*MEGATHREAD* - The Official 2014 Medicine Interview Preparation Thread

Withdrawal of artificial nutrition and hydration in certain carefully selected patients with no hope of neurological recovery is allowed and there is a fair bit of case law about it. You would not go ahead without careful discussion with the family and a lot of legal advice, but it can be done. Withdrawal of any treatment is not seen as an active means of killing someone.

Oh right thanks for clearing that up! I thought it was unless the patient was dying in which case you would be letting the natural course of events take place. However the patient who has locked in syndrome wanted to be euthanised for the courts disallowed it, could a feeding tube not be removed then since there is a lot of neurological damage?

You don't go breaking confidentiality in every case where a patient decides to make a decision that could potentially put them at harm. If they're competent and are still adamant they'll play the match (in this case), you explain the risks, document it well, and leave him to it.

It's different if it's a communicable disease, if required to do so by a court order, if it's in the interest of the public etc.

Have a read - http://www.qub.ac.uk/methics/BrooksK.pdf

Hi guys not sure if this has been asked.. Why do you want to be a doctor and not a nurse? I'm finding it hard to explain why I want to be a dr and not a nurse cause it's something I just feel!

Doctors do all the sciencey stuff- diagnosing, deciding what treatment to use, doing most procedures.. Nurses are responsible for day-to-day care, like changing dressings etc. So that brings you back to medicine being more challenging, learning throughout your career etc.


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Even if the potential harm could be something as severe as paralysis you would not be allowed to breach the confidentiality and tell the coach providing the 17 year had capacity and clearly understood what he had been told/ he could become paralysed if he played?

Or in this particular case because paralysis is so severe/irreversible then on this occasion the consequences of playing would override the confidentiality and the coach could be informed?

Although that may be true, nursing is still a scientific field in its own right. Therefore, it is important that you emphasise the importance of nurses within the multi-disciplinary team, as with the new extension of roles that nurses acquire in the modern NHS, some do accomplish roles that are traditionally done by doctors, such as taking histories and diagnosing patients. Hence, it is not a good reason to use the science in medicine and the practical facet of nursing as the only factors that differentiate the two. You will have to expand and also talk about the overall responsibility that lies with the doctor. The doctor's role in leadership within the clinical team and its associations with vital decision making.

Nurses do study science.

The former option. You mostly can not override the confidentiality between you and the patient, if (s)he has the capacity to make decisions. If the patient can understand the risks associated with his decision, and clearly communicates the decision he has taken, he is deemed to be competent and has a right to do as he wishes. The GMC does not advise you to forcefully break confidentiality, even if it does lie in the patient's best interest. They have the autonomy to competently decide what they will do or accomplish- for the better, or the worse. All you can do, in this instance, is act as a source of information and advice.

As doctors are allowed to breach confidentiality when there is risk serious of harm or death to the patient or a third party, wouldn't paralysis count as serious harm :O?

In general you can only breach confidentiality if there is risk of damage to others. If a competent adult understands the risks of doing something and willingly persists, that is their decision and you should not interfere. It is different if they lack capacity or are mentally ill, but for a competent adult who understands their decision your job is not to police their life.

Ohh okay I didn't know that, I read it somewhere as even if they are competent and will cause injury to themselves confidentiality can be breached, thanks!


Quick question can confidentiality be breached but doctors generally will not if they are competent? It said it in a book as "Disclosure of personal information without consent may be justified where failure to do so may expose the patient or others to risk of death or serious harm"

Which book? The GMC guidance generally only talks about "the public interest" or "third parties" rather than the patient themselves.

You would certainly be justified in seeking legal advice on a case like this, if the patient really was "at risk of paralysis" (though IRL if a patient's spine was so badly injured that this was the case it's unlikely you'd want them to leave hospital even if they weren't going to play football - but this is a technical flaw in a hypothetical case) but I think it very unlikely that telling the coach - an unrelated third party - would be considered the right answer.

You are there to advise and treat, you cannot force a patient to follow your advice/treatment (except for under the Mental Health Act/Mental Capacity Act) - it is their choice.

It's "Medical Ethics and Law" by Tony Hope

It says that quote under "Confidentiality and the GMC: the interests of others (abbreviated from GMC guidance)"

So for interview purposes if asked would I generally not breach confidentiality? Or would I seek legal advice?

It's "Medical Ethics and Law" by Tony Hope

It says that quote under "Confidentiality and the GMC: the interests of others (abbreviated from GMC guidance)"

So for interview purposes if asked would I generally not breach confidentiality? Or would I seek legal advice?

wondering if I should get that book? is it any good? looks slightly complicated :P

I'd recommend it! It's really, really thin and "unbrick like", unlike normal textbooks these days.

Correction: Wait, sorry! I was referring to the tiny "A Very Short Introduction to Medical Ethics" by the same author. XP