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delivered by our vice president's. Yes, it vicepresidente Mr Cenovus Shaariibuu. So thanks for joining us train. Um, it's going to be a very interesting talk. So, um, make notes if you've got if you've not been doing so already, and please do ask any questions in the chat and I'll filter those and and ask them at the end. But without further a do, I'll pass on to soon. Thank you. Thank you for asking. You hear me? I hope you can. Yeah, I can hear you. Well, yeah. Brilliant. Brilliant. First of all, thank you for sorting out such a brilliant day. So far, we've had some great talks. And, uh, first of all, congratulations to Mike. He's clearly had a lot on his plate, and he's done very well. Um, from my side, thanks of as in the team for drawing me back into this today because, uh, a bit of a last minute thing, but I hope that, uh, what appears to be a relatively, uh, mundane or the dry topic as it were, it turns into something a bit more interesting for you. I will do my best to start sharing my slides now and Hopefully, you can see them. Um, but yes. So myself. I'm a trauma orthopedic registrar in not a million miles from our previous speaker in the chair, living in Chester, Cheshire region, but working in West Midlands itself in the Ulster Story state rotation. Um, and asthma said I have the pleasure of representing as the vice president's present in my one of my other hats, which I've carry is that I've completed my masters of law from Edinburgh University and hence have a little bit of interest in this topic. By no means don't expect you all to walk away from this today, expecting you to turn off a load of complex cases or case law or anything like that. It's just the principles. And I think often when we have these sort of talks, the the challenge that people have is that, uh, you feel, uh, inundated with so much case law is that you lose the value of actually what the points are. So the key things that we want to go through today, or what they're going to appear or likely be discussed in principle at interview level, or at least how you can demonstrate it as our previous speaker is as mentioned within the answering, so the topics would be capacity, consent, negligent and duty of candor. And, of course, we'll wrap up with some of the key messages at the end. Now this is pretty much how I started off the bed school thinking when it came to medical legal stations, half the crowd would be giving up already. Um and no, it's not quite as dramatic and uh, fearsome as just dread on the right. We are a bit more civil when we talk about these topics, although there is a massive misnomer that is often propagated within healthcare systems as to what medical legal means. And I think often times it's used, uh, in a in an unfair way in in an unfair way to suggest that it is on a day to day basis. You you'll hear your, uh, senior state oh, legally or medical legally, and it may have next to no relevance to the to the point being stated. So if nothing else, they should hopefully give you a bit of heart, hopefully go through the cases. So there are some basic background to all of this, and why we are talking about it more and more. Um well, we know that n s just resolution, which is the negligence, which is more the complaint sector of the NHS. Um, the liability, uh, costs are approximately 2.2 billion in the 2020 21 year alone, with nearly 12.5 over 12.5 1000 claims in that period. There is clearly a frame shift in the way that complaints are being processed, and indeed the cost of litigation as a result of that as well. Um, and we know that, uh, from a surgical specialties, uh, we are pretty high on the hit list if you look at both complaints, but also the payment's that are that are resultant of that obstetrics consistently seem to top the list. Understandably. And, uh, you know, things like orthopedic surgery, general surgery, uh, are not a million miles behind in in the in the list as we were. So we have to look at where this this sort of initial transition has taken place. And if we consider that we had that classic, uh, I forget the chaps name now from doctor in the house, the Lancelot Spratt. No, that's it. Lancelot Spratt sort of attitude of the doctor was that be all and end all that paternalistic I walk in What's the bleeding time? Sort of character and and and And that was probably too far into the wrong direction. And we want to strike a balance where you're working with your patient in a shared decision making, uh, sort of, uh, sort of Axion rather than one person having absolute control. Now the fear is for many people is that we are shifting into what's more of a consumerist psychology and the but But again, we shouldn't drove into that too much. There are some statements from the previous G M C chair, which would explain this a bit better, and Terence Stephenson himself stated that, uh, it's more become defensive over his lifetime, and it's more out of a fear of litigation than even being reported to the regulators. Um, and there's the classic problems test that people always used to talk about in the respect of this is that it's not guilty if he's acted in accordance with practice, as accepted by a reasonable body of similar similar working professionals. Now this whilst it's all well and good. Having this, uh, frameshift in terms of the environment that we're practicing in the issue is you'll often hear people talking about things like the blood test alone. And I'm sure that you appreciate We have moved a bit further in case law since then. And that's the sort of stuff we need to look through today. And I want to bring in some other interesting cases to you today. So you don't feel like every single talk on this topic, uh, speaks about the same obvious situations. So we're talking about capacity. Um, it's a 2005 act in England and Wales and then we have the Scot. Scotland has got a separate act to that in 2000. Um, you're starting position has to be consistent. It has to be consistent that every adult has capacity. Of course, it's time specific. And of course, you shouldn't be based in your assessment on any sort of personal characteristics, and you'll see the relevance this a bit later. That could be age, disability, health, core, mobilities, religion, faith and nothing. I mean, absolutely nothing should play a factor in your assessment, and you know your opinion of their decision making isn't really relative. You could have your, uh, your patient in front of you who is making a completely illogical decision as per your own assessment or your own belief structure. But that can't really be something that you could assume. They don't have capacity because of that. So there are various things that are listed there, and they all fall into this class trick in this criteria of they don't have capacity, but you can't make those decisions like that. So we've heard this. How 1000 times a court, even from medical school days. Simple structure. Keep it simple and you'll win with these answers, which is, understand, retain balance out the decision making process and effectively communicate. And you should be doing everything in your power to help the patient achieve that. So that can be the least restrictive pathways to them to do it. If you know somebody has been documented in the clerking notes to have hearing aid issues or hearing issues, I should say, and they haven't got their hearing aid changed. Then, presuming that they can't understand anything or presuming that they can't way up the decisions because they haven't been able to hear what you said is not a fair way. That's a very simplistic way of describing it. But that person, naturally, does have capacity. They just simply haven't been given the information appropriately because they haven't got their equipment with them now. The other thing, which sounds sometimes far too obvious. But it is true. It has to be without coercion. It's all well and good having the family members there and say No, absolutely, even though you have my my, my my parents would would always want this doing. My parents have to have this doing. But with a patient who has capacity in front of you, it's clear that it they should be the ultimate decision makers of this and it no matter what, always you need to be functioning in the patient's best interest and the there are some aquatic of equivalence to this. But the important thing you need to say is that if there is an absence of capacity with no other secondary decision makers, um, then you can always consider the lasting power of attorney specifically for health. Um, if they are incapable of doing so now, well, quickly shift off into shift into some interesting cases and hopefully, cases which none of you have seen before if you have and forgive me, but it takes it away from the obvious group, and the first I'll start with is a case of, UH, C R C R E C. And this was in 94 starting with the facts, the facts were a patient who's test effect mental capacity. Um, and this is this is now reflected mental capacity at this. This particular principles the 68 year old chap known paranoid schizophrenic, developed angry and the foot while Steel's in prison at Broadmoor is transferred to a general hospital. Uh, the to be reviewed by the consultant and the consultant's said, At the end of the day, you only have 50% chance of survival if you, as in terms of getting septic and subsequently die if you don't allow us to amputate the limb and the patient clearly refused the amputation and in the process, it's obvious to us now. But, uh, they presumed that he did not have capacity. This was taken to a legal situation, and indeed, Justice Justice thought at the Time, said the previous fascia evidence is that even though they have this pre established diagnosis that has nothing to do with their right, their ability to have capacity to answer the specific question for medical treatment and indeed their ability to refuse medical treatment. Now, whilst this general psychology, maybe psychiatry, may have diagnosed with schizophrenia, that does not establish that he doesn't understand and ultimately be able to make that decision. Primacy of the payment. Ultimately, the primacy of the patient's autonomy in capacity in one of several areas of life does not preclude the autonomous behaviors and others. So that's really important, because we see often to receive patient's with many different diagnosis. And that should. This is a good example of where you cannot use that or should not use that, I should say, to get in their decision making process for capacity. Um, a really interesting case that we pick up is the case of be versus NHS Hospital. Um, be was a 3rd 43 year old patient paralyzed from neck down, maintained on ventilator, and, uh, this will be refused the intervention shortly after it was introduced. Now there was clearly adjust to be incompetent by the medical, uh, by the to psychiatrist back in 2001, that is. But then subsequently, independent review of that year, Uh, it's declared that it was competent. Now the physicians refused to remove the ventilator, Uh, despite the advocating, and instead the patient attended the rehabilitation unit. Mrs. Be had clearly maintained capacity throughout this okay rejected the course of action and repeated refusal. Supplications. And the presidente at that time of the family division, of course, had attended the patient's bedside. And the ruling that butler slash provided at the time was that the fundamental principles that now govern So we're specifically talking about the ability to have to have capacity and rightly refused treatment irrespective of the consequences were observed. Now, the patient is an involved decision maker. In the process, they can't be a by the by as a slide as a side side effect to all of this just because they're in a severe healthcare situation. Um, so ultimately, the decision was a notional Damages were, of course, uh, provided to them in terms of the fact that this was technically an assault. If you could effectively argue it that way, of doing it against the patient's wishes. Um, so this was a particular interest in case in that sense. Good. So we have to then consider what really the terms of consent are and how you would assess that if you keep it again, always to go down to your basic principles each time. Sorry, I think is a voluntary. Is it informed? And do they have capacity? You've already looked at capacity before, um, validating this. We're going through medical intervention. Um, if you don't do this is ultimately can be constituted as an assault or a criminal act. Um, we obviously have loads of situations in our day to day practice, such as a patient where you say it. May I examine you? It can be an intimate examination where it takes a blood test from you, and they will naturally nonverbally or verbally provide you a cue to the effect, of course, doing things without their consent and that fashion would be it would be inappropriate. Mhm. And the consent has to be specific, of course, to the to the intervention you're suggesting and ultimately informed consent. There is. There is. It's It's a bit of a great greatest gray issue here because we talked about informed consent, Um, in a very open fashion. What we are trying to say is medical professionals is we have tried our best to have a recent explanation with the patient and answered all their questions and provided them with the do information so that they can ultimately ultimately make a decision in their own accord now. And the challenge with that is legally there is no official standing for informed consent. It is not recognized in that fashion. It is, It is and remains an ambiguity, and it doesn't really have a standing now consent on itself. Understood. Now the background to this is quite complex. We won't delve into that right here today, but if you maintain the principles of what we've stated there, so the patient's got to be doing it on their own accord. They have had the information to make a decision, and ultimately they've made they have the capacity to do it, and that is fair. That is absolutely appropriate Now. If you look at negligence, as we mentioned earlier, there's there's there's this, the big bogeyman in hospitals of negligence, medical negligence, There's medical negligence that you got to remember. This is based on taught, uh, in the majority of cases, and that is a non contractual civil wrongdoing now clear to state the medical NHS patient's in the secondary care that it is. And they're not contracted The clinician as such, but rather the hospital, G, p and independent sectors. We shouldn't get caught up in that too much. That's a separate affair. And largely there will be, um, but the the principles again that they have to establish, uh, the defendant owed them a duty of care. Okay, so the professional or duty owed the patient duty of care. There is a breach of that duty. Okay, So duty breaching that duty and fell below the standard expected by the law. And because of that, there is a reason to reach. There is a legally recognized heart, so it's very well established, and that is referred to as causation. So is as obvious as that sounds with only three elements to it. It's often not as easy to say, you know, satisfy all that evidence, and the principal is yes, the patient or the individual is entitled to monetary compensation. So as to get them back to the position they were If they had not. If they're negligence had not taken place. Now it's a bit difficult to say it. Establish what exactly that. Fine. It's not to say, you know, you have to pay to someone who lost a lost of amount of money because of a trade deal or something they've done and and that is the exact amount of recompense they should be getting. It's med in medical care. It's always a lot more complicated than that. And to say that, say, for example, a complication in surgery is worth an X amount of money. Whilst various calculations have been made, it's difficult to do that, and it really does come to a case to case by case assessment Now. Historically, medical legal cases were really challenging, As I said for the claimants, um, actually only 30 or 40% of them were successful. But the court's have become more sensitive to establishing those principles that we stated by the by the individual okay, and they do apply some corrective measures and there's a principal referred to as less. It's a lucky to, and this is basically saying it's evidence they've had a treatment. Something's gone wrong is the way of interpreting it. It's unambiguous. You may in for that they're based on the prima fascia evidence that something has gone wrong, not because of completely incidental results of something, but because their treatment or something hasn't has taken place, and therefore it's obvious that you have to take some influences to it. So when we look at some of the interesting cases back in history, um, we won't delve into nitty gritty of it. But basically Ashcroft and Mersey regional Health back in 83 Justice killer Brown was looking at when absurd gin operated on a patient here. The complications, results of that and the basic thing that they were identifying is that common sense, natural justice, the patient should be provided an element of compensations because of this and the person who should be doing that. Negligence has led against the person of high skill. Now, whilst we refer to this as I say, come back to initial point, it's the it has to be the, uh institution, not the individual. In this case, the individual may have been found to be negligent as such but ultimately compensation will be, uh, lead against the institution, as opposed to that individual in majority of cases. And the important other fact in all of this is that there is a clear distinction with what a medical mistake with a law regard and a mistake, which is negligence. That's two different things altogether. Mistakes we're all capable of. Every one of those makes mistake on, you know, on a regular basis. And that's just an ordinary human fallibility. Okay, which which is which is which is understood. The difference is where you start straying beyond the bounds of what is recently expected of a competent individual. Now that's a challenging point to consider, because then, as ourselves as trainees, we have to consider Well, what about me as a c t to what about me is enough to what about me As an ST, uh, doctor, I I have to demonstrate an element of competency of my practices, but ultimately you are still within the confines of a training environment. And you can argue that the interestingly historically, the hospital trust could not confer upon junior employees vicarious liability, which is institutionally I ability as it were, Um, and that's what presents this. And there was a really, really, um, sad for interesting case back in the fifties, where there's a burns patient who sent to the hospital with his condition at the time was not life threatening, but due to work, environment issues, staffing issues, it was seen by two relatively and experienced junior doctors, Doctor S and W. We refer to them for the purposes of today, and they had discussed whether how to provide an anesthesia in order to not just treat the breed to treat the burns, but also allow him to provide some relief from the pain the patient's in. Uh, now they provided him with initial treatment. It didn't work, and they took undertook a procedure which which ultimately giving them a lethal ended up being a lethal dose. The patient died, and appropriately, Lord Denning, um, was came to the opinion this is would be extremely in just these are inexperienced doctors and expecting them to perform a duty without the adequacy provision. It is not appropriate, okay? And we can't be throwing all the responsibility on those doctors. So this is this was a very classic case. Is once that you should all take heart from I'm not suggesting for a second that you go around doing silly things, but ultimately you are within the confines, and you should act within your remit. Don't go straying outside your remit to extremely always make sure that you have the adequate, uh, supervision available. Um, but this is this is one of those unusual scenarios where, um uh there is the law on your side to extend. Uh, these are more with these are some more common cases which we're all aware aware of. I'm not going to labor the point too heavily, Chester. Versus after this was a quarter, quite a case with patient, all the appropriate steps were taken, but the materialist so that the the the patient was not adequately informed of the risks of procedure and that which may be relevant to them. And this was further emphasized in the rather famous case. Now which everyone quotes uh, in pretty much every interview go to is the much comedy Lanarkshire, which is, uh, the the importance of describing materialist risk material risk and that is specific to what that individual has attach is relevance, for it's not simply what that clinician would attach as a common risk to a procedure. But it's what that that particular patient would attach important to do as well. Um, so this comes boils back down to the when you are with the patient that you can't just apply a one fits all approach and you need to find out with the patient what makes them important. Now, uh, you know, a few years ago we had this exact discussion we had a concert pianist with who is developing, Uh, you know, do Beltran's contractors and, uh, the effect that will have, as opposed to a lay member, the public who was not a concert pianist. That's a very different clinical picture. Uh, and the importance they would attach the risks, therefore of surgery, are dramatically different. And you do. The patient does deserve to appreciate the severity and the impact this could have on the long, long term prospects of the career. So that's the sort of thing whilst relatively much more less less damaging in terms of the risk to life. That's still a very important thing to consider. Um, there's a few more cases here. I'm probably going to skip ahead here because I think we've We've looked quite a few of those already, and something I'll previously speaker touched upon was duty of Candida. Now, this is really a very important thing to keep in mind. You probably all heard of it. I know, um, but there are different elements to this. Uh, we don't always appreciate that. So in the best basic form, it is being open and transparent when something has gone wrong. We know that, as I say, they're the W. H s. Statistics show that one in to pretend patient's does receive harm. Uh, to some extent, whilst they're receiving care, most of you know half of those are preventable. I mean, that's a massive. If you walked into any surgery or any operating theater on a regular basis and told your patient's, you've got a one in 10 chance of me doing something wrong to you. Uh, they you'll turn, they'll turn around with a very different expression. Um, then then what? It is So these are important principles and there are two limbs to this one. Is your so called professional okay. And these are guidance and advice and there is the statutory elements. Now that's That's the These are two divisions. Whilst we talk about duty of candor, we have to respect that. There's two different arms to this. Both are recognized within the health service, and both are promoted through your organizations, Um, and also at the national level. And it is the the process. The purpose of this has to be clear. It's not there to necessarily drop you in it or cause you trouble or anything like that. It is a mechanism to identify the problems and ultimately prevent it recurring. And that's that's what it's about. It's not about beating someone with the stick. The duty of candor professionally is a framework of ideas and a framework of principles that is delivered by the as a, as a good example, the General Medical Council for our purpose, and they deliver principles that you have to observe. So, uh, admitting, uh, in a very good example, that was given by a previous speaker when something went wrong. Shoulder surgery, something went wrong. You apologize to the patient, you appropriately try and remedy the issue, and you also explain it to the relevant individuals to that. That person and and also reflect on in an appropriate fashion, that is that that is pretty much the limit of what we're talking about, okay? And it's ultimately the prints. The only thing that that is aimed to do is not to start causing trouble but to simply understand that you're trying to learn from the issues there, learn from whatever has happened and try and prevent the repeated mistakes and the reflection of this would come back to. It's actually a very mature attitude to take. It's not about, um, you know, it is a more mature. It's a more grown up thinking. It's very much a you know, professional attitude to what you're doing. And in most cases there is stronger evidence to this. The majority of cases patient's do prefer to know the truth, thinking it may not be that it's always the most pleasant thing. But ultimately the evidence, through the clinical relationships between clinicians and patient's irrelevant of how challenging the circumstances, transparency and honesty will always take you further. And that's ultimately what this is trying to establish. Now. The statutory side of duty of candor is defined within the healthcare body, so that so that's the specific Health and Social Care Act, and that's looking at the foundation trust or special health authority, or or within that context, at healthcare body level and the healthcare body. Whenever an incident has happened, they have the duty legally. That is different now. They legally have the duty to notify that incident and also provide the reasonable support for that. That's something that is enshrined from a statutory level, not a guidance. It's a statutory level thing. You may think that, um, gosh, there's so many things that go along wrong in hospital There's so many issues that arise. There's so many complications that happen, you know? But there's never you will hear about the odd case here and there. But the first demonstrable episode at an institutional level where this where this statutory act was enforced was in 2017, and there's about an elderly lady who had a perforation here in an endoscopy. Now, the investigation into that demonstrated quite clearly that the renamed Trust at the time did not apologize, did not explain and had largely ignored the issue with communication not only to, uh, their statutory, uh, responsibilities in reporting it, but they also didn't tell the family in a in a fair fashion in an appropriate time. As soon as it happened, they delayed and delayed. After much questioning, they still delayed. And so this is the first time legal proceedings were taking the institution level as relative failure to statutory. And so that's a different thing. And it's important to to differentiate between those two. The being fair report is something that was taken by the Royal College. Uh, today you know. So David Dalton and proper Williams, uh, that undertaken this. And you know that in most reporting systems we talk about date X, for example, as an example of this, uh, only you only capture a window. That's right. You only capture a tiny little windows 7 to 15% as it were. Uh, it can be complications, problems, as you know, relationships between patient's apology. Uh, you know, is the you apologizing? And actually establishing your professional duty of candida was was actually the ultimate way of preventing legal proceedings. And to be clear, the medical profession unions are very clear about an apology is not an admission of liability. That's one thing to remember, and often it does rebuild that professional patient professional relationship that you're that you're always trying to to to protect. In 2019, the report has stated, um, it was emphasizing that you you have to look at this, not at the individual level. And that's often the fear that we all have is that if I say something, if I admit something, is there something going to be? It's just gonna kick back on to me. Am I going to have problems with that? It's not about that you may have in the real world. I appreciate there will be a certain element of fear factor to this. But ultimately it is about not focusing on individual, but the entire circumstances around it. Okay, And without this, you can't develop a diverse, positive culture which actually picks up the issues and deals in a fair fashion. We have seen thousands of examples in the media in legal system where individuals have targeted, uh, they were targeted, I should say inappropriately, and these are sort of things that reports like this are aiming to to To stop those practices is to move away from that sort of old practice. So there's an awful lot I've gone through there, and hopefully some of it is interesting and different to what you may have heard before. I doubt that the overall topics and themselves are. But at least some of the some of the scenarios and some of the interesting cases may have been different for you. There is a lot more guidance out there for all of us to be able to maintain a good quality of healthcare, but also be accountable for it. And so take take whatever opportunity can to to read around the subject. Remember, for the purposes of your interview, the principles are ultimately what matter and what's how you best integrate those into your questions is what you should be looking at. What I hope this does is largely provide. You has helped you understand or recap or revise some of those key concepts. So thank you very much to all of you and uh, yeah, all the best. That's pretty in thanks so much, absolutely fantastic talk and incredibly informative. So I hope everyone enjoyed that. And please post any questions that you have in the chat. We still have a couple of minutes before lunch, so if you have any questions then, Um, please do ask you did a stellar job so far of as you're keeping your ships only. Thank you. That's very kind. Um, looking forward to the mock interviews later as well. Um, we've got our first question. So Christian has said I understand professional duty of candor, as we all have to be familiar with G. M c guidance. But would you mind clarifying statutory duty of candida and how it relates to the individual doctor? Sure. Thank you. Yes, I was I was hoping to ask the specific question again because it's often a point where everyone gets, uh, caught so the you're absolutely right. Your professional duty of candor remains within the remit of guidance and advice. The second you move ahead and you start talking about statutory this throughout this fall, squarely within the remit of institutions healthcare organizations, um, different as I should stay for GP practices and independent sector that works differently. So within the context of yourself as individual doctor, it may be as limited as to suggest you have reported the issues. You've explained the problems you've recorded everything appropriately reflected on everything that would fit your professional duty statutorily, you would not have any further intervention required. The trust should be taking over or the hospital or the department should be looking after all of that, and that is separate to you. But that is something that you need to understand as well. And the reason I say that is because, um if there are cases that do go down, the more litigious routes or they're going to review process, you, you may find that individuals are asked to have their statements taken, are requested for appropriate account of events. This all falls and remains within the context of your professional duty to support. It is not to suggest that you as an individual, are the one that is facing the litigation or facing the case itself. There are that's a separate thing complaint structure versus duty of candor for statutory duty of candor where trust are the ultimate bearers of responsibility. There, you may have noted, as I'll flip three backwards. Um, so a great example Here, uh, didn't like the case. My fault. So, uh, Okay, great. Okay. So this, for example, this is one of the cases I didn't touch on very well. Didn't go through, but the issue was squarely in. So, for example, second case that burst virtuous University College Hospital Foundation Trust. The patient had a stroke after the catheter inserted. Okay, investigate cerebral, Andrew and angio. Were alternative investigations possible? You could have an MRI, whatever breach of duty was established. Ultimately, the clinician was responsible there for not explaining the adequate information there. And the professional duty of candor would have been established by identifying the issues, highlighting the problems, stating the problem to the patient, their family making sure that you've done everything within your practice to reflect and improve your practices going forward, your professional duty you are establishing. At that point, the statutory level takes it beyond that, and the trust must report it now. The decision, then to take it forward into a legal situation. It remains within the context of the individual and the trust. So that's the That's the distinction there, and what you have to do is not. It's not for you to then go reporting beyond the confines of your trust or anything like that. It's for the trust to take over. So that's the distinction. I hope that answered that brilliant. Thank you. Sure. Um yeah. Looks like it did answer it. Um, if there aren't any more questions we are in encouraging on lunchtime now. So lunch lunch is between 11. 30 till 12. Just a bit of an early lunch so we can get cracking with mock interviews in the afternoon. Um, if you do have any more questions, then just please do post on here, and then I can forward them to Sharon. Or, um, you're gonna be around then. There might be a few minutes of questions, if that's all right, But otherwise, um, if you don't have any, you don't have any questions, then please go and enjoy a lunch refresh. Get some coffee ready for this afternoon, and please double check your slots. Some of them might have changed. So do keep an eye out as to the correct time slot. But thank you. Um, should we do have another question if I saw. All right. Uh, any advice for a situation in which your senior is not expecting, uh is not X executing their duty of Canada's. Sorry. Okay. It's an interesting one. I won't ask to the circumstance, but I presume for the exact details of it. But I presume it's along the lines of something's not quite right. And you feel the patient or individuals involved deserve to know. Um, and they are not explaining. I'm maybe simplifying it, but I interpret that as what you're suggesting. Um, it's a challenging situation, and the other part of this is whether you directly are involved with this. Um, the challenge you'll have is that you may not be one. You may not have the full information to hand. You may not understand the nuances of what that cases and therefore they. It may be a situation that they will eventually explain once all the details are to hand as soon as one earlier on Better. Really. Um, and that's one avenue. I'm trying to be generous now. The alternative avenue to this is there's clearly something's gone pear shaped and, uh, not appropriate dealt with. And in fact, they're withholding information that would largely be more challenging, Um, for yourself, uh, within the confines of what you understand, I would I I would wouldn't take it upon yourself to start charging down and explaining things to family friends. All this sort of stuff. My suggestion more than anything else, not a legal advisers of my suggestion would be to, say, explore the issue with the senior coalition to hand if you're still concerned and go through the appropriate senior management hierarchy. So this would be your supervisors, your adjacent senior clinicians, your clinical directors. It's the natural chain of escalation. What you don't want to do, however, is if you clearly know okay, if you clearly know that a case that has been had a complication has not been escalated, then you'd have to, uh, and you were involved. Then it very much falls on you to disclose it with all transparency. Um, it is not for a cover up act. Nothing is for a cover up back. Um, so that that became my suggestion in terms of interview situation. I think you've written that, haven't you? Yeah. Thank you for doing that. Within the confines of an interview situation, you'd say you'd state the facts way, state the facts, patient checks, intervention, y complications said. Because of these situations we've we've had established that the important thing is to want ensure the patient is safe. I have to review the patient appropriately intervene and ensure that I have made them clinically safe. I have to state the established my professional duty of candidate the patient in order to disclose, uh, the issue that has stabbed taken place and explain that we'll do everything we can to to remove remedy that situation. And I will be reflecting on this appropriately and ensuring that my relevant supervisor informed now if they themselves are reticent to the fact, then you have to search for alternative senior leadership to be able to escalate the issue to that would be my and and you may be because they have their own fears or concerns. But ultimately, this is about the patient, and then not wanting to disclose a complication is that may be damaging to the patient is not good enough. Really? Well, hope you answer that Good. Thanks for, um I think that should be okay. Yeah. So Michael said thank you. So all good. Um, that's brilliant. I'll bring this session to the clothes so we can go off for lunch. But just to remind everyone, um, you would have had an email from to medal, which contains your mock interview slot to just have a look at that and that will tell you which time has been allocated to you. If it has changed, then you would have received more up to date email this morning. Other than that, if your interview slot is say at half past three, then just come back at half past three. You don't have to come back at 12 o'clock. Um, but, uh, but yeah, any questions, then just keep them coming, and we'll be here. Thank you so much. Thanks again. Thanks for your time. Appreciate that. Thank you. Very well. The best guys enjoy your afternoon. Brilliant sessions coming up.