Dr Alex Reid, Medicolegal Consultant for MPS members in Ireland, answers medicolegal questions commonly asked by junior doctors
I’m currently working as an intern in general surgery. Yesterday, I mislaid my theatre list on the ward and later found it next to a patient who had read its contents. Do I need to tell someone or will it be ok?
Confidentiality is central to the doctor–patient relationship and patients are entitled to expect that information about them will be held in confidence. Any inadvertent breaches of confidentiality must be dealt with seriously, no matter how small they might seem.
The patients on the list (ie, those who are affected) and the data controller (ie, your employer) should be informed of the loss of data in the first instance. All incidents of loss of control of personal data in manual or electronic form by a data processor must be reported to the relevant data controller as soon as the data processor, in this case you, becomes aware of the incident.
The relevant person on the ward should in turn inform the Data Protection Commissioner, in accordance with the Data Protection Act.
Any inadvertent breaches of confidentiality must be dealt with seriously, no matter how small they might seem
Working on call in the ED, a patient becomes very angry about his treatment and starts to challenge me about it, raising his voice and making threatening gestures. What should I do?
When dealing with challenging or difficult patients it is important to try and remain calm at all times. Ask about the cause of the problem, speaking calmly and slowly and attempting to resolve the situation. Do not raise your voice.
If you are asked to examine or treat a patient who presents a risk of violence, the Medical Council states that you should make reasonable efforts to assess any possible underlying clinical causes of the violent behaviour.
However, you are not obliged to put yourself or other healthcare staff at risk of undue harm in the cause of such assessment or treatment.
I have just helped to treat an eight-year-old girl in the ED who had a cut to her head that required stitching, following a fall. She also has bruising over her arms, but I am concerned that this is not consistent with the history of her fall. What should I do?
Firstly, you should discuss any concerns you have about child protection with a senior colleague. As a doctor, you should be aware of the Children First: National Guidelines for the Protection and Welfare of Children. The Medical Council states that if you have any concerns regarding alleged or suspected abuse of children, you must report this to the appropriate authorities and/or the relevant statutory agency without delay.
You should inform the child’s parents or guardians of your intention to report your concerns, unless informing them might endanger the child. Giving information to others for the protection of a child would be a justifiable breach of confidentiality, if you feel that it is in the patient’s best interests.
The Criminal Justice (Withholding of Information on Offences Against Children or Vulnerable Persons) Bill is currently under consideration in the Dáil, which will legislate for mandatory reporting. For more information see MPS’s factsheet on Safeguarding Children.
I keep having headaches that I think might be migraines. Can I self-prescribe?
If you become ill, you should seek advice and help from another doctor rather than treat yourself
Tempting though it may be to write yourself a quick prescription ready to take to the pharmacy after work, this might mean you don’t get the best treatment possible, or a valued second opinion. You should make an appointment to see your own GP instead – the Medical Council in A Guide to Professional Conduct and Ethics advises that if you become ill, you should seek advice and help from another doctor rather than treat yourself (52.1).
Similarly, the medical Council Advises that a doctor does not treat, issue prescriptions, or write sick certificates or reports for family members (52.1).
I have just received a conviction for being drunk and disorderly after a staff night out. Should I tell the hospital?
If you are convicted of a criminal offence, the Medical Council will be notified, and they will investigate the circumstances involved. Claiming that you were not on duty at the time of the offence will not help you avoid an inquiry, which could potentially affect your professional registration.
It is much better to share this information with your employer in the first instance, rather than keep quiet in the hope that they won’t find out.
A patient, Mr T, is extremely unhappy with the standard of care his mother, Mrs T, is receiving. Mrs T has had a stroke. Shortly after the ward round, you were making an entry in Mrs T’s notes when Mr T approached you and asked to have a quick look at his mother’s medical records as he is very concerned. Should I have let him?
Patient’s relatives and close friends may understandably be concerned, but you must not disclose information to anyone without the patient’s consent, if they have capacity. This can be hard, especially if family members ask for a quick look and say they only have their mother’s best interests at heart.
You must first check that Mrs T consents to the disclosure, except where failure to disclose would put others at risk of serious harm. You should only discuss a patient’s care with their family if there is a lack of capacity and it is in their best interests. You would need to assess whether Mrs T has capacity following her recent stroke.
You should only discuss a patient’s care with their family if there is a lack of capacity and it is in their best interests
One of my intern colleagues appears to be suffering from acute psychological stress and it’s beginning to impact on his work. What should I do?
If you are concerned about a colleague’s conduct or competence, you should talk through your concerns initially with the doctor in question. The best way to support a colleague is to advise them to seek expert help or consider referral to the Medical Council’s Health Sub-Committee.
You must also act to prevent any immediate risk to patient safety by notifying the relevant authority about your concern as soon as possible. If you are unsure who to report your concerns to, ask a senior colleague for advice, or contact MPS.
I am working on the vascular ward. Should I give each patient the same amount of information when taking informed consent for an elective operation?
Every adult patient is presumed to have the capacity to make decisions for themselves and you have a duty to provide information in a clear and comprehensive manner. You should take a functional approach when assessing an individual’s capacity, based on:
- Their level of understanding and retention of the information they have been given
- Their ability to apply the information to their own personal circumstances and come to a decision. (Medical Council, A Guide to Professional Conduct and Ethics, 34.3)
Every adult patient is presumed to have the capacity to make decisions for themselves
The Guide’s ‘Appendix A’ contains details of the information that patients should be provided with prior to giving consent, for example: details of the diagnosis and prognosis; details of the procedures or therapies involved, including methods of pain relief; and preparation for the procedure and what the patient might expect during or after the procedure, including common and serious side effects.
For more information, see the MPS booklet, Consent to medical treatment in Ireland.