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Medico-legal helpline

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Sample questions

Breaking bad news

An example of both types of question is shown below. Answers at the bottom of the page.

Q1 - ranking question

Whilst taking a history from Mr A, a 63 year old diabetic patient who is being admitted as an emergency with a black toe, he asks you if he is going to lose his leg.

Rank the following responses in order from most appropriate to least appropriate.

  1. Explain that you can't feel his foot pulses and there is a possibility he may lose his leg.
  2. Reassure him that everything will be okay.
  3. Tell Mr A that you need to take a full history and complete an examination as well as arrange some further tests. Once the test results are back a senior doctor will discuss the results with him.
  4. Advise Mr A that you will need to discuss his case with your registrar before you can answer his question.
  5. Tell Mr A that there is an expert limb fitting centre locally, so he shouldn't worry about losing his leg.

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Q2 - selecting question

Whilst rewriting a patient's drug chart, you notice that one of your colleagues has prescribed enoxaparin for a patient who is also on warfarin.

Choose the top three most appropriate actions from the following list:

  1. Immediately rewrite the drug chart without the enoxaparin, and call your colleague to tell them you have corrected the error.
  2. Complete an incident form.
  3. Tell your colleague and suggest that they might want to inform the patient's consultant.
  4. Tell the patient.
  5. Ask the nursing staff and the pharmacist why they hadn't spotted the error.
  6. Rewrite the drug chart without the enoxaparin and hope no-one spots the error.
  7. Discuss the incident with the consultant in charge after reviewing the patient and their recent blood tests.
  8. Rewrite the drug chart without the enoxaparin and ensure that the old chart is clearly marked as an old chart so that the error will not be repeated.

Q1 answer: C, D, A, B, E

The GMC's 'Good medical practice' (2013) says you have a duty to listen to your patients, take account of their views and respond honestly to their questions (paragraph 31). You must also recognise and work within the limits of your competence, whilst adequately assessing the patient's condition (paragraphs 14 and 15a). Assess and investigate the patient before giving them information on their condition, and seek support from senior colleagues when developing a management plan for patients.

Q2 answer: H, G, B

Your first concern should be the care of the patient, and the error should be corrected. Assess the patient thoroughly, document that assessment and then tell the doctor in charge of the patient about the error and the patient's current condition. To keep patients safe you must contribute to adverse event recognition. Because there is a duty of candour, the patient needs to be told of the error and an apology offered, but this would usually be done by a senior doctor. Additionally your colleague will need to be informed so they can reflect on the error, but the first priority is to the patient.

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