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ISCE101CBDstation By Yasmin MayoufWhatistheCBD station? Presenta case – discuss history, examination, Case baseddiscussion 7minutes topresent investigations, management. Should have a printedcopyas an aid social/ethical memoireinthe examCriteria • Maxone sideofA4, calibri size 12 font • Full name andnumberin topright handcorner • Anonymiseddata • Clear structure with headingsfor the Hx • Widely used abbreviationsare accepted (e.g.TIA, ECG) • OnlyPDF versionsallowed • New case foreach setting(formative,summative,re-sit) • assessmente.g.ptpathway/oncology/SLEscannothavebeen submittedfor apreviousQuestions • With respect to [the investigation selected], why was that particular test undertaken?’ • ‘Regarding the patient’s management [e.g. the choice of a particular drug (being started or stopped) or procedure] what do you think are the risks and benefits of this approach to the patient’s management?’ ‘Are you aware of any guidelines that support this approach/ management?’ ‘What are the key impacts of [this management plan] from the perspective of your patient?’ Takenfrom2023CBDtemplate• ‘Finally, in regard to [ethical, EDI or social science issue] what issues arose and how were they addressed?’ • ‘Are there any ethical frameworks, guidelines or principles that you encountered during the care of this patient?’ • ‘And finally, what was it about this patient that made an impact on you?’ Theymaynotask theseQs….Mark-scheme • Assessed onabilityto ‘succinctly’ present the case • Ability to consider risks/benefits of alternative Mx options using evidence based guidelines • Person-centered consultationand managementskills • Equality and diversityprinciples – pt capacity,consent, confidentiality, safeguarding.Communicationskills-process • Make eyecontact • Cohesive: PC  HPC  PMHx  DHx +allergies  SHx  differentials  Ix  final differential  MxCommunicationskills-content • Must have ethical/socialcomponent • I woulddiscuss it during the initial7 minutesbutnot inmuchdetail, otherwise youwill end up repeating yourself.Diagnosticsandclinicalreasoning • Discuss why Ix were done • Appropriate differentials with reasoning • Risk managementClinicalcare&ptsafety • Risks vs benefit • Guidelines • Managing complex cases social/ethicalProfessionalism • Empathy • Ptcentered • Social/ethicalSocial/ethicaltopics Children Refusing consentingto MHA MCA treatment treatment Communication DoLS difficulties DNACPR Whatiscapacity • Capacity – ability to make decisions for themselves. • Decision and time specific. May have capacity forsome decisions but not others. Understand Weighup information Retain risks/benefits CommunicateMentalCapacityAct • PHYSICAL HEALTH • 1. Assumecapacity • 2. Supportfirst.Help someoneas much as possibleto maketheirown decision • 3. Rightto makean‘unwise’decision • 4. Checkcapacity • 5. Ifnot proventohavecapacity, thenany decisionmustbemade intheirbest interests. • Least restrictiveinterventionDeprivationofLibertySafeguards(DoLS) Restrictingsomeone’sfreedomto keepthem safe Indications:keeppersonsafe fromharm,providingessentialcare. Personlackscapacityto consentto their care/treatment. Mustbe inperson’sbestinterest Mustbe leastrestrictiveoption Mustbe legallyauthorised– DOLSassessmentAdvanceDirectives • Advance decisionto refusetreatment • For specific treatment ina specific circumstance. • Can’t demandtreatment • Must be written down, signed by patientand awitness. • make decisionhas beenconferred too another person (Lasting Powerof Attorney), not incapacitated and can decidethemselves.DNACPR • Ultimatelya medicaldecision • Conversationshouldbe had with patient+ family ofthe decisionand signed nd • If patient disagrees withyou, 2 opinionshould be offered. • Not legally binding • Doesn’t apply if there is areversible cause – e.g. choking, anaphylaxis.Mentalhealthact Section Who Whatit does 2 Approved mental health professional+ 2 Drs Admission for assessment for up to 28days Can'tbe renewed • Mental health conditions 3 AMHP + 2Drs Admission for Tx for 6 months Canbe renewed • At risk to themselves, others OR 4 GP 72hr assessmentorder (emergencyassessment) AMHP When section 2 would be delayed refusing urgent Tx. 5(2) Dr Detainedin hospital • Canoverride mental capacity act 5(4) Nurse Detainpt for 6hrs in hospital 17a Community Recall pt to hospital for Tx if not complying • “sectioning” 135 Police Remove person in their property to place of safety 136 Police Public (6 letters for 136) place Taken to place of safety 24hrswhile mental health actassessmentarrangedGillickandFraserguidelines Fraserguidelines Gillick Competency What? Relatedtosexualhealth Child <16yrsconsidered‘Gillick Inparticular–contraceptive competent’iftheyhaveenough adviceand Txtochildren<16yrs understanding,maturityto withoutparentalinvolvement comprehendnature+ implications Considerations 1. Childunderstandsadvice 1. Childcanweighthe given risks/benefits 2. HCP can’tpersuadechildto 2. Childunderstands informparents consequencesoftheir 3. Childlikelytoengagein decisions sexual activityregardless 3. Assessabilityto 4. WithoutTx, child’s communicatereasoned physical/mentalhealthmay decision suffer 5. Txinchild’sbest interest Ifcompetent+ consents to Tx give Tx Ifcompetent+ refusesTx maybe <16yrs+ overriddenbycourt/parentsifrefusal consent risks harm Childnot competent bestinterest meetings NICE guidelines Microguide Trustguidelines Guidelines Anyroyal colleges Recommendations from trust’s microbiology Researchpapers (any)