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					GMC cases
Sources BAPIO/INDIGO • MDU • GMC • BMA AIM Prevention of complaints- stick to good medical practice Harm minimisation- If already referred what can you do

Basics
• Our job is welfare of others who trust us • The new consumer culture has made GMC/ doctors to redefine themselves • They have defined themselves as professionals persuing professionalism • This is a big document which basically says professionalism in Medicine is different from professionalism among refined and unrefined crooks/ businessmen/ teachers/ lawyers etc

The basis remains unchanged
• Hippocratus has laid it out- We haven’t had a more refined and creative society since that time to break this great achievement. • The modifications to all oaths across the world are still based on it and not based on each other yet.

What needs to be clear
• We need to be guided by ethics which are well beyond any regulatory agencies achievement limits. • The regulatory agencies set only the minimal standards- so there is no excuse for not adhering to them.

Good Medical Practice
• what is expected of all doctors • your responsibility to be familiar with Good Medical Practice and to follow the guidance • Serious or persistent failure to follow this guidance will put your registration at risk – so mistakes are taken into account especially if they are accidents

Fitness to Practise
• To practise safely, doctors must be competent • fit to practise • Have good conduct

Competence
• establish and maintain effective relationships with patients • respect patients’ autonomy • act responsibly and appropriately if they or a colleague fall ill and their performance suffers.

conduct
• Doctors have a respected position in society • privileged access to patients

• Therefore we need to justify the trust placed on us

Good Medical Practice
• sets out the standards of competence, care and conduct expected of doctors - Good clinical care - Maintaining good medical practice - Relationships with patients - Working with colleagues - Teaching and training - develop the skills, attitudes and practices of a competent teacher - Probity - honest and trustworthy - Health - must not allow their own health condition to endanger patients

question of fitness to practise
• performance has harmed patients or put patients at risk of harm • deliberate or reckless disregard of clinical responsibilities towards patients • doctor’s health is compromising patient safety

• abused a patient’s trust or violated a patient’s autonomy or other fundamental rights • behaved dishonestly, fraudulently or in a way designed to mislead or harm others

duties of a doctor
• • • • • • care of your patient your first concern Protect and promote health good standard of practice and care Treat patients as individuals Work in partnership with patients Be honest and open and act with integrity – act without delay if any risk, never abuse or discriminate

Hippocratic Oath
• swear by Apollo Physician • who has taught me this art as equal to my parents and to live my life in partnership with him • offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant – sex discrimination • keep them from harm and injustice – not just illness • I will not give to a woman an abortive remedy • in particular of sexual relations with both female and male persons

Confidentiality
• Confidentiality has been defined by the International Organization for Standardization (ISO) as "ensuring that information is accessible only to those authorized to have access" and is one of the cornerstones of Information security. • Both the privilege and the duty serve the purpose of encouraging clients to speak frankly about their cases

0-18 years
• assessment of best interests – get views of all concerned- child & parent • Communication – child and parent- talk directly, don’t overburden with info • Assessing the capacity to consent- Ability to understand, retain, use and weigh this information, and communicate their decision to others. • Note- a young person under 16 may have the capacity to consent, depending on their maturity and ability to understand what is involved (Gillick Competence)

confidentiality
• right to expect that information about them will be held in confidence • central to trust between doctors and patients • seek patients’ express consent to disclosure of information • observe the requirements of statute and common law, including data protection legislation

Disclosing information about patients
• implied consent to disclosure - Sharing information in the health care team, clinical audit • express consent - research, epidemiology, financial audit or administration - explain how much information will be disclosed and to whom it will be given • If the patient withholds consent, or consent cannot be obtained, disclosures may be made only where they are required by law or can be justified in the public interest.

Disclosures without need of consent
Allways try to get consent even if they don’t agree for these • The public interest - not competent, obtaining consent would undermine the purpose of the disclosure, action must be taken quickly like in communicable disorders • required by law – litigation and statutory regulatory bodies

Other GMC guidance available
• • • • • • • • • • • Accountability in Multi-Disciplinary Teams Audio and Visual Recordings Conflicts of Interest Consent Gunshot wounds Maintaining Boundaries Management Prescribing References Research Withholding and withdrawing life-prolonging treatments: Good practice in decision-making

Capacity
• Different from Consent • Mental Capacity Act- new- it supersedes GMC Guidance • provides a legal framework for people whose capacity is impaired • supported by a detailed Code of Practice

MCA - five principles
•

•
• • •

A person must be assumed to have capacity unless it is established that he lacks capacity, A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success, A person is not to be treated as unable to make a decision merely because he makes an unwise decision, An act done, or decision made under the Act for or on behalf of the person who lacks capacity must be done, or made, in his best interests. Before the Act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can effectively be achieved in a way which is less restrictive of the person’s rights and freedom of action.

significant changes
• Introduction of Independent Mental Capacity Advocates. • Creation of Lasting Powers of Attorney – which will replace Enduring Powers of Attorney, and which will now cover personal welfare as well as finance and property affairs. • Provision for advance Decisions concerning healthcare – on a statutory basis for the first time. • The creation of a new Court of Protection

two-stage test for capacity
• Does the person have an impairment of the mind or brain, or is there some sort of disturbance affecting the way their mind or brain works? (impairment may be temporary or permanent.) • If so, does that impairment or disturbance mean that the person is unable to make the decision in question at the time it needs to be made?

Need to consider if the patient is unable to
• Understand the information relevant to the decision (including information about the reasonably foreseeable consequences of deciding one way or another, or failing to make a decision) • Retain that information, • Use or weigh that information as part of the process of making the decision, or • Communicate his decision (whether by talking, using sign language or any other means). • If any of these four criteria cannot be met, the patient is unable to make the decision.

checklist of matters for Best Interest
• permit and encourage the patient to participate • it may be possible to defer a decision about treatment until the patient recovers capacity • not be motivated by a desire to bring about the death of the patient • patient’s past and present wishes and feelings • views of those named by the patient as someone to be consulted

Lasting Power of Attorney
• Enduring Powers of Attorney (EPA) • could only enable an Attorney to deal with a donor’s property and affairs • has to be registered with the Office of the Public Guardian (OPG) when the donor starts to lose capacity • EPAs and LPAs relating to property and affairs can be used before the donor lacks capacity if the donor provides for this • Lasting Power of Attorney • can cover property and affairs, but it is now also possible to create a LPA which covers personal welfare, including decisions about medical treatment. • LPA can be registered at any time. • personal welfare LPA can only ever be used when the donor lacks capacity

Advance decisions
• Advance decisions enable someone with capacity who is 18 years or more to refuse specific medical treatment for a time in the future when they may lack capacity to refuse or consent to that particular treatment. • No specific requirement that an advance decision must be discussed with a healthcare professional • Advance decisions must be made verbally or in writing. If that decision relates to the refusal of life sustaining treatment, it is necessary for the decision to be in writing. • advance decision can be reviewed from time to time.

Independent Mental Capacity Advocates
• IMCAs are designed to support vulnerable people who lack capacity to make important decisions, where there are no friends or family members available to consult • IMCA must be instructed and then consulted • IMCA should represent the patient in discussions to work out whether a decision is in the patient’s best interests.

children
• The Act does not apply to children under the age of 16. except two exceptions, • Court of Protection can make decisions about a child’s property or finance if a child lacks capacity to make such decisions. • Second, the Act creates a new offence of ill treatment and wilful neglect of a person who lacks capacity, and that will also apply to patients under the age of 16. • Only those of 18 or more will be able to make an LPA, or an advance decision to refuse medical treatment


				
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