PDF Medico-Legal and Ethical Issues in Cardiology and General Medicine

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Do I have an obligation to tell the DLA? You should advise Mr O about the impact of his potential medical condition and recommend he does not drive until the incident is investigated further. If a patient has a condition that may affect their ability to drive, you should tell them to report their condition to the Driving Licensing Authority DLA.


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If Mr O is diagnosed with epilepsy and is started on treatment, he should adhere to prescribed medical treatment and attend for regular follow-up so monitoring of his condition can be made and consideration given to his fitness to drive. He must comply with the requirements of his licence, including periodic medical reviews. If the patient is hostile about the possibility of restrictions to their driving or withdrawal of their licence, you should consider referring the driver to another practitioner or referring them directly to the DLA.

Consider the immediate risk to public safety; risk of disclosure versus non-disclosure; ethical and professional obligations, and whether the circumstances indicate a serious and imminent threat to the health, life or safety of any person. In exceptional circumstances where there is a risk to the public and the driver cannot, or will not, cease driving, you should report your concerns to the DLA.

The DLA will attempt to make contact with the patient. So, for example, if a patient is diagnosed with epilepsy and has been advised not to drive by a neurologist, as their fits are not under control, but you become aware that they are continuing to do so, you can report that matter to the DLA as a public interest disclosure. Thank you for the comment! Your comment must be approved first. You've already submitted a review for this item.

Thank you! Your review has been submitted successfully. Comment cannot be empty. Rating is required. You typed the code incorrectly. Please try again. Skip navigation Search. Membership information Counselling service Help in dealing with unwanted attention from the media FAQs. Medicolegal contact Feedback Contact the press office Have a complaint? Member Services Online Adverse incident reporting Request a speaker. Common problems: Your medicolegal dilemmas resolved Members in Ireland contact MPS about a range of medicolegal dilemmas — here medicolegal adviser Dr Sonya McCullough shares some of them, together with the advice given.

Reasonable grounds for removal include: The patient is unlikely to co-operate The patient is unlikely to make the lifestyle changes required to make the treatment effective The patient is violent or threatening. Has there been a misunderstanding that can be rectified? Explore alternatives to ending the professional relationship. However, you still owe a duty of care to the patient and so you should also take steps to ensure that arrangements are made quickly for the continuing care of the patient.

Scenario 4 The solicitor of the wife of a patient telephones you to inquire about the diagnosis and prognosis of your patient. The principles of disclosure of information other than for treatment of the individual patient are described in the following instructions from the GMC:.

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When asked to provide information you should. There are circumstances where you have no choice but to disclose confidential information about your patient, for example if instructed to do so by a judge, or to comply with a specific statutory requirement such as notification of a known or suspected communicable disease. In this case you may not tell the solicitor anything about your patient without the specific consent of the patient.


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  • When dealing with telephone queries it is difficult to ascertain with whom you are talking. It is better to refuse to discuss issues on the telephone but to answer questions in writing after obtaining consent.

    Even after obtaining consent you should only disclose factual information which you can substantiate and present it in an unbiased manner. Since the Access to Medical Reports Act of your patient has the right to see written reports about them before they are disclosed. You should ask your patient if this is required. Scenario 5 You admit a barrister after a sudden collapse where an eye witness observes him to have a grand mal fit. After full investigations are negative you discharge him.

    He tells you that he is due in court the next day in Liverpool. You have advised him not to drive but you are convinced that he will. If it is not practicable, you should disclose information promptly to an appropriate person or authority. The GMC gives specific advice for the patient who continues to drive despite medical advice not to do so. If you think the patient may be a danger to himself or others when driving and you cannot persuade him to stop driving or to inform the Driver and Vehicle Licensing Agency himself, then you should disclose the information to a medical adviser at the agency.

    You should let him know of your decision. Scenario 6 Your patient is a drug addict and during the course of the consultation admits to mugging a number of people to rob them in order to pay for his habit.

    Singapore Medical Association - For Doctors, For Patients

    He asks you for methadone in order to stop this recidivist behaviour. The patient is admitting to having committed criminal offences involving violence. He is threatening to commit further offences. He is a possible threat to your safety.

    If you feel your safety is at risk you could sign a prescription as a means of getting the patient to leave so that you could contact the police. Scenario 7 The ward sister complains to you that the cover doctor did not get up at night to see an elderly women who was terminally ill and dying from leukaemia. She had severe thrombocytopenia and was bleeding from every orifice.

    Browse Medical Ethics

    The patient was very distressed, as were all the ward staff even though they knew she was dying. The doctor had been telephoned twice but refused to get up. He was a registrar acting down on a senior house officer call rota. Referring the patient to another practitioner, when indicated. This problem can therefore be considered in a similar manner to scenario 2 in considering an under-performing doctor. Scenario 8 Your colleague appears to be drinking heavily. He is late for work, always smells of alcohol in the morning, and has unexplained absences during the day.

    Ethical Dilemmas: An Integrated Approach to Consultation and Problem-Solving

    The safety of patients must come first at all times. If you have grounds to believe that a doctor or other healthcare professional may be putting patients at risk, you must give an honest explanation of your concerns to an appropriate person from the employing authority, such as the medical director, nursing director or chief executive, or the director of public health, or an officer of your local medical committee, following any procedures set by the employer.

    If there are no appropriate local systems, or local systems cannot resolve the problem, and you remain concerned about the safety of patients, you should inform the relevant regulatory body. If you are not sure what to do, discuss your concerns with an impartial colleague or contact your defence body, a professional organisation or the GMC for advice.

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