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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.
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:
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.