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Medicine 2012...(hopeful entrants) !!

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Imagine you're a GP. A woman comes to see you because she has a chest infection. When you go to listen to her heart/take blood pressure etc, she refuses. After you explain to her that it's necessary to examine her so that you can make a diagnosis, she reluctantly agrees, and you find bruises all over her body. When you question her about it, she gets hysterically upset and admits that her husband is physically abusing her, but begs you not to contact the police. She's competent and doesn't have minors in her care. What do you do?

(Note- I don't even know if you check heart rate/bp for chest infections but that's not the point of this so I'm just making assumptions!)
Original post by Unbiased Opinion
Imagine you're a GP. A woman comes to see you because she has a chest infection. When you go to listen to her heart/take blood pressure etc, she refuses. After you explain to her that it's necessary to examine her so that you can make a diagnosis, she reluctantly agrees, and you find bruises all over her body. When you question her about it, she gets hysterically upset and admits that her husband is physically abusing her, but begs you not to contact the police. She's competent and doesn't have minors in her care. What do you do?

(Note- I don't even know if you check heart rate/bp for chest infections but that's not the point of this so I'm just making assumptions!)


Tell her to come back for an appointment with a female GP who would examine her properly. Tell her if she didn't come back you'd tell the police.

Just my initial reaction, thinking time roughly 2 seconds. I should probably buy a medical ethics book.
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Mobs25
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loool think i might hve 2 apply with u all if i dont get my offer from kings lol... so has any1 decided wer ther going? btw if thers anything any new ucas applicant wants 2 knw ..fire away... :smile:
Original post by Unbiased Opinion
Imagine you're a GP. A woman comes to see you because she has a chest infection. When you go to listen to her heart/take blood pressure etc, she refuses. After you explain to her that it's necessary to examine her so that you can make a diagnosis, she reluctantly agrees, and you find bruises all over her body. When you question her about it, she gets hysterically upset and admits that her husband is physically abusing her, but begs you not to contact the police. She's competent and doesn't have minors in her care. What do you do?

(Note- I don't even know if you check heart rate/bp for chest infections but that's not the point of this so I'm just making assumptions!)


Oh, who doesn't love a bit of medical ethics :P
The woman is competent enough to make her own decision on the matter, and the situation may be unclear, however it is generally taken that a doctor should do whatever they can to improve the quality of life of a patient if they want it. It would be best to discuss the situation with the woman, and explain to her that getting the police involved should not put her in any danger, however if she still refuses, the GP has to respect her wishes and remain silent (may be wrong here).

Some doctors on my work experience gave me a good one, a young girl aged 12 who is a Jehova's witness comes into hospital after a car crash and needs a blood transfusion or will die. Her parents are called up and state if you give the blood transfusion you will be sued and have all sorts of legal action taken against you. What would you do?
(edited 13 years ago)
Original post by Straight up G
Tell her to come back for an appointment with a female GP who would examine her properly. Tell her if she didn't come back you'd tell the police.

Just my initial reaction, thinking time roughly 2 seconds. I should probably buy a medical ethics book.


Well, there isn't a right or wrong answer in ethics (within reason!). I think I can see where you're coming from, but why would she prefer a female GP? It's not the examining part she has an issue with, it's the whole "ahhh crap, my GP knows I'm being abused, will he tell the police?!" that worries her. Would the female GP examine her psychologically or physically?

Original post by Normandy114
Oh, who doesn't love a bit of medical ethics :P
The woman is competent enough to make her own decision on the matter, and the situation may be unclear, however it is generally taken that a doctor should do whatever they can to improve the quality of life of a patient if they want it. It would be best to discuss the situation with the woman, and explain to her that getting the police involved should not put her in any danger, however if she still refuses, the GP has to respect her wishes and remain silent (may be wrong here).

Some doctors on my work experience gave me a good one, a young girl aged 12 who is a Jehova's witness comes into hospital after a car crash and needs a blood transfusion or will die. Her parents are called up and state if you give the blood transfusion you will be sued and have all sorts of legal action taken against you. What would you do?


I think I know the GMC guidelines on this, but I'm keeping my mouth shut so we get a full on ethical discussion. :smile:

Competence only stands insofar as certain conditions are met: one of these is that the patient makes decisions free of coercion. In the context of research, it means that the patient isn't threatened with GBH or death if they refuse to take part. I reckon this can be transferred to consent in privacy... so, like, the woman, in not wanting the doctor to tell the police is making this decision because she is being coerced into it by her husband. But then the husband may not have explicitly said "if you tell anyone I'll kill you", in which case he could claim (and she could claim) that's he's not coercing her. But it can be implied, surely, the threat?

Well, the GMC guideline is that a doctor may act against the parent's wishes in an emergency situation if it prevents death or serious harm from happening to the child... so legal action against me wouldn't go far, I hope. :p: I'd be worried about the child being shunned by parents though. I would probably try and somehow stop them from rejecting their... get a higher up JW person who's not against blood transfusions to talk to them? If that's even possible.
Original post by Unbiased Opinion
Imagine you're a GP. A woman comes to see you because she has a chest infection. When you go to listen to her heart/take blood pressure etc, she refuses. After you explain to her that it's necessary to examine her so that you can make a diagnosis, she reluctantly agrees, and you find bruises all over her body. When you question her about it, she gets hysterically upset and admits that her husband is physically abusing her, but begs you not to contact the police. She's competent and doesn't have minors in her care. What do you do?

(Note- I don't even know if you check heart rate/bp for chest infections but that's not the point of this so I'm just making assumptions!)


Confidentiality can, and is supposed to be broken when the patient is at risk. This is not a dilemma, as doing anything other than reporting would likely get you struck off.
Original post by Normandy114
Oh, who doesn't love a bit of medical ethics :P
The woman is competent enough to make her own decision on the matter, and the situation may be unclear, however it is generally taken that a doctor should do whatever they can to improve the quality of life of a patient if they want it. It would be best to discuss the situation with the woman, and explain to her that getting the police involved should not put her in any danger, however if she still refuses, the GP has to respect her wishes and remain silent (may be wrong here).


yes you are
Has anyone decided when they're going to sit their UKCAT exam? (BMAT's on one specific day, isn't it?)
Original post by SteveCrain
Confidentiality can, and is supposed to be broken when the patient is at risk. This is not a dilemma, as doing anything other than reporting would likely get you struck off.


But then couldn't we apply this to everything? If autonomy is overriden by beneficence, then why should a patient be able to make a decision the doctor doesn't deem in their best interest? Why is it that an abused woman can have her autonomy overridden but someone refusing lifesaving treatment for no reason meaning they'll die painfully even though they could carry on living can't?
Original post by Unbiased Opinion
But then couldn't we apply this to everything? If autonomy is overriden by beneficence, then why should a patient be able to make a decision the doctor doesn't deem in their best interest? Why is it that an abused woman can have her autonomy overridden but someone refusing lifesaving treatment for no reason meaning they'll die painfully even though they could carry on living can't?


Sorry I didn't make it clear in my previous post

When the patients life is at risk or the patient puts the lives of others at risk, autonomy is to be broken.
How much Work Experience has everyone got?

I'll have been doing Receptions in a Hospice for a just under a year when I apply, and I did 6 evenings in a GP's... will that be enough? (Looking at Oxford & Manchester at the minute!)
Original post by JoeLatics
How much Work Experience has everyone got?

I'll have been doing Receptions in a Hospice for a just under a year when I apply, and I did 6 evenings in a GP's... will that be enough? (Looking at Oxford & Manchester at the minute!)


If I continue as is, 1 week shadowing consultant/F1s, 1 week teaching assistant, and 6 months charity shop volunteering. If I actually stop procrastinating, I'll try to get a job at local care home and hopefully some work experience at a GPs. Remember though, Quality > Quantity!
Original post by JoeLatics
How much Work Experience has everyone got?

I'll have been doing Receptions in a Hospice for a just under a year when I apply, and I did 6 evenings in a GP's... will that be enough? (Looking at Oxford & Manchester at the minute!)


I've done about the same at a GPs and a couple of afternoons at a Methadone clinic. Some in hospital and then the obligatory volunteer work.
I think what you've got'll be enough
Original post by Normandy114
If I continue as is, 1 week shadowing consultant/F1s, 1 week teaching assistant, and 6 months charity shop volunteering. If I actually stop procrastinating, I'll try to get a job at local care home and hopefully some work experience at a GPs. Remember though, Quality > Quantity!


Lordy, that's not bad at all!!

Original post by SteveCrain
I've done about the same at a GPs and a couple of afternoons at a Methadone clinic. Some in hospital and then the obligatory volunteer work.
I think what you've got'll be enough


Only ask because the Connexions people are going on about how they can get us WE, wondering if it's worth getting (seeing as I'm already committed to Med!) - will probably go for it, I think!
Original post by JoeLatics

Only ask because the Connexions people are going on about how they can get us WE, wondering if it's worth getting (seeing as I'm already committed to Med!) - will probably go for it, I think!


no point doing more at a GPs
Original post by JoeLatics
How much Work Experience has everyone got?

I'll have been doing Receptions in a Hospice for a just under a year when I apply, and I did 6 evenings in a GP's... will that be enough? (Looking at Oxford & Manchester at the minute!)


got 2 weeks at Royal National Orthopaedic Hospital, shadowing anaesthetists and surgeons :biggrin:

in the process of calling up as many GPs as possible who are around me to ask for work experience during the May/June half term as all of my AS exams will be over by then

got some work experience shadowing an ENT doctor/surgeon (not sure) in Germany at end of this June :biggrin: (German work exchange programme from school)

so hopefully i can boast about this in my personal statement (got nothing else good to write :sad:)
Original post by thegodofgod
got 2 weeks at Royal National Orthopaedic Hospital, shadowing anaesthetists and surgeons :biggrin:

in the process of calling up as many GPs as possible who are around me to ask for work experience during the May/June half term as all of my AS exams will be over by then

got some work experience shadowing an ENT doctor/surgeon (not sure) in Germany at end of this June :biggrin: (German work exchange programme from school)

so hopefully i can boast about this in my personal statement (got nothing else good to write :sad:)


Nice, try to get some variety, as currently all you have sorted is shadowing hospital doctors, get one of those GP ones and some decent volunteering and you're good to go.
Original post by JoeLatics
How much Work Experience has everyone got?

I'll have been doing Receptions in a Hospice for a just under a year when I apply, and I did 6 evenings in a GP's... will that be enough? (Looking at Oxford & Manchester at the minute!)


So far I've had a week in two hospitals and I'd been volunteering in British Heart foundation shop (and my family fostered if that counts though I guess thats more life experience than work). I had an interview at St. Andrews and the woman said "so I see you've had a lot of experience then" and went on to ask about BHF (i'd covered the 'real' work in my ps.

But then again I didn't get in so it mighta been lack of W.E. that screwed it for me, but I think it was the UKCAT. But if you can get more experience, it's not going to hurt - thats what I've been advised :smile:
Original post by SteveCrain
Sorry I didn't make it clear in my previous post

When the patients life is at risk or the patient puts the lives of others at risk, autonomy is to be broken.


So you don't believe that a patient can make the decision to end their life at all? Even if they're suffering a lot? What if they have a terminal illness? I agree with patients putting others at risk because then other people's autonomy (i.e. desire to live/carry on unharmed) is endangered, but I don't agree that a patient can't make the decision to end their life because, at the end of the day, I have no right to impose what I believe to be their best interests on them.
Original post by Unbiased Opinion
So you don't believe that a patient can make the decision to end their life at all? Even if they're suffering a lot? What if they have a terminal illness? I agree with patients putting others at risk because then other people's autonomy (i.e. desire to live/carry on unharmed) is endangered, but I don't agree that a patient can't make the decision to end their life because, at the end of the day, I have no right to impose what I believe to be their best interests on them.


I said: When the patients life is at risk or the patient puts the lives of others at risk, autonomy is to be broken.

I did not say the patient cannot make choices such as life or death.

The only thing you can infer from my statement is that I believe if the patient chooses to admit to a doctor that they are planning to end their life, they cannot expect confidentiality.

Rights have nothing to do with it.

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