PPD

Question 1

Give 3 considerations in the Ethics of resource allocation

Answer 1

1) Cost-benefit analyses, using QALYs
2) Opportunity cost
3) Public/media perception

Question 2

Describe the libertarian (JSM), egalitarian and utilitarian (maximising) principles in resource allocation

Answer 2

Libertarian - weight
Egalitarian - equal opportunity, equal access
Utilitarian - maximum utility, greatest pleasure and least harm

Question 3

Define sustainability. Give 3 types of sustainability issues in the NHS

Answer 3

Defn: meeting the needs of the present without compromising the needs of the future

1) Economic - ageing population
2) Environmental - antibiotic resistance, pollution
3) Clinical waste - over…intervention/prescription/investigation

Question 4

Human Rights Act - issues related to:

a) Art. 2 (right to life)
b) Art. 3 (to refuse dehumanising treatments)
c) Art. 8 (respect for family life)
d) Art. 12 (found a family)

Answer 4

a) Abortion, euthanasia
b) Withdrawal, patient choice
c) Confidentiality
d) IVF

Question 5

DOLS:

a) Only valid in what 2 settings
b) Assessment involves capacity and what else?
c) For patients of what age
d) For what treatment

Answer 5

a) Hosp. Care home
b) Best interests, consulting family
c) over 18
d) anything that will involve them being deprived of liberties and staying under close supervision in a care setting (for people without capacity)

Question 6

Common law:

a) Vs statutory law
b) Confidentiality breaches allowed in what 3 instances?

Answer 6

a) Common - precedent; statutory - legislated

b) Patient consents, public interest, required by law

Question 7

Give 5 ways in which HCPs or PHE may effect health behaviours/patient choice (scale)

Answer 7

Educate/inform, enable, advise, incentivise/ disincentivise, restrict choice

Question 8

Expected utility = ?

Answer 8

Likelihood x Value

Question 9

Define sick role in terms of:

a) Rights

b) Obligations

Answer 9

Rights:
The sick person is exempt from normal social roles
The sick person is not responsible for their condition
Obligations:
The sick person should try to get well
The sick person should seek technically competent help and cooperate with the medical professional

Question 10

Give 4 cognitive biases/heuristics

Answer 10

Availability, representativeness, anchoring/adjustment, affect heuristic

Question 11

Human error models:

a) Person approach = ?
b) Systems approach = ?
c) Active failures
d) Latent conditions
e) High reliability organisations

Answer 11

a) Treat errors as moral issues (just world hypothesis)
b) Errors are unavoidable. We cannot change human condition; we can change working conditions.
c) Unsafe acts
d) Resident pathogens predisposing to failure
e) Adopt systems approach and prepare for failures

Question 12

GMC duties of a doctor:

a) Make the…?
b) Act how?
c) 3 pillars

Answer 12

a) Care of your patient your first concern
b) Honestly, openly, with integrity
c) Knowledge, skills, performance

Question 13

Jim Reason’s Swiss Cheese Model

a) How it works
b) Example - Wayne Jowett and rule of 2s

Answer 13

a) Holes in defences align - allow failure

b) intrathecal vincristine - 2 doctors, 2 days, 2 places, 2 pharmacy deliveries - all failed

Question 14

Bucket model of error

a) What are the 3 buckets?
b) 3 examples for each
c) Preparedness - 3 points

Answer 14

a) Self, context, task
b) poor knowledge/skills/experience/energy levels; distracted, stressful situation, poor organisation on ward; many steps, difficult task
c) Accept that errors are unavoidable, have contingency plans, care of patient > professional courtesy

Question 15

Neglect - 3 types

Answer 15

Medical, personal, nutritional (Mid Staffs)

Question 16

Negligence:

a) Define
b) 4 things patients must prove
c) 2 tests for whether there was a breach - explain
d) Awards for 3 things

Answer 16

a) Legal term for civil case where awards paid to patient on balance of probabilities
b) Duty of care; breach in this duty; harm; harm due to breachbree
c) Bolam - reasonable group of Drs would have done the same; Bolitho - this group would be reasonable to do so
d) Loss of income, care costs, pain & suffering

Question 17

Intended actions - mistakes vs violations

Answer 17

Mistakes (accidental), violations (knowingly broke protocol)

Question 18

Never events:

a) Most common. Other surgical
b) Medical, obstetric, mental health
c) Published on ….?
d) Define!
e) Who needs to be notified for a never event?

Answer 18

a) Retained items. Wrong implant
b) Medication wrong/too high dose/wrong route; PPH death; suicide
c) NHS Improvement
d) Never Events are serious incidents that are entirely preventable so should not occur if procedures are followed correctly

e) Strategic executive information system (StEIS)
and the National reporting and learning system (NRLS)

Question 19

Martin Bromiley’s story:

a) Case
b) 3 errors

Answer 19

a) Tonsillectomy - “Can’t intubate, can’t ventilate” - death (should have been trached)
b) Teamwork - no communication, hierarchical, no leader; loss of situational awareness for time and severity

Question 20

Shared mental model:

a) Describe
b) 3 key features
c) Example in healthcare (communication)

Answer 20

a) Shared understanding of roles, and strategy
b) Problem/solution, roles in team, strategy
c) SBAR

Question 21

3 leadership styles

Answer 21

Transactional, transformational, laissez-faire

Question 22

Theory of planned behaviour.

a) 3 initial stages resulting in intention, then behaviour

Answer 22

Attitude, perceived control, subjective norm

Question 23

Duty of candour - when is it statutory

Answer 23

When harm arises

Question 24

Heinrich’s safety triangle: 5 stages

Answer 24

Unsafe acts, near misses, minor injury, time loss injury, fatality

Question 25

Cases: (what could have been done differently)

a) Meningococcal child
b) Breast cancer referral
c) Warfarin old lady

Answer 25

a) Feverish child - proper screen, proper triage
b) BRCA positive in history, proper referral, AM message followed up
c) Don’t alternate dosage, take INR to check stable

Question 26

RCGP social media highway code:

a) Benefits and risks of social media
b) Relationship to GMC guidance

Answer 26

a) Benefits - interactions, education, networking; Risks - loss of personal freedom, inappropriate behaviour
b) Nothing should weaken the patient’s trust in HCPs

Question 27

Public health

a) 3 goals
b) Consider what? (not individuals)

Answer 27

a) Health care delivery, health protection and health improvement
b) Population perspective

Question 28

Rule of rescue

Answer 28

Rule of rescue: ‘a perceived duty to save endangered life where possible’

Will be protected by the Good Samaritan rule

Question 29

DNACPR decisions.

a) Discussion

Answer 29

a) Must be discussed with patients and families unless they have explicitly said they don’t want to discuss it