in applying the principle of 'patient-centered care' to patients with significantly varying cultural beliefs?
What is the most complex challenge in applying the principle of 'patient-centered care' to patients with significantly varying cultural beliefs?
What is the most significant ethical consideration when health professionals use social media?
What is the most significant ethical consideration when health professionals use social media?
When reflecting by using a 'What, So What, Now What' framework, which stage involves the most critical evaluation of personal ethics and values.
When reflecting by using a 'What, So What, Now What' framework, which stage involves the most critical evaluation of personal ethics and values.
How can medical professionals show integrity in their day to day practice?
How can medical professionals show integrity in their day to day practice?
What is a professional way for a medical leader to demonstrate accountability to their team?
What is a professional way for a medical leader to demonstrate accountability to their team?
What are the key components in the professional duty of candour?
What are the key components in the professional duty of candour?
What does it mean for medical staff to act as advocates for their patients?
What does it mean for medical staff to act as advocates for their patients?
When raising concerns, what is the most critical factor in assessing and acting professionally?
When raising concerns, what is the most critical factor in assessing and acting professionally?
There has been reasonable grounds to suspect neglect of a non-verbal child, what actions need to occur?
There has been reasonable grounds to suspect neglect of a non-verbal child, what actions need to occur?
What is a protected disclosure?
What is a protected disclosure?
What are the key areas that you can raise a concern policy about?
What are the key areas that you can raise a concern policy about?
Of the list, which is the best example that demonstrates compassion, integrity and respect for others?
Of the list, which is the best example that demonstrates compassion, integrity and respect for others?
What are the core lessons from past scandals such as Harold Shipman or the CervicalCheck Scandal?
What are the core lessons from past scandals such as Harold Shipman or the CervicalCheck Scandal?
What is the most far-reaching implication from Robert Francis' Report (2013) after the Mid Staffordshire NHS Foundation Trust Public Inquiry?
What is the most far-reaching implication from Robert Francis' Report (2013) after the Mid Staffordshire NHS Foundation Trust Public Inquiry?
If there has been an unintended event with a patient that has caused moderate or severe harm, what should a staff member do in line with the 2014 UK Duty of Candour?
If there has been an unintended event with a patient that has caused moderate or severe harm, what should a staff member do in line with the 2014 UK Duty of Candour?
Following The Patient Safety Accident relating to Civil Liability, what will an open discussion result in?
Following The Patient Safety Accident relating to Civil Liability, what will an open discussion result in?
Under the HSE Open Disclosure Policy 2021, what method will communication occur?
Under the HSE Open Disclosure Policy 2021, what method will communication occur?
The ASSIST model of communication can help aid disclosure, what do the components concern?
The ASSIST model of communication can help aid disclosure, what do the components concern?
After incidents of a patient safety nature - staff require a safe space, what does 'ASSIST ME' stand for?
After incidents of a patient safety nature - staff require a safe space, what does 'ASSIST ME' stand for?
What was the main problem that was identified in the Andrew Wakefield scandal?
What was the main problem that was identified in the Andrew Wakefield scandal?
There are often many different problems that lead to scandals, what was the triggering problem in the CervicalCheck Scandal?
There are often many different problems that lead to scandals, what was the triggering problem in the CervicalCheck Scandal?
What are the most consistent traits of incidents caused by Harold Shipman?
What are the most consistent traits of incidents caused by Harold Shipman?
What traits are most important for demonstrating professional values in medicine and healthcare to the team and patients?
What traits are most important for demonstrating professional values in medicine and healthcare to the team and patients?
A patient has an accident that causes the professional team to feel stressed and shocked, what acronym helps in staff support?
A patient has an accident that causes the professional team to feel stressed and shocked, what acronym helps in staff support?
What is one action that a team lead does not need to do the next time there has been a high level incident?
What is one action that a team lead does not need to do the next time there has been a high level incident?
If errors have occurred what MUST the next practice be from then?
If errors have occurred what MUST the next practice be from then?
What is the most consistent trait that should be provided during an incident of neglect in medical health?
What is the most consistent trait that should be provided during an incident of neglect in medical health?
What are the 'social media risks' in online communications?
What are the 'social media risks' in online communications?
What paradigm shift does the University of Michigan Health System's adoption of a full disclosure policy exemplify in managing medical errors?
What paradigm shift does the University of Michigan Health System's adoption of a full disclosure policy exemplify in managing medical errors?
In complex healthcare settings, what constitutes the most challenging aspect of applying the principle of open disclosure?
In complex healthcare settings, what constitutes the most challenging aspect of applying the principle of open disclosure?
What key element distinguishes 'accountability' from other professional values in healthcare settings?
What key element distinguishes 'accountability' from other professional values in healthcare settings?
When addressing patient safety concerns, what is the most critical initial step a healthcare professional should take?
When addressing patient safety concerns, what is the most critical initial step a healthcare professional should take?
According to the Medical Council of Ireland (IMC), what is the fundamental role of doctors that establishes a 'privileged position of trust' in society?
According to the Medical Council of Ireland (IMC), what is the fundamental role of doctors that establishes a 'privileged position of trust' in society?
Which principle is most crucial in fostering public trust in medical professionals?
Which principle is most crucial in fostering public trust in medical professionals?
Within the context of online medical communications, what aspect poses the greatest challenge to maintaining medical professionalism?
Within the context of online medical communications, what aspect poses the greatest challenge to maintaining medical professionalism?
What organizational attribute is most likely to foster an environment of candour and honesty?
What organizational attribute is most likely to foster an environment of candour and honesty?
In light of past medical scandals, what proactive measure can healthcare organizations take to prevent similar occurrences and foster a culture of integrity?
In light of past medical scandals, what proactive measure can healthcare organizations take to prevent similar occurrences and foster a culture of integrity?
What long-term strategy would most effectively promote patient-centered care?
What long-term strategy would most effectively promote patient-centered care?
When a healthcare professional is faced with a situation that could compromise patient safety, ethical guidelines suggest prioritizing which course of action?
When a healthcare professional is faced with a situation that could compromise patient safety, ethical guidelines suggest prioritizing which course of action?
What action would be most in line with duty of candour following a severe iatrogenic injury?
What action would be most in line with duty of candour following a severe iatrogenic injury?
To support staff after any patient safety incident, which of the following components of 'ASSIST ME' is described incorrectly?
To support staff after any patient safety incident, which of the following components of 'ASSIST ME' is described incorrectly?
Which attribute was not a trait of Harold Shipman?
Which attribute was not a trait of Harold Shipman?
Which of the following events was responsible for a mandatory 'Open Disclosure' policy?
Which of the following events was responsible for a mandatory 'Open Disclosure' policy?
To help communicate with patients following any Patient Safety Incidents, what does the 'TRAVEL' component entail when using the ASSIST model of communication?
To help communicate with patients following any Patient Safety Incidents, what does the 'TRAVEL' component entail when using the ASSIST model of communication?
Why was the MMR Wakefield paper so damning?
Why was the MMR Wakefield paper so damning?
What do the GMC and Medical regulated bodies suggest when there has been a professional duty of candour?
What do the GMC and Medical regulated bodies suggest when there has been a professional duty of candour?
A doctor is approached by a journalist regarding a recently published medical study. What should the doctor do to maintain professional standards and public trust?
A doctor is approached by a journalist regarding a recently published medical study. What should the doctor do to maintain professional standards and public trust?
A hospital implements a new policy requiring staff to report all errors, including near misses. What would occur because of this measure?
A hospital implements a new policy requiring staff to report all errors, including near misses. What would occur because of this measure?
An elderly patient scheduled for hip replacement surgery expresses concern that they are worried and that there has been 'too much on the news' about errors in the hospital. Which of the following reactions most appropriately integrates empathy, honesty and open disclosure?
An elderly patient scheduled for hip replacement surgery expresses concern that they are worried and that there has been 'too much on the news' about errors in the hospital. Which of the following reactions most appropriately integrates empathy, honesty and open disclosure?
If a colleague suspects fraud what should they do?
If a colleague suspects fraud what should they do?
If a staff member makes a protected disclosure, can it be penalised?
If a staff member makes a protected disclosure, can it be penalised?
Why were the actions of Sir Liam Donaldson and the WHO so important?
Why were the actions of Sir Liam Donaldson and the WHO so important?
An experienced surgeon consistently dismisses feedback from junior colleagues regarding potential improvements to surgical techniques. What core value is most obviously lacking?
An experienced surgeon consistently dismisses feedback from junior colleagues regarding potential improvements to surgical techniques. What core value is most obviously lacking?
An attending physician discovers that a patient's research data has been falsified to show more promising results. What duty overrides all others?
An attending physician discovers that a patient's research data has been falsified to show more promising results. What duty overrides all others?
A medical device malfunctions during a critical operation. To whom is accountability most directly owed?
A medical device malfunctions during a critical operation. To whom is accountability most directly owed?
What conditions are required to be aware of in the Protection of Children and Vulnerable process?
What conditions are required to be aware of in the Protection of Children and Vulnerable process?
What measures support public trust in medical staff?
What measures support public trust in medical staff?
Flashcards
Medical Professionalism
Medical Professionalism
Values, behaviours, and attitudes promoting professional relationships, public trust, and patient safety.
Primacy of patient welfare
Primacy of patient welfare
The principle focusing on altruism, trust, and prioritizing the patient's best interests.
Patient autonomy
Patient autonomy
Incorporates honesty with patients, educating and empowering them to make informed medical decisions.
Social justice
Social justice
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RCP definition of Professionalism
RCP definition of Professionalism
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Values for Doctors
Values for Doctors
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Professionalism (IMC)
Professionalism (IMC)
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Pillars of Professionalism
Pillars of Professionalism
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The Medical Council
The Medical Council
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Trust (in medicine)
Trust (in medicine)
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Professional Boundaries
Professional Boundaries
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Maintaining Public Trust
Maintaining Public Trust
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Patient Confidentiality
Patient Confidentiality
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Open Disclosure (IMC)
Open Disclosure (IMC)
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Raising concerns (IMC)
Raising concerns (IMC)
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Patient-Centred Care
Patient-Centred Care
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Medical Professionalism
Medical Professionalism
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Accountability
Accountability
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Professional Duty of Candour
Professional Duty of Candour
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Advocacy
Advocacy
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Reporting concerns
Reporting concerns
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Child Protection & Vulnerable Adults
Child Protection & Vulnerable Adults
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Study Notes
- Y2 DEM workshop covering Professionalism
- Includes topics such as honesty, trust, and open disclosure
Learning Objectives
- Define honesty and truth-telling
- Define candor and open disclosure
- Discuss advocacy and raising concerns
- Discuss learning from public inquiries, such as the CervicalCheck Scandal
- Apply knowledge of honesty and open disclosure to common clinical scenarios
Workshop Plan
- Starts with an honesty exercise
- Followed by definitions of honesty, trust, and open disclosure
- Then a discussion on reflection
- Including what, so what, now what?
- Small group work and then debrief on lessons learned
Honesty Exercise
- Yamagashi and Yamagashi's General Trust Scale was developed in 1994
- A person's responses to the questions are averaged to produce a general score (between 1 and 5)
- Statements include:
- Most people are basically honest
- Most people are trustworthy
- Most people are basically good and kind
- Most people are trustful of others
- I am trustful
- Most people will respond in kind when they are trusted by others
Medical Professionalism at RCSI
- Medical professionalism involves the values, behaviors, and attitudes that promote professional relationships, public trust, and patient safety
- Key components include:
- Patient-centered service
- Self-care
- Compassion
- Communication
- Integrity and honesty
- Advocacy
- Cultural sensitivity
- Evidence-based practice
- Reflective practice and continuous improvement
- Working in partnership
- Ethical practice
- Altruism
- Real-life application involves patient-centered care and self-care
American Board Internal Medicine Foundation: Physician Charter
- Patient welfare relates to altruism, trust and patient-interest
- Patient autonomy means giving honesty and empowering patients to make medical decisions
- Social justice relates to considering available resources and patient needs
Royal College of Physicians (UK) definition of professionalism
- Signifies a set of values, behaviors and relationships that underpins the trust the public has in doctors
- Six commitments (values) for doctors:
- Integrity
- Compassion
- Altruism
- Continuous improvement
- Excellence
- Working in partnership
Professionalism according to the Irish Medical Council
- Professionalism is at the core of the patient-doctor relationship
- It is crucial for patient safety and healthcare delivery
- Good professional practice relies on a shared understanding between healthcare professionals and the public
- This includes values that underpin good care
- The three pillars: partnership, practice, and performance
Medical Council of Ireland (IMC) and Trust
- The Medical Council safeguards the public by setting high standards for doctors
- Doctors hold a "privileged position of trust"
- This requires applying skills, knowledge, and high ethical standards
Good Medical Practice (IMC)
- Intended for patient safety and quality of Care
- Eight domains include:
- Professionalism
- Clinical Skills
- Communication & Interpersonal Skills
- Collaboration & Teamwork
- Management (including Self-Management)
- Scholarship
- relating to patients
Professionalism and Trust responsibilities for Doctors
- Doctors must maintain professional boundaries.
- Patients trust doctors to act solely for their well-being
- Doctors must not engage in sexual or improper relationships with patients
Professionalism and Communication responsibilities for Doctors
- Doctors must maintain public trust by applying professional standards and ethical principles
- This must be done in all communications, including online to protect confidentiality and privacy
- Doctors must also respect all persons
- Doctors should consider the impact of comments on patients and public
Online Communication risks for Doctors
- Unprofessionalism
- Misinformation
- Confidentiality breaches
- Privacy breaches
Confidentiality responsibilities for Doctors
- Central to doctor-patient relationship
- Doctors have duty to maintain patient confidentiality, but it's not absolute
- Required if disclosing info for patient care or by law
Open Disclosure responsibilities for Doctors
- Involves being open, honest, compassionate, consistent, and timely
- Healthcare must acknowledge what has happened
- Express regret, keeps patients informed
- Provide reassurance, learn from the event, and prevent recurrence
- Important legislation includes the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023
Raising Concerns
- Doctors must raise concerns if patient safety is compromised
- Raise concerns if systems, policies, or colleagues' practices cause you to believe harm is being done
- Seek advice from colleagues or medical indemnity organization
- Escalate if issues aren'r resolved internally
Patient-Centered Care, and aspects of Doctoring
- Care is respectful and responsive to individual patient preferences, needs, and values
- Patient values must guide all clinical decisions
- Includes elements such as
- Professionalism
- Caring
- Excellent care
- Good Communication
Public Trust requires
- Trust between doctors and their patients
- Trust between doctors and their colleagues
- Trust between the profession and society
- Trust comes from integrity and honesty
Top 5 Most Important Characteristics of a Doctor
- Honesty
- Integrity
- Respecting patients confidentiality and privacy
- Behaving in a reliable and dependable way
- Acting in a responsible fashion toward patients
- Treating patients fairly and without prejudice
Integrity
- An unimpaired moral state, freedom from corruption
- Doing the right this even when nobody is watching
Accountability
- Comprises both reliability and answering to those who trust
- Accountability equals to professionalism
Candour and Honesty
- Involves being open and honest
- Healthcare professionals disclose and apologize when care causes harm or distress
- Offer remedy or support and explain short and long-term effects
Advocacy
- Health and social care staff must empower people to communicate their needs
- Protect their human rights
- Staff should help people access services to support
- Ensure person-centered care with any decision-making
Raising concerns
- Doctors have an ethical obligation to raise alarm
- They should do this when patients are harmed or could be harmed.
- Inform appropriate person or authority
- First, approach clinical or medical director and if not appropriately investigated, escalate concerns
Protecting children and vulerable persons
- Doctors should follow reporting guidelines for suspected abuse or neglect
- Reporting is a justifiable breach of confidentiality in the public interest
Whistleblowing definition and components
- A doctor can make a protected disclosure
- Under the 'The Health Act 2007' with reasonable belief
- Components:
- Patient's health or welfare is likely to be at risk
- Actions pose a risk to someone's health or welfare
- The person or body has failed or may fail in their legal obligations to their patients
- Misuse or waste of public funds
Raising Concerns Policy (NHS England)
- Raise concerns when risk is harming service
- Don't need to wait for proof to state your concern
Entrustable Professional Activities (EPA)
- Demonstrate a commitment to carrying out professional responsibilities
- Adhere to ethical principles
- Comprise compassion, integrity, and respect for others
- Being responsive to patient needs
- Accountability to patients, society, and the profession
Defining Incidents and Events
- Incident: event leading to unintended harm, including near misses and staff/service user complaints
- Adverse Event: Incident that results in harm, maybe from an error
- Serious Reportable Events (SREs): incidents that should not occur if preventative measures are in place, and are mandatorily reported within 72 hours
To Err is Human, patient safety
- Medical errors cause 98,000 deaths annually
- To Err Is Human" emphasizes that faulty systems, not bad individuals, cause majority of issues
Open Disclosure the Michigan Health System Model
- Disclose apologize and learn from errors
- This reduces litigation
- Saves money to invest in patient safety
Learning from Harm requires
- The process of learning from errors
Staffordshire Hospital Scandal led to
- Higher mortality rates
- Cut back to staff and services
- Statutory Duty of Candor (DOC) required following events resulting in death or harm
Duty of Candour (UK) obligations
- Inform people of incidents
- Offer reasonable support
- Give truthful information
- Apologize
CervicalCheck Scandal
- CervicalCheck audit knew results were incorrect but Phelan was not informed until 2017
- The HSE confirmed 206 women developed cervical cancer due to misdiagnosis
Irish National Adverse Event Study findings
- Adverse events happened in 12.2% of admissions
- 70% of events were preventable
- 6.7% contributed to death
HSE's Open Disclosure Policy 2021 dictates
- Communicating openly, honestly, and transparently if something goes wrong, harm occurs, or harm is suspected.
Patient Safety Incident, defined
- Caused unintended injury/harm
- Did not result in actual injury/harm but provider believes placed patient at risk
Aspects of the Open Disclosure Process
- Open, honest, transparent, and timely communication
- Acknowledgement and factual explanation
- A meaningful apology
- Displaying empathy and compassion
- Listening
- Providing reassurance
ASSIST Model of Communication
- Acknowledge
- Sorry
- Story
- Inquire
- Solutions
- Travel
The intention for ASSIST ME Model, for staff, is to
- Acknowledge & Assess
- Sorry
- Story
- Inquire and Inform
- Solutions and Support
- Travel
- Maintain, Monitor, and Move Onward
- End and Evaluate
Key point of Patient Safety Bill (Pending)
- Calls for mandatory open disclosure
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