Hello medics,
Ethical issues are commonly tested in OSCEs and written exams throughout medical school and post graduate professional exams. It tests the ability to be a safe and competent doctor outlined by the GMC. Please see GMC website for more detailed information.
Ethical issues may arise in different scenarios in the exam ie:
1) Relative wanting to discuss family members information without consent
2) Patient has no capacity to make decisions
3) Safeguarding scenerio
The list is endless, but the principles are similar. Below are some points to get you thinking about these cases so that you can apply them whatever the case.
ACT IN PATIENTS BEST INTEREST
This is the “go to” with these cases. The patient is always at the centre of it. Your duty as a doctor is to protect them and do the best for them (which may not always be the easier or most obvious thing).
Using this as the back bone of the case and referencing back to this ie a disgruntled relative, will diminish most conflict.
CONFIDENTIALITY
No information should be disclosed for an adult unless there is written/verbal permission to do so (unless for patient safety or to other health professionals).
Now, this is not always clear cut, i.e. You may need to talk to a relative about their dying mother without searching through notes for consent.
For exam purposes, you will need to gain consent to discuss any information (in a non emergency scenario), whether that be diagnosis, test results or patient decisions.
On the wards this is really case by case, and also you have the decision to discuss with your colleagues and seniors. GMC guidelines are in place to provide help and guidance on this.
AUTONOMY
Patient have the right to make their own decision even if not the “right” decision. As long as they have capacity (I will cover this in a later blog) then they can make their own decision about their care including refusing care).
COMMUNICATION
I cannot emphasise this enough. Whatever the case, however difficult, however complicated- having effective communication skills is key.
This means, being clear in your communication, avoiding jargon, listening skills (both verbal and non verbal), not being judgemental in your tone. You may have your own agenda, but you have to listen to those around you to get anywhere. Medicine is not an isolated career, it involves patients, relatives, other health professionals.
DOCUMENTATION
All discussions and decisions should be documented in the notes (especially those decisions which were not clear cut). In the exam, you will say this to the examiner. The exam should feel like a driving test, where all actions are made obvious and safety is the top of the list.
I hope this has helped and reminded you of the principles if you are faced with an “ethical” case.
Any further information, please don’t hesitate to contact me via social media or email.
There is also time to sign up for one to one consultation skills revision if you would like more structured and focused OSCE revision with feedback.
Happy revising :)