Reflection bank – list of my

experiences and the links to medicine

Note from author: Thanks for buying my notes and all the best for your interview! To be clear this PDF does
not consist of any of my interview questions and this document is not permitted to be shared around or to
be resold. This is not the original copy, but is the purchased copy.
- Olivia

Definitions of the values

Communication “The act of exchanging, expressing or conveying information

to one another” this can be through forms of speech which is
a form of verbal communication, non-verbal communication
includes body language, facial expressions and gestures,
tailoring communication
Empathy “The ability to sense other people’s emotions, coupled with
the ability to imagine what someone else might be thinking
or feeling” this includes acknowledgement of what someone is
going through or encouragement
Intelligence “Main two intelligences used, cognitive intelligence which is
referred to as understanding developed through thinking,
experiences and emotional intelligence which is the ability to
empathise with others, own management of emotions”
Compassion “Feeling that arises when you are confronted with another’s
suffering and feel motivated to relieve the suffering”. This is
different to empathy as you want to take action, doctors have
to follow stranger compassion (compassion for people we do
not know), different types of compassion, familial (family
member) Compassion is not just recognising the suffering of
the patient but acting to reduce the suffering
Respect “Treating people in a fair and equal way, with upmost care”
respect in relationships builds the feeling of trust, safety and
wellbeing (similar to integrity e.g. willing to admit to one’s
limitations & accountability)
Resilience The ability to cope with and recover from setbacks,
compromised from the 5C’s community, compassion,
confidence, commitment and centring, “capacity to respond
to stress in a healthy way such that goals are achieved at
minimal psychological and physical cost”
Critical thinking “Is the ability to analyse facts and form a judgement, the
ability to think clearly and rationally and to understand the
logical connection between ideas” e.g., deciding how you use
your time as it requires continuous evaluation on how you
spend time
Leadership “The action of leading a group of people or an organization,
position of guiding a group” good leaders possess self-
awareness and communication. Has 3 attributes: courage, the
ability and desire to innovate and improve; and the ability to
manage risk and uncertainty
Decision making “Process of making choices, identifying a decision, gathering
information and assessing alternative resolution”
collaborative process which a clinician supports a patient to
reach a decision about their treatment
Teamwork “A group of people acting together as a team or in the
interests of a common cause” (e.g., the patient), the process
of working collaboratively with a group of people in order to
achieve a goal
 Patience “Patience means being able to wait calmly in the face of
frustration or adversity” the ability to wait or to continue
doing something despite difficulties
Professionalism “Encompasses the way you carry yourself, your attitude and
the ways you communicate with others” being profession
ensures a good first impression and successful interpersonal
relationships, conducting oneself with responsibility, integrity,
and excellence
Adaptability “A person’s ability to adjust to changes in their environment,
flexibility,” ability to change and remain flexible when
encountering new or different circumstances, dealing with
new policies and new team
Conscientiousness “The quality of working hard and being careful,
demonstrating a strong work ethic”, attention to detail and
showing commitment and purpose

** Capacity – Ability to give consent, relies on the patient being able to understand
information and use this information to make a decision CAPACITY ASSESSMENT

Tools to assess capacity - Mental capacity act, used for people who may lack capacity e.g
dementia, severe learning disability, brain injury and strokes.

2-stage test of capacity 1. Does the person have an impairment of their mind or brain as a
result of illness or external factors? 2. Does the impairment mean the person is unable to
make a specific decision when they need to?

UNABLE TO MAKE A DECISION IF: Cannot understand information relevant, retain

information, use or weigh up that information as part of making the decision

1. You assume the patient has capacity unless otherwise proves not to
2. First give them information and then allow the patient to understand
3. Make sure to provide them with risks or benefits
4. Then ask patient to retain and recite the information

[IF THEY CAN DO ALL THAT PERFECTLY THEY HAVE CAPACITY AND CANPROVIDE AN
INFORMED CONSENT]

6 core values in the NHS constitution

WHY IS THIS PUT IN PLACE – Patients, public and staff have developed these values that inspire passion in the
NHS and underpins everything it does, organisations will develop and build upon these values, provides
common ground for co-operation to achieve shared aspirations at all levels of the NHS

Working together for patients  Patients come first in everything

 Involve patients, staff, families, carers,
communities and professionals in and out of
NHS
 Put the needs of patients and communities
first
 Speak up when things go wrong
 Respect and dignity  Value every person as an individual (doesn’t
matter if its staff, patient)
 Respect their aspirations, commitments in life
 Understand their priorities, needs, abilities and
limits
 Take what others have to say seriously
 Honest and open about point of view and what
we cannot do
Commitment to quality of care  Earn trust by insisting on quality and striving to
get basics of quality of care
 Encourage and welcome feedback from
patients, families, carers and staff
 Use this feedback to improve the care
provided and build upon the success
Compassion  Ensure that compassion is central to the care
provided
 Respond with humanity and kindness to each
person’s pain, distress, anxiety
 Search for things to do to give comfort and
relieve suffering
 Find time for patients, their families and carers
 Do not wait to be asked because we care
Improving lives  Improve health and wellbeing and people’s
experiences of the NHS
 Cherish excellence and professionalism
 Recognise all have a part to play in making
ourselves, patients and communities healthier
Everyone counts  Maximise resources for the benefit of the
whole community
 Making sure no one is excluded, discriminated,
left behind
 Accept some people need more help and
difficult decisions have to be taken
 Wasting resources = wasting opportunities for
others

7 principles that guide the NHS

WHY IS THIS IN PLACE- 7 key principles guide the NHS in all it does, underpinned by the 6 core values which
have been derived from discussions with staff, patients and the public

WHAT DOES IT DO? – Brings together in one place what staff, patients and taxpayers can expect from NHS,
confirms that the NHS belongs to all of us, sets out for the first-time new rights for patients, explains where
the NHS pledges to improve services and working environment, describes everyone’s responsibilities and
makes clear how we can best make use of NHS resources.

WHY IS IT NECESSARY? – Secures the future of the NHS for generations to come, (gov must renew constitution
every 10 years), aims to ensure high quality free NHS services, tells staff and patients what their entitlements
are, sets out a vision which all staff should be trusted and actively listened to

RIGHTS AND PLEDGES? – Access to health care services, quality of care and the environment, nationally
approved treatments and programmes, respect, consent, confidentiality, informed choice
The NHS provides a comprehensive service, available to all  It is available to all irrespective of gender, race,
disability, age, sexual orientation, beliefs,
pregnancy or partnership status, no one will be
discriminated in any form
 Designed to improve, prevent, diagnose and
treat both physical and mental health problems
 Has a duty to every individual and respecting
their human rights
 Has a wider social duty to promote equality
though service it provides
 Pay extra attention to sections of society where
improvements in health and life expectancy are
not keeping pace with the rest of the population
Access to NHS services is based on clinic need, not an  One’s health should not be jeopardised by
individual’s ability to pay wealth, so the NHS services are free of charge
 There are exceptions in certain circumstances
however e.g., not ordinarily resident in the UK,
or specific prescriptions and so on
The NHS aspires to the highest standards of excellence  Provides high quality care that is safe, effective
and professionalism and focused on patient experience
 Supports the management of education, training
and development
 Respect, dignity, compassion and care should be
at the core of how patients and staff are treated
The patient will be at the heart of everything the NHS  Aims to support individuals to promote and
does manage their own health
 Services should reflect, be co-ordinated, and
tailored to the needs and preferences of patients
 Patients with their families and carers will be
involved where appropriate
 NHS will encourage feedback from public,
patients and staff and welcome it and use it to
improve the service
The NHS works across organisational boundaries  Works in partnership with other organisations in
interests of patients, local communities and
wider population
 Integrated system of organisations, services
which are bound together by principles and
values
 Committed to working with local authority
services, and wide range of private and
voluntary organisations to deliver improvements
in health and wellbeing
The NHS is committed to providing best value for  Committed to providing the most effective, fair
taxpayer’s money and sustainable use of finite resources
 Public funds for healthcare will be devoted solely
to the benefit of the people that the NHS serves
The NHS is accountable to the public, communities and  National service funded through national
patients that it serves taxation
 Government sets framework for the NHS but
most decisions especially about treatment is
taken by local NHS
  System of responsibility and accountability for
taking decisions in the NHS will be transparent
and clear to the public, patients and staff

** THE STRUCTURE OF THE NHS THE STRUCTURE OF THE NHS

 Primary care
o First point of contact for people that need healthcare e,g GPs, dentists, pharmacy or drop-in-
centres, this service is free care at the point of use and is the central pillar of the NHS
o It is delivered by general practitioners who often work holistically thinking of a patient in
their entirety
 Secondary care
o Provided to patients by specialists and healthcare professionals to whom patients are often
referred through a GP
o Includes both emergency and non-emergency hospital contacts such as A&E, mental and
maternity health access, outpatient routine clinics
o May be planned or involve urgent or emergency care
o Often referred to as ‘hospital and community care’
o E.g treatment for a fracture
 Tertiary care
o Refers to highly specialised treatment beyond the remit of traditional secondary care
o Provided over an extended period of time by specialists, involving advanced procedures or
may involve special state of the art facilities
o Services that may come under this umbrella include neurosurgery, transplant operations, ad
secure forensic mental health services
 Quaternary care
o Extension of tertiary care, even more specialised and highly unusual
o Very specific so not every hospital/medical centre offers this treatment
o Examples include experimental medicine and procedures
o Uncommon and specialized surgeries
 Clinical commissioning groups (CCGs)
o Responsible for providing primary care at a local level
o Made up of senior consultants, nurses, and GPs
o Ensures a fair representation of the different professionals who should be consulted when
making funding decisions
o Receive 60% of funding of the NHS and use this to fund hospitals as well as primary care
o CCGs are responsible for funding the whole spectrum of care-primary, secondary, tertiary
o Responsible for commissioning most NHS services, there can be many CCGs and each group
decides which services and treatments are available in their hospitals and chooses how
secondary care is provided
o In charge of locally sourcing and commissioning healthcare related services such as
ambulance services, mental health providers
 Department of health
o Headed by the secretary state for health, and is in charge of passing money onto several
areas
o Responsible for funding and coming up with policies to do with healthcare in the UK
 NHS England
o Umbrella body that oversees healthcare
o Independent body which means that department of health cannot interfere directly with its
decisions
o Responsible for ensuring that there is an effective system of CCGs and must provide support
for commissioning
o Setting NHS strategy
  What are integrated care systems?
o Partnerships of organisations that come together to plan and deliver joined up health and
care services
o The purpose is to bring partner organisations together to:
 Improve outcomes in population health and healthcare
 Tackle inequalities in outcomes, experience and access
 Enhance productivity and value for money
 Enhance productivity and value for money
o Helps health and care organisation tackle complex challenges:
 Improving health of children and young people
 Supporting people to stay well and independent
 Supporting those with long term conditions or mental health issues
 Caring for those with multiple needs
 Getting the best from collective resources so people get care as quickly as possible

MEMBERS OF THE MDT AND THEIR ROLES

MDT members Roles & duties Summary of education

Psychiatrist Performs assessments, provide talking Specialises in the assessment and

therapies, prescribe medication, management of mental health
investigate for physical illnesses conditions, different types of
psychiatrists e.g., one for adults, one for
forensics

Have expertise in assessment of mental

health problems, in the assessment of
risk e.g., suicide and violence and in the
management of mental illness, employ
treatments including talking therapies,
social interventions and medications
Psychologist Provide specialised talking therapies, Working in the mental health services
perform in-depth assessments of would mean that they must have
aspects of brain functioning and obtained a primary degree in
behaviour psychology, have expertise in
assessment of psychological functioning
and has specialist training in clinical or
counselling psychology

Occupational therapist Provides skills assessments, formulate Work in the rehabilitation of patients
rehabilitation plan which is delivered suffering with mental illness, aiming to
both individually and in groups help recovery in occupational, social
and day to day skills. Provide
specialised assessment of functioning in
areas such as social skills or ability to
perform everyday tasks

Social worker Provide support for families, provide Place emphasis on the strengths and
talking therapies, advise in relation to the natural coping abilities of the
housing, finance and supports service users, act to empower service
users to access the services and
resources required, to recover and
maintain good mental health and
achieve a good quality of life in terms of
relationships, income, occupation and
accommodation
 STRUCTURE OF MEDICAL TRAINING IN THE NHS

 First have to study medicine at an undergraduate level or via a graduate medical course (this will take
4-6 years of study)
 After graduation, you will progress onto postgraduate training via the foundation programme
o During this time, they are known as junior doctors
 After they must undertake and complete and integrated 2-year programme of general training in
order to practice as a doctor in the UK
 Foundation programme consists of foundation year 1 and year 2 (FY1 AND FY2)
o This programme acts as a bridge between undergraduate medical training and speciality and
general practice training
o Designed to provide trainees with defined practical skills and competencies
 After completing the foundation programme, doctors will continue to train in either a specialist area
of medicine or in general practice
o E.g. orthopaedics, surgery, anaesthetists, haematologist
o Can be delivered in following ways:
 Run-through training programmes = lasting 3 for GP and 5-7 for other specialities
 Core training = lasts 2/3 years depending on the speciality
 ACCS (Acute care common stem) = 3-year programme following F2, training for
those who wish to enter higher speciality training EM (emergency medicine), or
anaesthetist

THE NHS AND COSMETIC/NON-EMERGENCY SERVICES

 Is cosmetic surgery available on the NHS

o It is not generally routinely provided on the NHS however it may be provided if it has
psychological or other health reasons
 Breast implants = if you have very uneven breasts or no breasts and its causing
significant psychological distress (gender identity)
 Nose reshaping = if you have breathing problems
 Ear correction surgery = if child needs it or adult has prominent ears that are
causing distress
 Female breast reduction = distressed about size of breasts and causing problems
such as backache
 Weight loss surgery = if you cannot lose it (gastric sleeves, gastric bands)
o Reconstructive or plastic surgery is often available on the NHS as this is different from
cosmetic surgery
o Reconstructive surgeries main aim is to repair and reconstruct missing or damaged tissue
and skin after an illness, accident or birth defect, burns
o Plastic surgeries may include rebuilding a woman’s breasts after a mastectomy (operation to
remove a breast) or repairing a cleft lip
o Non-emergency services are provided (111) when you have an urgent healthcare need that
isn’t a life-threatening situation
 They provide you with a short assessment and then directs you to the right service
at the right time as close to your house as possible
o You cannot get general breast implants on the NHS, bum implants or muscle addition, must
be paid privately and at great expense due to the nature of the service
o Have to use ethics and the 4 pillars of medical ethics when assessing whether a surgery is
medically necessary e.g a bum lift is not going to cause a life-threatening issue if you don’t
get it
o Ethics: NHS does the most to maximise quality of life, and does what deems to be medically
necessary
  Beneficence: what doctor deemed to be good for their patient and good for their
health, ensuring further harm doesn’t leave these things unchecked e.g. a soldier
needing to get shrapnel removed from his skin and getting it reconstructed as well
as possible
 Autonomy: you can choose whether or not to have this intervention
 Non-maleficence = you’re stopping further harm that can be made to the patient by
doing this early

NHS LONG TERM PLAN

 On 7th January 2019 NHS England published their long-term plan for the NHS
 The plan sets a strategic direction for the NHS in England over the next 10 years
 It is there to improve the quality of patient care and health outcomes
 Plan has been developed in partnership with frontline health and care staff
 There’s been concerns about funding, staffing and increasing inequalities and pressures from a
growing and ageing population and therefore the NHS takes into account of all three
 The NHS long term plan aims to make sure the NHS is fit for the future providing high quality care and
better health outcomes for patients and their families
 The plan focuses on building an NHS fit for the future by:
o Enabling everyone to get the best start in life
o Helping communities to live well
o Helping people to age well
o Improve out of hospital care by supporting primary medical and community health services
o Ensure all children get the best start in life by continuing to improve maternity safety
including halving the number of stillbirths, maternal and neonatal deaths and serious brain
injury
o Support older people through more personalised care and stronger community and primary
care services
o Make digital health services a mainstream part of the NHS so that in few yeas time, patients
in England will be able to access a digital GP offer
 They try to base it on 3 things:
o 1: Giving everyone the best start in life
 Reducing stillbirths, and mother and child deaths during birth
 Taking further action on childhood obesity
 Increasing funding for children and young people’s mental health
 Bringing down waiting times for autism assessments
 Providing the right care for children with a learning disability and delivering the best
treatments available for children with cancer
o 2: Delivering world-class care for major health problems to help people live well
 Providing education and exercise programs, faster and better diagnosis
 Supporting families and individuals with mental health problems
 Making it easier to access talking therapies
o 3: Helping people age well by:
 Increasing funding for primary and community care
 Upgrading NHS staff support to people living in care homes
 Helping more people to live independently at home for longer

Roles of a doctor
WHAT IS THE ROLE OF DOCTORS - [REFERENCED FROM ADVANCING MEDICAL PROFESSIONALISM] , Doctors
are not only there to treat people, they have other roles which are stated below, 7 other roles

Roles of a doctor Summary Reflection

 To heal = to alleviate suffering, cannot do  Aristotle said a healer need 3 qualities,

this through standard medical treatments integrity, altruism, practical wisdom
Doctor as a healer alone  Integrity = training the intellect to
 Heal others through providing best care for discern truth
individuals  Altruism = making sound clinical
 Improving health of population judgements and putting needs of
 How advancing care is delivered patients first
 Healing starts with the relationship  Practical wisdom = training imagination
between doctor and patient to apply knowledge in right manner and
 Compassionate, listening doctors can heal understanding any circumstances
simply through their presence  Attributes that make healers = the little
 E.g having difficult conversations with things (e.g making eye contacts smiling,
dying patients = more important part of introducing themselves like what their
healing that rather prescribing more and role is, asking patients how they would
more treatments like to be addressed = makes patients
 Doctors must also care for themselves in feel acknowledged and welcomed into
order to be effective healers an unfamiliar frightening environment
 Presenting good demeanour may be
hard to the patients = continuously
writing notes and may be exhausting at
the end of a clinic to start an interaction
in a specific way
 Active listening = takes time and effort,
need to let patients talk at their own
pace, but some doctors may interrupt
patients too much because of working
under pressure which can transfer into
the doctor- patient consultation
 Means working hard to understand
patients, once patients have described
condition, doctor needs to ask
questions to understand if they have
understood them, to be healed = to be
understood
 Need to be recognised as people
instead of a cluster of symptoms e.g.
asking about family can build
relationship which is central to healing
 Being open, responding emotionally to
patients = enhance their powers as
healer, need to show appropriate,
emotional intelligence to show
humanity and vulnerability of the
doctor as well
 Important in asking open ended
question e.g. how do you think I can be
help you?
 May argue that healing is a vocation, a
desire to help others and commitment
to a greater good, aptitude of sciences,
undertaking work which is valuable to
society
  Patient-doctor relationship is at the core of  Creation of an effective patient-doctor
the doctor’s work relationship means patient autonomy
Doctor as patient  Traditional relationship of patient has been can come to play
partner replaced by equal partnership  Meaningful autonomy = free form
 Values e.g. integrity, respect and external control or influence
compassion underpin partnership with  Informed consent, Bolam test”
patients obtaining consent from a patient,
 Integrity = staying up to date, but also doctor needed only to reach the
willing to admit limitations standard of a responsibly body of
 Can show respect for patients by listening medical opinion
to them actively, involving them in  When patients experiencing the
decisions and respecting their choices uncertainty and risk of illness need to
be able to trust doctors and others who
care caring for them
 Need to uphold professional values e.g
responsibility, empathy, respect
integrity, collaborative, humility and
resilience
 Teamwork is important = professional  Teamworking has 3 important benefits
satisfaction and engagement  Has a large effect on clinical
Doctor as a team  Improves patient outcomes and performance, patient safety also
worker satisfaction/ productivity improves and the medical errors are
 Become more important = growing very low
complexity of patient’s problems and  Effective team working reduces
health systems absenteeism and increases employee’s
 Barriers to teamwork = failure to recognise engagement and satisfaction
that it depends on learning, failure to build  Reduces burnout, stress-related
it into training of healthcare workers illnesses and anxiety related to litigation
 Should focus on improving are culture,  The negative impacts from the
communication and reflexivity (ability to challenges of providing care can be
reflect on events and learn from them) reduced by a well-supported by a team
 Link to MDT  Good with long term development,
teams can be sustained during time of
difficulty if there’s a shared vision
aligning a common purpose
 Challenges to effective team working:
insufficient awareness of the difficulty
and skills required, lack of prioritisation
of teamwork, the structure of
healthcare
 Successful team will: Demonstrate
understanding, commits, support,
negotiate, communicate, speak up,
reflect, disagree, experiment, listen
 Clinical engagement and leadership is  Doctors are placed to understand the
pivotal to the success of health systems trade-off between medical science and
Doctor manager & and doctors make many decisions that organisational imperatives
leader determine where resources flow  Medical leadership can define the
 Requires clinical leadership, embracing it culture of an organisation,
will enable profession to flourish transparency, leadership and
 Need to be well supported in order to be compassionate care
effective clinical leaders  Managing peers can be challenging
 Good leaders = courage, the ability and  Effective leadership of teams, wards,
desire to innovate and improve, and ability clinics and practices can improve
to manage risk and uncertainty patient outcomes, staff morale and the
ability of teams to work together
 Professionalism = doctors advocate on  Requires doctors to advocate to
behalf of their patients, all patients and improve the health of their patients, all
Doctor as an future patients patients and future patients
advocate  Raining concerns about poor care, or the  Advocacy can be personal and collective
potential for poor care, professional duty  Highest priority in advocacy is patient
for all doctors safety
  Advocacy needs training, practice and  Requires speaking up even in the most
mentorship difficult circumstances when patient
 Errors may arise from both systems and safety is threatened
personal failures  Advocacy includes identifying common
 Doctors have a professional duty to systems failures in everyday care
advocate on broader issues affecting through observation and measurement
health, e.g. tobacco, alcohol, poverty and  Raising concerns about poor care or the
many others e.g. climate change, the major potential for poor care is a professional
threat to global health today duty for all doctors

 Must have the ability to reflect on an event  Lifelong learning is a fundamental

or experience and improve one’s practice principle of professionalism
Doctor as learner & defines an effective professional  Medicine is evolving and a commitment
teacher  Revalidation necessary every 5 years to keeping up to date
 Recognised as a necessary competency in  Practicing evidence-based medicine is
the roe of a doctor an important component of the
 Informal teaching and supervision and role professional commitment to lifelong
modelling are all important for passing learning
wisdom onto the next generation  Research is dynamic, and the evidence
 Need continuous improvement using tools is continuously being updated
of measurement, reflection and feedback  Lifelong learning is a commitment to
continually improving individual
practice and the health system
 Research is important for development of  Innovation in healthcare has been
healthcare and innovations may be in extensive and rapid
Doctor as innovator technology and how healthcare is  NHS itself was an innovation,
organised and delivered innovations may be due to technology,
 May be small or large health systems, health policies and
 Innovation can be driven by doctors health financing
themselves and sometimes from outside  Innovation is driven by doctors
medicine themselves and sometimes outside of
 Should welcome innovation as medicine
improvement to patient care  Doctors as scholars: taught science and
 Machine learning is likely to have large clinical skills at medical schools, but
effects on medicine, could lead to exposed to literature, philosophy, and
progressive replacement of face-to-face other humanities as option
patient doctor consultations in which the  Doctors believe the way to improve
machine becomes effectively an them as a doctor is to expose
independent actor themselves to humanities
 Doctors can only provide solidarity and  Medical humanities is growing as a
understanding and compassion unlike discipline and may play a role in
machines increasing role within modern day
 Research is important for development of medicine curricula
health care and all doctors should be
supporters and critical consumers of
research, some will be primarily
researchers

** DUTY OF CANDOUR = duty of honest and telling the truth, especially about a difficult or embarrassing subject.

Every health and care professional must be open and honest with patients and people in their care when something that goes wrong wi th
their treatment or care causes, or has the potential to cause, harm or distress.

This mean that health and care professionals must:

 Tell the person (or where appropriate, their advocate, carer or family) when something has gone wrong
 Apologise to the person (or where appropriate, their advocate, carer or family)
 Offer an appropriate remedy or support to put matters right, if possible
 Explain fully to the person (or where appropriate, their advocate, carer or family) the short- and long-term effects of what has
happened

Health and care professionals must also be open and honest with their colleagues, employers and relevant organisations and take part in
reviews and investigations when requested. They must also be open and honest with their regulators, raising concerns where appropriate.
They must support and encourage each other to be open and honest, and not stop someone from raising concern
 1. Voluntary work at a care home

WHAT WAS MY ROLE? – Worked alongside the activities co-ordinator to set up and organise activities for the resident, this
included karaoke, bingo, Halloween and Christmas parties, gardening and reading. Worked alongside the carers, was a 6 month
placement, volunteered at lunch time

List of qualities Examples

Communication When a resident was upset, I communicated with them in an
empathetical manner to see what was wrong and they told me
they missed their family so suggested to ring their family and
put-up photos in their room so they don’t feel as lonely, non-
verbal communication (asking a deaf patient what they would
like from the hospital menu card)

Empathy & emotional intelligence & compassion Empathy was needed when a resident told me about her past
life and how she had lost a child to a medical illness, I had to
ensure I had emotional intelligence whilst conversating with
her

Respect Respecting certain religions e.g a very religious Muslim man not
wanting to be touched by females when needing help to get
out of his wheelchair, gender preferences or space and
distance preferences (didn’t like carers getting close to her)

Resilience & overcoming challenges & problem solving A resident didn’t want to partake in an activity and I didn’t
know exactly why, so I tried to adapt the activity to her liking so
she could participate and kept trying to get to the bottom of
the reason she didn’t want to partake in the activity, e.g was
shy as she was a new resident

Leadership & decision making Having to organise the activities, ensuring I explain the
activities to the residents and making sure they all participate
in one way or another
Decision making when everyone gave ideas on activities, and
deciding which activity to go with

Teamwork Physical teamwork of helping someone out of a wheelchair

with another volunteer so they could go to the toilet and walk,
communicational teamwork in collaborating ideas for new
possible activities for the residents to engage in

Patience When talking to a resident that has slurred speech or has

trouble making their mind up on what to eat, or having to
explain something continuously to ensure they fully are on
board and understand

Professionalism Not taking part in any inappropriate conversation, ensuring I

don’t make any personal comments or opinions, not enquiring
further into someone’s personal life at the resident’s home, no
letting personal views influence a person’s decision to make
their own choices, respecting cultural and religious differences

Compassion Motivating a resident to try and go outside for a bit to get some
fresh air and to try walk around to ensure they have some
exercise
 Time management Having to come to volunteer on time, had a busy schedule, had
to ensure transport times were running at the right times and I
wasn’t late as activities for the residents started at a specific
time and therefore couldn’t risk being late

Adaptability Adapting to the way of conversation the residents gave, some

residents were more laid back and chill in their mannerism of
speech and therefore I ensured I was slow and had a calming
tone in my voice, some residents were very bubbly and excited
and therefore I aimed to bring back the same energy

Specific qualities Examples Reflection

Respecting dignity and privacy When entering a resident’s room and Focuses upon the value of every person
they are unaware you’re coming, always as an individual
knock and be waited to enter respecting others’ views and choices and
decisions
Ensuring that you speak about personal not assuming about how people want to
information in a private place where be treated
authorised people are around, working with care and compassion
maintaining confidentiality provides personalised care and support
which puts individual at the centre of
When touching their belongings, always their care
get their permission first (ask if they need Working in a respectful manner reduces
help first rather than taking over) risk of harmful treatment
Patient centred care is based upon
Never engaging in derogatory comments/ principles of dignity and respect
gossip made about someone

Valuing the uniqueness of an individual Tea is served at 4pm for residents, but a Not just offering support for care
resident specifically likes to take his But also understanding the uniqueness of
afternoon walk at that time so ensure the person
that the tea is waiting for him when he Value and respect individual as a person =
returns allows the right to choose and have
control on how their needs are met

Communicating in effective and Residents’ speech has been affected by Central to upholding the dignity of
meaningful ways stroke, so take sufficient time to actively individuals
listen and hear what they are saying and Forming and maintaining positive
check back with them to confirm you relationships = allow person centred care
have understood what they are saying Body language, words and tones =
and actually mean indication of respect, courtesy and
integrity
Communicating with the residents about Establishing consent is very important
the activities coming up, and introducing and should be a continuous process after
who you are to ensure a comfortable every action/activity performed and give
open atmosphere is maintained reason and rationale behind what you are
going to do

Recognising the environment is important Helping display a resident’s photographs Choosing familiar and meaningful things
to their sense of dignity in their room, wanted to discuss the to have them around to help create a
photographs and therefore I engaged in sense of place and belonging
the conversation, listening to their The loss of familiar environments may
memories but do not make any personal lead to a sadness, confusion with a sense
comments about the photos or intrusively of lost privacy and confidence
enquire

** WHAT DOES PATIENT CONFIDENTIALITY MEAN AND WHEN CAN YOU BREAK THIS?
Confidentiality = helps build trust in the doctor-patient relationship, use example from work experience where you were
shown how patient confidentiality works you can reflect on this

Mention different situations where patient confidentiality can be breached e.g patient poses a significant risk to the health
of themselves or others e.g man unwilling to disclose HIV status to wife

GMC has guidance in place

Implied consent = patient is aware that a doctor will share information about them to other individuals in the healthcare
team to provide the patient with the best possible care, IMPORTANT TO HAVE CONVERSATION WITH A PATIENT ABOUT
CONFIDENTIALTIY AS A DOCTOR

Doctor is duty-bound to protect patient confidentiality, and how professional duty should always come above personal
beliefs

If patient visits you with a family member and talks about it openly, can break if information needed by a court/judge e.g. if
police need to access medical records for investigation

In the public interest to protect the patient or others interests to society of disclosing information outweighing benefits of
keeping information confidentially e.g. notifying authorities of notifiable diseases e.g. measles and mumps as well as
epilepsy to DVLA as it could affect their driving skills.

2. Voluntary work at British heart foundation

WHAT WAS MY ROLE- I worked behind the till, had customer interactions, stocked some items in the shop, worked behind the
shop to put clothes on hangers and tag them, sorting out donations, taking donations

List of qualities Examples

Communication Basic forms of communication: asking someone if they wanted a
receipt or not, more complex forms of communication: talking
to someone who had a disability in speech, someone who was
deaf, someone who couldn’t speak English very well
Empathy & emotional intelligence & compassion Customers would talk to me about their personal life, e.g., a
woman was talking to me about her chemotherapy and how
much it had affected her life, had to ensure empathy when
speaking to her and exercise emotional intelligence
Respect Had to step in when someone didn’t want to be served by a
male volunteer due to past trauma, therefore I had to step in
and help her out at customer service, respecting someone’s
comfortability about talking about their day
Resilience & overcoming challenges Overcoming challenges included having a power cut at the till
and had a long line of customers to serve, had to engage in
conversations and communicate to them what had happened,
overcoming challenges included asking questions where I was
unsure of the answer and answered honestly so therefore asked
someone with more experience
Leadership Was working at the till alone on the shop floor, any enquiries the
customers had they came to me and I answered to the best of
my ability, taking lead when taking donations and filling out
necessary paperwork, new volunteer had to show her around
and speak to her about my experience and any advice
Decision making Decision making on what to do when there was a power cut,
when answering questions
Teamwork When the donor had a huge amount of donations, had to work
with the team to go and carry all the donating from the lorry to
the shop, when stocking items I was part of a chain of processes,
worked as a team to tag the items and make them ready to be
put onto the shop floor
 Patience Patience when speaking to someone speech impaired, or
someone who couldn’t make their mind up at the till, patience
when speaking to someone in the midst of a long que of people
waiting, had trouble counting money when paying
Professionalism Had to handle difficult situations professionally, e.g., someone
asking for my number, trying to innate inappropriate
conversation with me, trying to ask for a discount, causing
issues/disruptions within the environment
Compassion When I saw a pregnant lady, and someone on a wheelchair
trying to get out had to help them out, hold the door out for
someone, someone who was struggling counting money
Time management Very important when serving customers, had to pick up the
speed and cut conversations short in a mannered way as the line
for the till was becoming longer and was becoming busier, the
shop wasn’t too big so it was very chaotic when the line was
long
Adaptability Physical adaptability, adapting to serving someone in a
wheelchair where there might be a significant height difference,
other adaptability of communication e.g., if someone found it
hard to understand words, I’d ensure I say them in a slower and
clearer way, adapting to someone’s interests to engage in more
conversation with the
Critical thinking Evaluating my time and expenditures when travelling to the
charity shop, and thought about ways to make my voluntary
work as rewarding as possible, by engaging in more work when I
had free time on the shop floor e.g sorting out shelves
Problem solving When the donor had a huge amount of donations, had to think
of a way to get all the donations indoors with minimal effort

3. Work experience at a hospital

WHAT DID I DO – Foreshadowed Upper GI consultant, pharmacist and physician associate, went to look at x-rays, attended
MDT meetings, attended ward rounds as well, OBSERVED THE ROLES OF DOCTOR**

List of qualities Examples Explanation and reflection

Communication Gaining consent from speech impaired Didn’t know what rheumatology meant
patients (gaining consent is a form of but is study of joints & the
autonomy) (informed consent from swelling/inflammation of joints
someone who has capacity)
Osteoarthritis =’wear and tear’ arthritis,
Rheumatology clinic, witnessed the doctor tends to develop over age due to overused
prescribe a lot of medication and review joints
dosage of medication that the patients
where on, would explain any possible side Rheumatoid Arthritis = chronic progressive
effects (good practice as it increases disorder causing painful inflammation in
patient awareness of what has been the joints
prescribed) (used non-jargon medical
terms so it’s easier to perceive)– Patient was well aware of what had been
Importance in involving patients in their prescribed and how it may affect hem, also
treatment plans so no unnecessary worry is caused if they
suffer from any of the side effects =
During consultations doctor would display Helped me reflect upon the importance of
effective communication skills e.g., involving patients in their treatment plans
maintain eye contact, asking open
questions, confirming what the patient has Would confirm what the patient had told
said through questions her in the way of questions e.g. you’ve had
this pain for 2 weeks is that right?
 This was effective because it reduces the
scope for misunderstanding between the
doctor and the patient e.g. questioning to
clarify the doctor found out patient had
been taking a certain medication at night
when it was supposed to be in the morning
but it wasn’t life threatening just meant a
lot of inconvenience for the patient waking
up every night

End of each appointment, doctor would

give patient space to ask any questions in
which they could clarify something already
mentioned or cover something that was
not mentioned
Empathy Doctor talked to the patient about their Re-enforced the real need for health care
life and not just their illness and physical workers to be empathetic towards the
symptoms, patient mentioned family were patients and even if they can’t sort out of
not being very helpful, took a significant all the patients’ problems, sometimes all a
number of days to get him a fresh pair of patient desires or need is a listening ear
clothes, does not receive any aid from
them, felt as condition is worsening Man obviously felt like he couldn’t tell
because of family’s lack of care and anyone else about this problem, so he told
responsibility, said social services and someone that he could feel he could trust-
other agencies to get involved so he can his nurse
receive the care that he needs
Important for all patients to feel this way
about any health care professionals
involved in their care

Doctor would as general things such as

school, made consultation more personal,
less hostile, more effective approach a
patient is more likely to open up to a
friendly doctor about anything that may be
concerning them
Intelligence When a patient started to get agitated Ensured that the patients were very much
about a form of treatment that he involved in their treatment plan, the
specifically wanted, the doctor could have doctor used own knowledge to suggest
just used cognitive intelligence to tell him what medication would be appropriate,
that’s not the most effective plan of doctor took time to explain why that’s the
treatment but instead used emotional most effective route in plan of treatment
intelligence to ensure he understood why
it wasn’t the best and took the time to
explain it in depth and clarity
Compassion One form of compassion is through the ICE Method – ideas, concerns,
skill of listening, witnessed appointments expectations
where doctor would summarise the
contents of the appointment to patient Method is where doctor would ask the
before left, use ICE method plan (doctor patient about their ideas on what the
ask patient about ideas on what the problem is, and what they think is causing
problem is), addressing concerns about the their symptoms
problem or illness, and listening to their
expectations about what they have for the Secondly- their concerns about the
doctor problem or illness and its effect on them,
and thirdly what they expect the doctor to
do about it

Very important as not only does the doctor

ease the patients concerns but address
aspects that the patient expects will be
addressed so that the treatment and plan
 of action can be tailored to their needs and
expectations
Respect Respecting patient autonomy, saw this Important as it maintains a professional
from the doctor asking for consent before doctor patient relationship and means that
doing anything and explaining what it patient autonomy will be satisfied
involves even for simple examinations such
as taking blood pressure GMC – Good doctors work in partnership
with patients and respect their rights to
privacy and dignity

Do not discriminate, follows the NHS

values, respects their decisions they have
made with informed capacity
Resilience One of the patients that the nurse was Helped me reflect that a career in
meant to go and see on the wards had medicine, witnessing the loss of life is
sadly passed away that night, resilience is a inevitable and is important not to get too
key skill in medicine saddened and emotional about the passing
of patients

Need to be resilient and continue with

daily job and duties, and try comfort the
family of the decreased
Leadership Sat in a CBL session in a gastro clinic, gave Treatment plans, leadership role in the
me true insight to what it is like to work as MDT, has to delegate tasks to the MDT and
a doctor in a hospital clinic, doctors has the final say in things
involvement in teaching and mentoring
medical students as well as helping to train Can be educator, teaching other medical
the next generation of doctors students

Contributes to patient satisfaction

Decision making Doctors deciding on the best treatment of Helped me reflect on the fact that NHS is
care for the patients, e.g. patient came in limited in resources and money so not
saying medications were making her feel every single person can be offered the best
sic and said she knew someone who took and most effective treatment
another form of medication and was
almost pain free, said that the medication Many tools are put in place to determine
was very expensive 10k a year and that if who can receive the medication and who
the medication she was on right now cannot, only those that desperately need it
wasn’t working then it would be very due to their condition e.g. reflected by
unlikely that the medication for 10k a year their disease activity score are eligible to
would work, said patient would not be receive the very expensive drug, increasing
eligible to be put on this medication as cost- effectiveness of the treatment
disease activity score was not high enough
Teamwork MDT team work Re-enforces the idea that the multi-
disciplinary team must work together in
Observed specific roles in the MDT e.g order to provide the best care for the
healthcare assistant feeding a patient who patient
had suffered a stroke (the patient had
paralysis to the left side of their body and There’s no ‘I’ in medicine and its all about
had trouble swallowing) = needed teamwork & how everyone works together
assistance feeding and their food pureeing for the best interests of the patient (NHS
learnt that their role is centred around constitution)
supporting patients whilst they are in
hospital with activities of daily life. Referred her to a physiotherapist so the
patient can receive the adequate aid and
In rheumatology clinic, patient complained expertise she needs to help her
that they were not able to do day to day
tasks such as opening lids, doctor Witnessed the importance of the
suggested to book her with the healthcare team working together
physiotherapist to help regain muscle in
forearms, physiotherapist will be able to Doctor would decide the best treatment
plan for the patient and the nurses would
 provide adequate aid and expertise she deliver this treatment in a caring manner-
needs to help her. without the nurses, the wards would not
function at all
Attended oncology MDT meetings, level of
communication between both doctors and Importance of the healthcare team, such
healthcare professionals, the manner in as porters carrying out their job
which each was able to show their
expertise and explain this expertise to Providing the best care to patients can be
others in a way that they could achieved by team work and without all
understand, and the clear empathy shown members of the multi-disciplinary team,
to the patient through ought the meeting the hospital would not function
reinforced what attracts me to medicine.
To become an expert = able to From doctors to consultants who must use
communicate, teach and finds their their expert knowledge to diagnose and
practice on empathy propose treatment plants, to the cleaning
staff who must maintain a hygienic, safe
and sanitised environment, every role is
valuable and essential in providing the best
quality of care to patients
Patience Doctors time schedule is very tight e.g., The doctors allow the patients to take time
not just seeing patients but have to explaining their condition or symptoms
print/sign prescriptions, checking blood and the doctors no matter how under
test results, telephoning patients as well, pressure he/she may be will practice the
although time restrictions doctor still took virtue of patience
time to ask about psychological and social
aspects of the patient’s life instead of Although a busy schedule, a doctor needs
solely focusing on their physical symptoms patience to establish a good patient doctor
rapport despite it taking some time, he
may do this by asking about the patient’s
life or how their day is going, although this
may not be significant to their prognosis, it
plays a crucial role in establishing a
trusting relationship and therefore is
necessary
Professionalism Working within their own capabilities and Confidentiality issues helped me reflect
competencies, said in the GMAC. Doctor upon how careful a doctor must be, as
saw patients who smoked, didn’t offer a he/she cannot do what seems to be the
scheme or anything specific because of most helpful as they must consider all
tight schedule, wouldn’t have time to aspects on what it entails to be a doctor
actively help every single one of his e.g. the trust the patients have in them to
smoking patients (job of clinics based keep their details confidential
around helping people to stop), referred to
gastrologist, important to recognise the Professionalism is to understand and
scope of practice manage oneself, prevent burnout and to
work within their competencies
Saw a doctor attend to a patient in the
gastro clinic (upper GI consultant), asking To abide by the principles and guidelines
doctor to speak on the phone to her underlaying the work of medics e.g the
daughter but cannot be 100% sure that GMC
this was her daughter and may breach
confidentiality SJT- Being appropriate in what you do, e.g
only developing appropriate relationships
within the workplace
Critical thinking Attended a 5th year CBL session, consisted Without critical thinking, physicians are
of students presenting real life interesting more prone to making cognitive errors
cases which they had witnessed on the which can lead to diagnostic errors
wards, students take turn presenting ideas
and question each other’s explanations if Doctors will be able to identify alternative
they didn’t understand the logic behind options for diagnoses and treatment, help
someone’s reasoning boost confidence and improve knowledge
and understanding of subjects
 Gives a better ability to make clinical
decisions, increases quality of thinking and
work output and increased productivity

Time management Long waiting lines, important work-life Need to care for the patient and care for
balance, spoke to two doctors who were yourself
married and was hard to balance their
work life balance as they were raising a Professionals expected by society to put
child as well, both are very demanding jobs the needs of their patients before their
e.g. shifts overlapping, child asked if he’s own
getting fed tonight because they forgot
due to busy schedule Doctors must care for themselves too,
putting patients interests first cannot
mean that doctors seriously harm their
own health

(GMC) says to seek help if their judgement

or performance could be impaired
Adaptability Adapting to patient’s needs, doctor asked Helps integrate a patient’s cultural values
patient if he was allergic to any drugs and beliefs into an encounter
when prescribing antibiotics and she was
actually allergic, seemed beneficent at the Have awareness and skills to assess verbal
time (prescribing antibiotics to treat an and non-verbal cues to adapt an
infection) could have turned into a fatal individual’s care to maximise the patients
and maleficent act (because of the allergy), comfort and minimise misunderstandings
adapting to certain preferences e.g not
wanting to be treated by the opposite sex Adaptability enables someone to manage
due to religious, comfortability issues, challenges and be flexible with their
adapting communication e.g using sign practices and expectations in face of
language if deaf rapidly, changing and unpredictable
circumstances

Expands your capacity to handle change

Overcoming challenges Language barriers, witnessed patient that Made me reflect on the fact that although
could not speak English, luckily doctor many healthcare’s e.g taking blood,
could communicate with them through putting in cannulas can be fiddly and it can
another language showing emphasis of be frustrating if you are unable to do these
usefulness in multilingual skills on the first go

Foreshadowed a nurse (part of the MDT), Important not to show frustration to the
patient had come for a routine blood test, patient as it may them unnecessarily worry
nurse tried for 15 mins to retrieve an or may cause them to lose the trust, they
arterial blood sample but was unable to do have in healthcare professionals
so, she then had to try another way of
retrieving the blood sample e.g., from the Made me reflect on how resourceful one
ear lobe, important to stay calm and must be in a healthcare profession, one
empathetic. must know what other options there are
when things don’t necessarily go according
to plan
Problem solving Asthma patient very desperate to go Helped me reflect that what the patients
home, guidelines say patient has to be off want may not always be the best thing for
nebuliser for 24 hours before being them medically and it’s the job of the
discharged, patient seemed distressed by doctor to put the health of their patient
finding out she couldn’t go home until 24 first, instead of what the patient always
hours was gone, but dealt with this wants
problem by easing distress saying she
could very well be discharged earlier if the Beneficence – acting in the patients’ best
doctor feels that she can after reviewing interests
her conditions, ensured the doctor
explained why it is an important guideline,
 and importance of follow up appointments Examples of safety netting and follow up
to see patient coping, given asthma advice appointments: patients are given an advice
sheet and review of condition sheet so the patient isn’t left with no
guidance, and told how to manage their
condition, within 6 weeks of discharge the
patient is brought back to the clinic and
their condition is reviewed

4. My own personal experiences showing these qualities (CYCLIC ENDING?)

FRAMEWORK WHEN ANSWERING QUESTIONS UPON PERSONAL EXPERIENCE:

List of qualities Examples Reflection (link to medicine)

Communication In St Johns ambulance had to use non- Had encountered situations where the
verbal communication, and verbal patient was not in the state of mind to
communication to get consent from the listen or had trouble listening or
patient in order to treat them, effective & understanding my manner of
clear communication, non-verbal forms communication.
including body language, gesture, tone
Important to gain consent, ensures
S- A boy came with swelling from his knee patients have sufficient and relevant
as it was grazed when he was playing a information to make an informed decision
football match about their own medical care (whether
we can treat them or not)
T- His knee was really swollen he was
really worried and stress as well, it was Communication cultivates growth as well
raining and the weather was really cold as developing strong relationships, helps
avoid misunderstandings as certain
A-Gave him an ice pack, reassured him information may get lost within
about his worries and concerns, ensured translation
that he was warm as well his body as it
was a cold weather, Important in personal life, can improve
personal relationships by helping you
R-He felt better as his decreased and felt understand others
as if he could play again, he took it slowly
and carefully and his mind was at ease, Two-way process, listening and speaking,
needed to communicate to him about it is an active process and a circular
further steps process

Important in medical environments to

establish rapport with their patients,
effective ethic in working as a team and
solicit crucial health information
 ICE TECHNIQUE – ideas concerns
expectations

Position of trust I was given a position of trust (working Doctors are given position of trust by the
behind the till) within my voluntary work public, they trust their decisions are the
at the British Heart Foundation charity best form of treatment for them, being
shop. Through this position, I was working able to own up to the consequences of
with charity finance & donations given to responsibility if that does occur
the shop from the public. This consisted of
filling out forms with personal details Have responsibility to uphold the values
given by the donor and handling money of the NHS, and the principles of the NHS
from customers. Whilst working on the
shop floor, I dealt with shop complaints as Link to where position of trust has been
well as inquiries in a professional manner mis-used (Harold shipman case), the
ensuring that their questions were patient has placed trust in the doctor but
answered in a clear and concise manner. mis-used it

I was motivated to organize two

fundraising events for different
organizations after observing how much
the general public contributes to the
operation of the entire store. The first
event involved skydiving to raise £1200
for neurological research at St Georges
Hospital, while the second involved
collecting donations at social gatherings
to raise £800 for Ukraine. Skills developed
through this experience such as
teamwork, time management, and
leadership can prove beneficial when
working in a medical environment.
Critical thinking Saw a man who was epileptic and was Critical thinking can be argued to have
having a seizure on the way to school, had links to emotional intelligence, someone
to assess surroundings to ensure safety, with critical thinking skills can think clearly
had 2 kids, had to call ambulance, UCAT and rationally when situation may come
and BMAT, scheduling usage of time in at demand
revision
Allows them to perform problem solving
S- On the way to school, morning rush and decision making more effectively
hour, saw a man having an seizure on the
ground, a middle aged man who was Aid good decision making e.g., ensuring
coming back from exercising and dropping the safety of the man with the seizure first
his children
Medics have to use critical thinking often,
T- He was shaking on the ground, and as it allows them to make the right clinical
needed help standing up, the kids around decision and provide the best care in the
him was very worried and crying as well patient care process

A-Called an ambulance whilst trying to Doctors apply critical thinking when

reassure the children, called for help from analysing and managing health risks,
the public, first looked for danger when accurately diagnosing in emergency
approaching him situations

R- The man was transported off to Guarantees objective and efficient

hospital, his wife was contacted, the problem-solving, ultimately reducing cost
children were reassured and less worried errors, and ensuring organizations
as well resources are used wisely
 Link to mid Staffordshire crisis case study
(READ NOTES)
Empathy Had to speak to my friends about their They needed someone who they can
mental health, helping year 7’s settles in confide in and trust in
and listened to any issues or problems
they had and ensured that these Specific times where I was with my friends
problems would be passed onto the and I had to take time out to help with the
representatives of the year year 7’s settling in

S- I was a mentor in year 11 helping new Helping year 7’s has resulted in well
year 7’s settle in, I would go into forms adjustment, eased their transition into
and interact with the year 7’s to form new high school which is something that my
friendships and give them a helping hand own leader helped me with (circular
with any questions or problems they had moment)

T- A friend had an issue with an older Questions may be raised if true empathy
student being really unfriendly to her and is feasible for every patient in healthcare
she was really scared about this, she felt and whether it is necessary
like she didn’t want to come into school
Was able to understand how the year 7’s
A-I had to use my empathetic and was feeling using empathy and therefore
communicational skills to help her, I also responding appropriately according to the
advised her on telling her head of year as I situation
had to weigh up the trust, she had given
me to any danger that would be caused to Self-rewarding, transcends personal
her, she wanted advise on how to go relationships, leads to teamwork and
around this situation improves communications skills

R- She told the head of year and the issue

was resolved, the student was sanctioned
and she was much happier that she didn’t
have to deal with this problem alone, the
air was cleared between the two and now
there are no issues between them
CYCLIC MOMENT – as I had a mentor in
year 7
Intelligence Comes in tutoring people, needed to use A shared form of intelligence within the
intelligence when treating people with group of DoFe ensured stronger
first aid (cognitive intelligence), DoFe teamwork and lead to a more efficient
required intelligence in map planning and route to success
skills for direction, can be emotional
intelligence Passing on intelligence with my peers
helped me strengthen the clarity in my
STAR TECHNIQUES USED IN TEAMWORK, communication
AND PATIENCE
5 key elements to emotion intelligence,
self-awareness, self-regulation,
motivation, empathy and social skills

Medical link: ability to prevent emotions

from affecting your clinical decision
making and bedside manner

Recognising when your competence is

being affected by your emotional state

Helpful in preventing burnout in a career,

increased forms of patient understanding
and satisfaction
 Respect School band had to respect people’s Respecting the members of banned and
scope of competency, e.g someone in those around me allows development in
band was struggling with a piece and feelings of trust safety and wellbeing in
therefore had to respect the fact that they relationships
couldn’t play as strongly in some parts
and therefore I had to play slightly louder, Respect is a sign of humility (state of
playing in band on Remembrance Day being humble) and maturity, respect aids
(special events), in memorial for the in empathy
soldiers that died in wars
Teaches us about compassion as it allows
S - In a band that played for school, us to see things from another person’s
played at masses, and other events perspective
Can increase the self-esteem of
T- Some members of the band were very individuals, indirectly motivating them to
scared when playing and didn’t feel as become the best versions of themselves
confident with some of the pieces
Medics: creates a healthy environment in
A-I gave them some time to practice with which patients feel cared for as
me after school lunchtimes to increase individuals, recognises the unconditional
their confidence, we worked on the pieces value of patients, respect for the
which they were not able to play well and autonomy
answered any questions they had they
were too scared to ask in a large group Respecting patients decisions to decline
certain treatments, acknowledging that
R-This increased their commitment to patients who have decision making
band as they were looking forward to capacity have the right to make decisions
playing instead of dreading it, they were regarding their care
more involved and became more
confident in playing, they also
recommended the band to their friends
which means the band became a lot larger
and more successful

Resilience Failed my grade 6 saxophone exam, but Was a very hard barrier to overcome as I
still carried onto grade 7, didn’t let that have never failed a graded exam before,
set me back and instead work on the had a lot of negative emotions running
points they marked me down for through my head

S- Failed my grade 6 exam last year after Had to use resilience to try again and
working on the grade for 2 years within improve on my mistakes, had to reflect
the pandemic upon my performance and critique my
performance
T-Problems I faced was I was very
demotivated, I felt like giving up and felt Resilience is not necessarily achieved
really upset all my efforts had gone to through working past tough times alone,
waste and felt like I could have done a important to tap into strengths and
better job support systems to overcome challenges
(e.g asked for extra support from my
A-I looked at the feedback I received upon saxophone teacher)
the examiner and ensured I practiced my
weak points a lot more often, I scheduled Important factor contributing to resilience
more practicing sessions when playing the was having the capacity to set realistic
saxophone, I asked for support from my plans and having the ability to carry out
saxophone teacher to help me and took those plans, sense of progression and
more independent study more seriously, satisfaction
worked on my tone and pitch more by
doing regular saxophone exercises Resilience helps staff manage stressful
situations, protect their mental health and
R-Resulted in retaking the exam once has a long-term positive impact on
again and passing it this time with a very improvement of their health and
high score, I also became a lot more wellbeing
confident in my own abilities and my
 overall quality in playing improved Gives them emotional strength to cope
drastically with trauma which they may have seen at
their work place, adversity and hardship

Leadership Organising my own charity event Making sure the MDT runs smoothly
skydiving and raised money for the though effective leadership in order to
neurology sector for St Georges Hospital provide the best high quality patient
Charity, organising the Ukraine charity centred care.
event which I raised funds from social
events e.g., selling food, selling old clothes In order to improve hospital efficiency,
and books, raffle tickets outside of the hospital setting leadership
Many disagreements in ideas on how to can also be used with teaching other
raise the funds, had to communicate with medical students.
everyone and listen
I had many responsibilities as a leader
S- Had to raise money for the Ukraine including communicating in a transparent
Russia war conflict, many people had no and constructive manner, settling any
homes and no food, health conditions disputes within members of the group to
needed paying for ensure we had an efficient working
method, motivating the team by constant
T- Had to propose ideas on how to raise reminder of the end goal.
money but everyone had different ideas Key leadership qualities including
and it was hard to find a common ground integrity, communication, influence,
because everyone had different strengths decision making, vision (by having an end
and weaknesses and we had a limited goal in sight)
budget
Realization that managing a team is very
A- Listened to everyone’s ideas and made hard is difficult to understand all complex
a pros and cons of everyone’s idea and people’s emotions
whether it fits into the budget, let an
anonymous vote happen and utilised
people’s strengths e.g., someone who is
artistic could do an art fundraiser

R-Very successful fundraiser, organised

over £800 and the team worked very well
as they were happy with the decisions
made as everyone was allocated to an
event where their strengths were utilised,
effective teamwork as leadership guided
the team to success

Decision making Decision making, deciding what charity to -

donate the funds I’ve raised to, deciding
what roles to give to someone in a team
project, and ensuring the roles adapt to
their strengths and weaknesses

S- DofE when completing the award, had

to make tough decisions on how to pack
the bags, what food to bring, deciding on
the roles of each team member within the
team

T- It was a problem because we didn’t

have that much space in our bags to pack
whatever we’d like, and we had to
rationed food and had to pack food which
everyone liked so it took less space in our
bags packing for food, some team
members had a weaker trait of reading
maps and compasses than others
 A-Conducted a google form to sort
everyone’s preferences of food out,
including those who were allergic to
certain things, allocated roles to everyone
who’s strengths were in align with what
their role expected them to do, had a
prior discussion to how to decide on the
food

R- What has resulted from this is

everyone ate well on the trip, we had
plenty of space to carry other items such
as the Trangia and the stove, had enough
space to pack clothes
Teamwork Working as a team in DofE, when Had transparency with my peers and
arranging food pre-hand, when arranging constructive criticism with any ideas they
kit and who holds what items, map had
compass and trying to find map
directions, working with others in a team Much more effective to work as a team
to arrange the funds for the Ukraine when overcoming a difficult task, one of
the foundations of teamwork effective
S - Happened when completing the award communication
for gold DofE, camping in Wales for 5
nights Hand in hand, creates an environment
where each team member benefits of
T – The issue was that someone tripped shared strengths to aid own CPD
over in a hole and their feet and legs were
bruised and was unable to walk with the Working together for patients (NHS value)
amount of weight on her back Reduces medical errors
Increases patient safety
A-We had to redistribute the Trangia,
stoves, the camping equipment so there Reduces patient mortality rates as higher
was less weight on her back and using quality of care is provided
teamwork we managed to decide who
was going to hold which item, we also Reduced stress and improved job
ensured that she had a significant role as satisfaction
well because of her excellent map reading
skills, we used her strengths as well Patient is treated holistically with all
aspects taken into consideration e.g.,
R- We completed the day successfully and including mental health
returned back to camp where she was
treated medically further to ensure she Protocols are more standardised between
was able to take up on some more weight different practices and departments
the next day, we managed to complete
the day as a team without leaving anyone Mid Staffordshire scandal (REFER TO CASE
behind STUDY NOTES)
Patience Needed patience when tutoring some Patience is a virtue, helps you to deal with
classmates with biology, explaining stressful and challenging moments in life,
difficult concepts to them and took them requires careful cultivation
a while to understand but still tried to
continue giving them guidance, this also Important in building strong relationships,
included resilience helps develop persistence and resilience,
make more rational and realistic decisions
S- Situation when tutoring people with
their biology, they didn’t understand Can better focus on your long-term goals
some concepts that we had learnt and dreams

T- The concept was really difficult and the Patience is a part of the emotional
people who I taught where more visual stability necessary to work in the field of
learners than audio learners and healthcare
therefore I had to adapt my teaching
according to their preferences
 Patience allows processionals to stay calm
A- I ensured I drew relevant diagrams and even under pressure
taught them in a simple way by ensuring
they knew the basic foundations and
building blocks for each process first
before continuing it, I asked them
questions continuously to ensure they
weren’t getting lost, or they understood
everything that I was teaching them, had
to be very patient when they did not
understand concepts

R- Had an assessed question on the

concept I had taught them, and they got
full marks on the exam question, their
confidence was also improved in the
subject as they were able to contribute
more to lessons aswell
Professionalism Writing articles for the church newsletter Being objective is important in writing as
and to ensure that I did not express any it suggests you are concerned about facts
bias opinion and not influenced by personal feelings or
bias

Professionalism can influence positive first

impressions, successful interpersonal
relationships

Displaying professional values by

reliability, consistency and honesty

Critical to delivering safe and effective

patient care, helps build confidence, trust
and respect

Providing top quality care to patients

whilst also upholding the values of
accountability, respect and integrity

Increases public trust within the hospital

environment
Compassion Participated in blog writing for a non- -
profitable organisation called only physics
which aimed to provide educational
resources to everyone especially those
who had low financial backgrounds and
struggled accessing these resources
Time management Crucial in scheduling time for revision, Importance for stress management as
may use different techniques e.g., balancing A-levels and voluntary work
pomodoro, time management (type of may be hard
critical thinking), many extracurriculars as
well as academics, important to achieve a Understanding the importance of
work-life balance, Using SMART targets, managing workload and personal stress
use physical notes to brain dump a list of levels as a health care professional as it
priorities (depending upon the due) and can affect the quality of care provided to
things to achieve, list things which may be the patients
hard to balance
Effective time management can increase
Time-table my week by the hour, productivity as a poor time management
especially by mock time (can begin to feel means patients are kept waiting, stress
stressed and overwhelmed if not planned levels increase and lose valuable time
properly) with family/exercise/sleep
 SMART = Specific, measurable, achievable, Emergencies can happen and you have to
relevant and time-bound, giving adapt schedule with things that may come
maximum hours to send up without losing sight of other clinical
tasks that need to get done
S- Managing time, had a lot of extra-
curriculars, needed time to play the Good time management allows you to
saxophone, revise for exams, time to accomplish bigger results in a shorter
study and relax, time for ambulance period of time which leads to more time
training freedom and better focus

T- The problem was I couldn’t manage my Student time management enables

time too well, I had so many clashes and students to become more confident,
ended up procrastinating due to burn out, organized and efficient learning being
was not good for mental health able to deal with subject assessments and
extra-curriculars
A-I managed my time using a timetable,
used pomodoro technique to provide Triaging, = assignment of degrees in
effective revision, used SMART targets to urgency to illnesses to decide the order of
ensure my goals were reasonable, took treatment of a large number of patients
time to relax and took account of times or casualties
where unpredictable events happened
and scheduled for those

R- I was able to manage my time a lot

more, I revised a lot more effectively as
well, I had more time to relax and I felt
more relaxed and calmer, I didn’t feel
overwhelmed, led to a long-term success
of saxophone and results in exams
Adaptability When giving out roles and responsibility in -
a group project for science I had to ensure
the roles were given based upon the
weaknesses and strengths of each person,
moved schools after year 11 adapting to
different environment

S – Had a project for science presenting

an illness of our choice and I was
appointed as leader when appointing the
roles for each team member

T-The problem was there was many roles

and many different people who had
different weaknesses and strengths and
they wanted different roles and this
clashed

A-Had to adapt each role to the persons

liking e.g if a person was more of a
creative person then I’d give them a role
that suited them more such as formatting
the presentation or if someone preferred
reading and literature more I’d appoint
them the role of research

R-Successful presentation and project as

everyone was happy with their roles and
responsibilities, everyone excelled in their
role and was content, provided a strong
result
Overcoming challenges During COVID-19 pandemic there were -
many mental challenges people had to
overcome, I live in a place where it’s full
with old people and they struggled the
most out of loneliness, went to play music
outside to entertain them and played old
songs which gave them nostalgia and
comfort

S- During COVID-19 face to face contact

wasn’t allowed, it was very quiet around
my neighbourhood area and was full of
elderly residents

T- Tried to cheer up the neighbourhood,

needed a reason to practice saxophone
again due to de-motivation, needed to
build the community up and restore the
relationships

A-Practiced saxophone daily and played

saxophone outside on the day of the clap
for the NHS, everyone enjoyed it

R- People enjoyed the music and felt less

lonely, they felt entertained and allowed
everyone to enjoy a common topic which
everyone liked e.g the topic of music, was
able to show my capabilities, gave them
peace and hope
Problem solving Got lost on DofE, had to work as a team to -
solve this problem, UCAT and BMAT,
practice DofE calculating average
estimated arrival time (mathematical)

S- Went camping for 5 days with my group

for the duke of Edinburgh award in
Scotland

T- Had got lost, didn’t know where we

were, started panicking as we weren’t
arriving on time and our scheduled plan
was not going right

A-Ensured to keep everyone calm, used

map skills to find another route to the
destination, solved the problem by
locating current pin point, also asking for
help from our DofE supervisor

R- We were back on track, we ended up

finding our way and there was no more
panic, we arrived at our destination at the
estimated arrival time despite getting lost
Integrity and kindness Donated food and old clothes to charities, -
volunteering at church and engaging with
events within the church environment
and helping them set up the events
 Key bodies and guidelines
for medical practice

Making the public healthier and reducing differences between the health
different groups, promotes healthier lifestyles, protects the nation from
public health hazards e.g COVID and response
Provides support to all Aims to promote equal
medical professional rights, opportunities Established on 1st
April 2013, public
It focuses health England
upon was replaced by
Initially established for Supporting diversity research, UK health security
sharing scientific and health agency
and creating open
medical knowledge improvement
inclusive environment
for employees and within
BMA (British alcohol, drugs PHE – Public
stakeholders
medical
and tobacco, health
and disease
Founded in 1832,
association) registration England
established in Trade union and
midst of cholera professional body for
outbreak doctors in the UK

Protect and improve health and

Ensures doctors have their individual needs Ensures doctors deliver the
highest quality health wellbeing and reduce health
responded to (through support and professional inequalities Focuses upon health protection, health
development) service
improvement, knowledge and information,
operations, regional units

NICE (National institute for health

and care excellence)

Provides national guidance and advice Investigates and acts upon concerns about doctors (e.g., if a serious concern is
to improve health and social care raised about a doctor), may need to remove doctor from register entirely if serious
situations arise
Considers effectiveness, evidence,
safety, practicality, ethics and cost to Protect patient safety and improve medical Have 5 key areas (set out
produce guidance on which treatments education and practice within the UK in medical act 1983)
should be offered on the NHS

Revalidation (system though which a Manage medical registration

Use NICE guidelines can help patients
licensed doctor keeps their (checking identities and
and carers, receive care that is based qualifications to ensure safe
on the best clinical evidence unknowledge and skills up to date)
practice)
GMC (Good
Producing evidence-based guidance
and advice for health, public health and Positive measure, having a national body medical council) The primary loyalty of the GMC
that draws upon expertise of doctors, in is to the patient, protecting
social care practitioners
charge of ML (medical licensing patient safety comes first, seen
agreement) in mission
Developing quality standards and
statement
performance metrics for those
providing and commissioning health Oversees medical education and
Sets standards (values, knowledges training (monitors training at
Commissions can use NICE standards to and skills required of the profession) universities)
promote integration of health and
social care Does this through appraisals, every 5
years senior doctor will correlate juniors’ Harold shipman case caused tightening of
appraisals and tell GMC if they are regulations, failures of acceptance = large
keeping up with standards) public outcry against the GMC, led to focus
Never abuse Make the care of your from self-regulation to professional
patients trust patient your first concern regulation
in profession

Provide a good standard of  CQC – Care quality commission

Treats a. Regulates all health and social care services in
practice and care
patients England
politely and GMC (Good b. Ensures the quality and safety of care in hospitals,
considerate medical council Keep professional dentists, ambulances and care homes
knowledge and skills up to c. Provides people with safe, effective,
examples) date compassionate and high-quality care
Be honest and
open and act d. Protects rights of vulnerable people, listen and act
Recognise and work within limits of upon public experiences, involve the public and
with integrity
your competence people who receive care
e. Values including, excellence, caring, integrity,
Protect and promote the teamwork
Take action if you think patient safety and
health of patients and dignity or comfort is being compromised
the public
 Relevant case studies
and links to principles

CASE STUDIES EXPLANATION IMPORTANT POINTS/ PROGRESS

Charlie Gard [ISSUES AROUND -Born in 2016 and died in 2017 age 11 months from a rare -Work must be done to decide where the boundaries
NOVEL THERAPY AND LIFE neurodegenerative brain disease (MDDS), believed was untreatable between benefit and harm lie, where overriding
SUPPORT] -Parents petitioned the hospital to allow the child to travel to the USA for parents becomes permissible
treatment -Should consider introducing innovative and
-Problems around what Charlie’s best interests may have been, baby had experimental treatments earlier in treatment phases
no autonomy, no ability to consent to treatment or understand it, his -Normal to assume that a treatment should not be
parents instead had to make the decision for him provided if its excessive cost will deny other patients
-Doctors believed that continuing his treatment will be going against the care BUT lack of funding was not an issue
pillar of non-maleficence -Should consider the use of resources in a robust
-Money was already raised and doctors believed Charlie was beyond manner that looks at past spending as well as current
feeling so how much could the treatment truly have damaged him? cost
-Amount of money that was put into investment was already squandered -Autonomy – Charlie’s case, his parents acted on his
(crowd funded 1.3 million) behalf due to his age and mental state
-Novel therapy had never been tested on someone with Charlie’s - Similar case study of Alfie Evans who suffered from
condition so potential discovery? a degenerative neurological condition
-Withdrawn because despite it being inexpensive the ongoing intensive -Parents wanted to fly Alfie to Rome for further
care was estimated at 150,000 which is against the NICE guidelines treatment, but hospital described decision as futile,
provides an advisory limit of 30,000 or less for quality adjusted life year unkind and inhumane
-Best outcome was that the quality of his potential life hood would be -At 23 months, the courts ruled for his life support to
decreased from 0.3 to 1.0 due to the severity of his disabilities be removed
-Likelihood of the treatment working was only at 10% as well (SHORTENED
LIFE SPAN WITH A SEVER DISABILITY)
-Success was too low to justify the trauma that Charlie would experience,
and even if successful it wouldn’t be a sufficient quality of life
Dr Bawa Garba -After returning from maternity leave, she was working in an unfamiliar -She reflected on her failure rather than the obvious
[GROSS NEGLIGENCE hospital with a faulty IT system, with he consultant off site (was doing system failures
MANSLAUGHTER OF JACK work of three registrars, covering the wards, casualty and the children’s -Charged with and found guilty of, gross negligence
ADOCK] assessment unit) manslaughter
-Saw a child called Jack Adcock who was admitted with diarrhoea and -GMC decided to erase the doctor from the register
vomiting, started him on antibiotic following chest x-rays showing he had and her training number to be removed
pneumonia -Caused much chaos and anxiety in public trust of the
-Suffered cardiac arrests and Dr mistook the child for another who had health community
been declared DNR (Not for resuscitation) and interrupted the -Importance of working as a team, importance of
resuscitation coping with stress and maintaining a good work-life
-DIED OF STREPTOCOCCAL SEPSIS balance
-Issues: there were failings of the hospital computer system prolonged -Demonstrates the lack of care and attention
blood testing results, nurses did not notify the dr that Jack was -Staffing issues and NHS shortages/burnout
deteriorating, she did not document some medical notes about Jack. -Shows how systematic flaws in hospitals can impact
-Dr did not make it clear to the mother to not continue his normal both patient care and doctors and nurses responsible
medications for providing care
-Ensure that handovers are of a good enough quality
to guarantee patient safety
Harold shipman case [BRITISH -British doctor and serial killer who murdered about 250 of his patients -Led to changes to standard medical procedures in
DOCTOR WHO WAS A SERIAL and one counts of forgery (WHICH THE GMC DID NOT REMOVE HIM OFF the UK (shipman effect)
KILLER] THE REGISTER) then sentenced him to life in prison -GMC strongly imposed on doctors to co-operate
-Injected his victims with a lethal dose of the painkiller (diamorphine) and with the certification system
signed a death certificate attributing incident to natural causes -Enforced medical coroners to work with judicial
-Why he did this?: Maybe to avenge the death of his mother, practicing coroners (coroners are those who investigate deaths
euthanasia, removing older people which burdened the health care system where the causes are unexplainable) revised death
-Took advantage of his patients that trusted him in as a doctor (non-Mali certificates to be completed for all deaths
fence) -The need for systems to protect patients from
doctors who fail to uphold the ethical standards that
they should
-GMC focused too much on protecting doctors rather
than caring for patients
Changes: to the coronial service and death
certification, making it easier for families to report
concerns about medical care to the coroner
Junior Doctor strikes/ Contract -UK government worked with BMA to negotiate a new contract that would -Led to a lot of doctors becoming very demoralised, 9
change [UNDERPAY,LONGER be more suitable for modern day doctors out of 10 junior doctors were considering leaving the
HOURS, 7 DAY NHS] -They were going to reduce the cost of employing doctors on the NHS
weekends in line with their plan to introduce a 7 day NHS, reduce extra -Ensured consultants were on hand to run A&E
pay the doctors worked for overtime and introduce a slightly higher overall departments meaning the public was not at huge
salary danger, however the public did turn against the
-Doctors claimed that they would see a decrease in overall pay as they doctors as their duty is to protect and support
were heavily reliant on the number of hours in overtime worked patients
-Implementation of a new system that provided increased pay with each -There were many safety concerns as junior doctors
new stage of training reached were concerned that the contract would increase
-Under new contract maximum working hours were reduced from 91 to 72 stress, tiredness and burnout amount their
hours a week colleagues
-All doctors went on strike in April 2016 -The new rota for 7-day NHS did not account for
-Doctors felt that the contract would not encourage safer working additional staff, the increase in antisocial hours was
practices and was an attempt to force them to work long antisocial shifts, also not reflected in an increase in pay
= making them more tired and less able to practice with competence -Less senior doctors work on weekends thus creating
-Issues with taking time off for research or maternity leave or pursuing a a work force with less experience could contribute to
PHD, the pay progression would have continued but in the new contract it the higher risk of death when admitted on a
was stated it had to be paused weekend.
MMR vaccines [ANDREW -MMR stands for Measles, Mumps and Rubella, the vaccination was given -Problems with the paper means other research
WAKEFILD AND LINK TO AUTISM to young children with the first dose around 12 months therefore the failed to replicate his results
AND MMR] decision is with the parents not the child -Evidence was found that he had ignored lab data
-The combination of the three vaccinations is useful which went against his hypothesis
-1998 Andrew Wakefield a surgeon published a paper showing a link -The sample size was too small (12 cases)
between the MMR vaccine and autism (a novel bowel disease), requested -Some children were reported to show symptoms a
for single japs instead of the three vaccines at once long time after the vaccine but report claimed the
-MMR vaccination rate began to drop significantly as parents were effect was immediate
concerned about the risk -He breached the trust of the people, he seized on
-Andrew Wakefield was struck off the UK medical register in 2010 the desires of a hugely vulnerable group of people,
-Reports showed that Wakefield chose data that best suited his argument the desperate parents of autistic children and he was
and was believed they did this for their own financial gain, had falsified highly respected surgeon
data -Peer review is very important, need to declare no
-Decreased the confidence in vaccination and the long-term effects, the bias and no financial interests
public trust in the medical community, portrayed autism as a very negative -Ethics of research, importance of finding the right
thing and worse than the risk of the deadliest diseases volunteers as he used children with autism as guinea
pigs and wouldn’t let them consent to procedures
and had no idea of them, e.g., would try out his
vaccine on one child without telling their GP, he
failed to pay attention to the high standards required
of medical researchers
-Long term consequences, very hard to remove an
idea of wake fields from public consciousnesses,
despite evidence showing against his work some
people still have doubts and real doubts and won’t
listen to medical research

Mid Staffordshire enquiry/ -Francis’s report was published based on a public inquiry into the poor -Outcome: Introduced new programme for tracking
Francis report [FAILED care at the Mid Staffordshire NHS foundation trust and eliminating falls, pressure sores and hospital
TEAMWORK AND -400-1200 patients died as a result of poor care over the months Jan2005- infections
RESPONSIBILITY] March 2009 -Demanding nursing rounds every hour, clear line of
-Was set up in November 2010 to examine the failure to spot the poor leadership established so it is clear who is ultimately
standards of care in charge when it comes to a particular patient
-Reported of dirty wards, lack of nursing care and long waits of medical -Public trust within the trust is reduced
attention -Changes made: staffing levels and skill mix,
-Patients left in soaked bed sheets because they had not been taken to the eradication of the blame culture and bullying (it’s not
toilet my problem), constant training and regulation of
-Food and water being left out of reach, not having a bath or shower for a healthcare assistant ants, recruitment, training and
month, chronic staff shortages, someone else’s problem attitude among standards of registered nurses
hospital staff – LED TO FAILURE IN TAKING RESPONSIBILITY -GMC – improved education, safety in the practice
-Failed to accept and respond to legitimate complaints and failure of environment
communication amongst the teams -Government – Gave recommendations of improving
-Showed huge understaffing in nurses, ratio of registered nurses to patient care, increasing openness and changing to
healthcare assistants dropped as low as 40:60 in some areas regulations
-Understaffing means that a given patient will likely not receive the care -NICE- Created guidelines on staffing capacity to
they need at the correct time, a test may arrive late ensure safety in the NHS
-Understaffing will lead to a tired and stressed workforce who in turn will
make more serious mistakes
 Medical Ethics & examples
on how to answer them

WHAT IS MEDICAL ETHICS – “(BMA 2020) Application of ethical reasoning to medical decision making’
Underpin the moral compass under which medical professionals must work

WHAT IS THE HIPPOCRATIC OATH – Dated back to at least 400BC, considered earliest expression of medical
ethics and reflections some of the pillars of medical ethics used today, swear by the oath to uphold specific
ethical standards, some parts of the oath has been adapted into GMC and many other documents of medicine

4 PILLARS OF MEDICAL ETHICS

Term Explanations Example

Autonomy  Gives patients who are competent  E.g lacking patient capacity, if a
enough the right to make decisions patient has dementia
about their own healthcare, patient  Jehovah witness who has
has a say and is in charge of their refused blood transfusion
own care (assuming patient has during a major bleed (has
capacity**) autonomy as they have
 Idea of self-governance capacity, decision must be
 Individual has right to make a respected even if it isn’t in their
decision and act under a chosen plan best interests)
 Refers to the fact that patient has the  Doctor needs to take a patient’s
right to deny any treatment that is blood then the consent of the
offered to them or choose between patient is important, has the
treatment options right to refuse the blood test
 Not paternalistic (doctors cannot  Charlie Gard** case- parents
force patients to undergo particular acted on his behalf because
management) Charlie was too young
 Although offered autonomy, cannot  Vaccinations – those opposed
demand a treatment if not offered to vaccines, COVID-19 refusing
e.g doesn’t have the right to receive to wear a mask**
a treatment that’s not licensed
 If patient lacks capacity, they cannot
understand, weigh up or
communicate their decision,
autonomy can be overruled
Beneficence  Doctors should maximise the  Patient requesting antibiotics
benefits that medical care has on a but the doctor knows of a
patient, may have a risk of becoming better alternative treatment
paternalistic then the doctor will use their
 Moral duty to promote the course of expertise to give the patient
action they believe is in the best the treatment that is best for
interests of the patient them
 Need to weigh up every option and  Someone has a cancer but
conclude to what the best course of daughter wants tumour
action is, and whether this aligns removed, son thinks it’s best to
with the patient expectation come home without operation
(beneficence- patients’ best
interests, assess physical
health, her fitness and surgery
and how beneficial surgery is to
her prognosis)
 Failure of beneficence –
Tuskegee syphilis trial
negligence
  100s of African Americans were
found to have syphilis told they
had bad blood, offered free
meals, healthcare but not fully
informed they had syphilis and
not offered any treatment even
when penicillin was found to be
effective
 Doctors failed to help their
patients as they didn’t offer
them effective treatment or
was not informed instead on
focussing on their research
goals which is a gross betrayal
of research ethics and
beneficence
Non-maleficence  Often seen as a sister to beneficence  A surgeon will not operate on
and considered as an inseparable patient in non-sterile
pillar of ethics environment because that will
 Has a duty to do no harm, cause harm to the patient
considering whether short term harm  Example used in beneficence-
outweighs long term benefit likelihood that doing the
 Tries to minimise the harm that surgery is to be more damaging
medical intervention does to a than good, it is likely you would
patient not recommend surgery
 Maintaining medical competence  Harold shipman case where he
and not giving patient treatments targeted patients and gave
where the risk outweighs the them high dose opiates ending
benefits their lives
 Differences to beneficence: weighs  Gosport war memorial hospital
risks vs benefits whereas beneficence scandal – shortening of
we consider all treatments and then hundreds of lives starting in the
rank them in preference late 1990s, patients were given
 Use beneficence in response to a high dose painkillers without
specific situation e.g. determining clinical indication
best treatment for a patient, non-  Euthanasia, abortion, 14-year-
maleficence is a constant in clinic old asking for oral
practice e.g. if you see patient contraceptive pill**
collapse in corridor  Asking patient for antibiotic
allergies – started of to be
beneficence but can turn into
non-malefice if it was severe
allergic to, so simple
communication can reduce the
risk of maleficence

Justice  When weighing up if something is  Free prescriptions for lower

ethical or not, have to think about its income individuals
computability with the law, patient’s  Fair distribution of resources in
rights and whether it is fair or a hospital
balanced  HIV+ patient has not discussed
 Ensures no one is unfairly diagnosis with partner, doctors
disadvantaged when it comes to must consider the effect issues
accessing healthcare in medicine affect society
 Responsibility lies in a very large part around patient
with the doctor and must live with
 consequence of choice e.g. two  Would encourage patient to
people needing liver transplant but reveal their diagnosis after
only 1 liver available checking their understanding to
why it’s important
 Thinking about other pillars of
medicine e.g. not wanting to
destroy the trust in patient-
doctor relationships by
breaking confidentiality (non-
maleficence)
 Public health measures,
medicinal cannabis and health
inequalities suffered by the
BAME community**

Examples of how to answer questions surrounding Ethics::

- IMPORTANT THINGS TO NOTE: 4 pillars of medical ethics, ICE method, Gillicks competence, consent,
confidentiality and competence, balanced argument (The 3C’S)
-
Philosophical theories that are key:

1. CONSEQUENTIALISM/ UTILITARIANISM

 Morality of a decision depends upon the consequences

 If the consequence was good then the decision was right but if the consequence was bad then the decision was
wrong
 This has its applications to utilitarianism which says the best consequence is that people are happy
 Utility principle- Achieving the greater good for the greatest number of people
 Has its issues though as we cannot predict every single consequence
 Ends justify the means, if the action has overall benefit = it does not matter about the action itself
 E.g., a patient who is terminally ill and is not likely to survive the operation, she asks Doctor will I be okay? Using
a consequentialist ideology, it supports that lying in this circumstance is acceptance even though lying itself is not
a moral action
 Utilitarianism says the best action is one that brings about the best increase in utility
 Utility is a form of consequentialism, takes part of the wider society not just the patient in question
 E.g Sum of money to fund a very expensive treatment for one patient with a rare disease or 5 patients with a very
common and easy to treat disease, the utilitarian ethics says that treating the 5 patients is morally superior as a
greater overall benefit is achieved

2. DEONTOLOGY/KANTIAN ETHICS

 Argues that certain things are always right or wrong, regardless of the consequences
 Counters the inhibitions that we may have towards consequentialism
 No room of flexibility in deontological ethics, so to stick rigidly to its principles could cause more harm than good
in certain situations
 Autonomy and consent is very important, stated in the second formulation
 Second formulation stated that you must not treat people as means to an end but in their own end
 Course of action is dependent on what your duties are and obligations
 E.g. a terminally ill patient asks if they’ll be okay after a surgery they’re unlikely to survive, a deontological
approach would suggest you don’t lie to comfort them, that’s because according to this concept, lying isn’t
morally acceptable because we have obligation not to lie

3. VIRTUE ETHICS

 Based on teaching and writings of Aristotle and Socrates whereby it is the character of a person and the
motivations behind their actions that are most important
 It suggests that a person should aim to be a good person and have good habits and therefore will automatically
act in a way that is moral and good
 Beauchamp and Childress suggest the 5 key virtues are compassion, discernment, trustworthiness, integrity,
conscientiousness
 All habits that doctor and medical students should have
 The qualities of a good doctor arguable is one that has these virtues
 A quality of a doctor is to heal, Aristotle says that the healer needs three attributes, integrity, practical wisdom
(phronesis) and altruism
 HOT TOPICS AND SCENARIOS

Patient refuses treatment for a life-threatening condition

 Important to consider the duty of the Doctor, e.g., it is crucial that the doctor has fully informed the patient of
the treatments benefits as well as the risks associated with not having the treatment
 Must respect the concept of patient autonomy (important pillar in medical ethics), if the patient has chosen not
to take the treatment, then the Doctor must respect this
 However patient autonomy does not always apply if the patient does not have capacity or is competent e.g. may
have to perform capacity testing tools, or use the three R’s (RECITE, RETAIN & )
o Capacity testing includes 1. Understanding the information relevant to the decision, retaining the
information in the making of the decision, using the information to weight up the information and
communicating the decision made
 Important to consider the patients age, e.g. if they are under 16 then parents may have to make a decision, link
to Gillicks competence tool
 Prove to be competent includes explaining the treatment to the patient and seeing fi they are able to weigh up
the consequences of refusing the treatment
 Beneficence and non-maleficence are often linked together, most beneficial thing may be to provide the patient
with the treatment they need BUT if this is against the patient’s wishes, this may be more harm than good
 Must always adhere to the GMC’s guidelines and respect autonomy, whatever the patient’s decision might be
 Autonomy pillar = patients’ autonomy should be respected so if they refuse treatment, a doctor should respect
that choice OR depends upon their competency
 Beneficence = Giving patient treatment will save their life would be doing good BUT giving it against their will
may not be in their best interests as they may feel they aren’t being listened to
 Non-maleficence = Harmful to accept the patient’s decision because they could die by not having treatment BUT
it could be harmful as something could go during the surgery that negatively impacts the patient
 Mental capacity act makes it very clear that a person with capacity has an absolute right to refuse treatment

For Against
Autonomy A patient’s autonomy should be respected so if The patient’s autonomy varies depending on their
they refuse treatment, a doctor should respect competency, so a patient may not be competent for
that choice the autonomy to be valid

Beneficence Giving the patient treatment that will save their If you give the patient the treatment against their
life would be doing good will, it may not be in their best interest as they may
feel that they aren’t being listened to

Non-maleficence It would be harmful to accept the patient’s It could be harmful as something could go wrong
decision because they could die by not having the during the surgery that negatively impacts the
treatment patient

**QOALYs

Means quality of adjusted life years- every intervention drug or treatment, think about how many years of life is added to
the person and how much longer they are expected to live with intervention

Weighed against how good quality of those years to be, how well they can perform activities, free from psychological stress

[NICE SUGGESTS IF ONE QUALY> THAN 3 THOUSAND POUNDS THEN AN ALTERNATIVE TREATMENT HAS TO BE OFFERD]
Cost be QALY is the tool that NICE uses to judge the cost effectiveness of new technologies

Patient under the age of 16 is asking for contraceptives at GP

  Under UK legislation, those under the age of 16 are unable to give consent to sexual activity, always important to
consult the GMC’s ethical guidelines on this
 Doctor must fully inform the patient of the benefits of the treatment (protected sex) and the risks associated
with not having the treatment (unprotected sex), should provide advice on sexual health
 Doctor has a duty to society to ensure the safety of their patients and to ensure child protection and safety e.g.
to confirm that sexual abuse is not taking place
 Competence is very important e.g., Gillicks and Fraser guidelines
 Autonomy = Doctors must respect the decision made by a patient, patient autonomy is not absolute
 Beneficence and non-maleficence= Doctors must continue to provide the best care in the patient’s best interests
and their personal views must not interfere with their professional duties
 E.g Do not be judgemental such as 14-year-olds shouldn’t be engaging in sexual activity, equality act 2010
 Important to consider confidentiality and effect on the doctor-patient relationship which is built upon trust
 If GP believes that the safety of the patient is at risk, they must follow child protection protocol
 Confidentiality important, if girl is deemed competent then the parents should not necessarily be informed
 If she is not competent, you would overrule her autonomy and make encourage her to tell her parents
 Autonomy = If the child fulfils the Fraser guidelines and is therefore deemed competent then you should respect
their decision, patient autonomy depends on the patient
 Beneficence = Could be in the child’s best interest to receive contraceptive treatment especially if they are
engaging in sexual activity BUT providing contraception without parental consent may not benefit the child as
they are now less likely to tell their parents
 Non-maleficence =Could put the patient in greater risk of sexually transmitted infections and pregnancy if not
given
 Justice= In accordance with UK legislation if a child fulfils the Fraser guidelines a doctor is legally allowed to
provide them with contraception
 Safe guarding issues: large age difference, drugs and alcohol, patient known to police, child is pregnant, may be
pressured by someone, capacity is also time specific
 Overview of medical ethic pillars:

FOR AGAINST

Autonomy If the child fulfils the Fraser Patient autonomy depends on the
guidelines and is therefore deemed patient and can vary at different
competent, then you should respect points particularly in young people
their decision
Beneficence It could be in the child’s best Providing contraception without
interest to receive contraceptive parental consent may not benefit
treatment particularly if they’re the child as they are not likely less to
likely to continue engaging in sexual tell their parents
activity
Non-maleficence Not giving contraceptive advice or
treatment could put the patient at
greater risk of sexually transmitted
infections and pregnancy
Justice In accordance with UK legislation, if
a child fulfils the Fraser guidelines a
doctor is legally allowed to provide
them with contraception

**Equality act 2010 – protects people from discrimination in the work place and in wider society

Anti-discriminatory practice is fundamental to the ethical basis of care provision and critical to the protection of peoples
dignity, it protects those receiving care and the workers that provide it from being treated unfairly because of any
characteristics that are protected under the legislation

[INCLUDES AGE, DISABILITY, GENDER RE-ASSIGNMENT, MARRIAGE AND CIVIL PARTNERSHIP, PREGNANCY AND MATERNITY,
RACE, RELIGION OR BELIEF, SEX AND SEXUAL ORIENTATION]
 Abortion

 Abortion is legal assuming that it meets the criteria of the 1967 Abortion Act
 UK 2 doctors must authorise the request before proceeding, if physician rejects then must refer to another
physician (called conscientious objection)
 Risk of the life of the pregnant woman, necessity for abortion to prevent grave permanent injury to the physical
or mental health of the pregnant woman, risk of injury to the physical or mental health of the pregnant woman
or any existing children, substantial risk that if the child were born it would suffer from such abnormalities
(reasons why a woman would have abortion)
 Moral debates: that we are deliberately killing an innocent human is wrong, foetus has own right to live
 Abortion is permissible until 24 weeks, which then poses a severe risk to the woman’s life
 Considering autonomy, patients should have the right to abortion if they wish, it is important to have the best
interests of the mother at the centre of their health care (ethical concept of beneficence)
 Abortion may be the most loving thing to do in the case of a foetus with severe deformities as this presents
issues with quality of life
 Non-maleficence, important for a doctor to prevent any harm, so considering harm to both mother and foetus is
important
 Autonomy= have the right to decide themselves instead of being regulated by laws, BUT the foetus has a right to
life and could argue that the embryo has genetic material and should have rights from week 1
 Beneficence= may be the best option for a mother who is unable to raise a child, or may contain a disorder which
means they have a limited quality of life
 Non-maleficence= a pregnancy can have physical and mental effects on the mother, may be born with defects
BUT abortion can be seen as killing a human being depending on the definition of when life begins
 Justice = England, Wales and Scotland abortions are legal according to the Abortion act up to 24 weeks it used to
be until 28 weeks until 1990
 Confidentiality must be upheld according to the GMC guidelines
 PROLIFE: Human life begin at the point of conception and therefore it is murder, if the mother cannot take care
of it it can be given up for adoption, many woman may be pregnant through rape and unborn child is innocent
and should be punished, an abortion can cause psychological distress for the woman, all children have great
potential may have extremely important role in society
 PROCHOICE: An abortion may be necessary to save the woman’s life in certain cases and thus this option should
be taken where necessary rather than risking the mother’s life, in the case of rape forcing a woman to have the
child is more psychologically damaging to her than having an abortion, fertilised eggs used for the IVF may be
destroyed or thrown away but destroying them is not considered as murder, keeping abortions legal will stop
unsafe practice from happening in secrecy which can be detrimental to someone’s health

Junior doctor strikes and whether this is acceptable

 Many arguments against this, e.g having fewer healthcare staff in hospitals will endanger patients, but the junior
doctor strikes in 2016 occurred and was ensured that adequate cover was placed in emergency settings
 A strike is morally problematic as it is defined as a refusal to work as a form of protest, but the main issue is that
the potential patients may be harmed
 This goes against the ethical principle of non-maleficence and therefore, some would argue it cannot be justified
 Can use consequentialism to argue for this
 E.g if doctors wanted to strike to have better food in cafeteria this would not be justified but if they stroked for
their working conditions which is very important has more potential to be justifiable
 Deontology ethical theory states that doctors have a duty of care to their patients, this could be interpreted to
mean that doctors should never strike and they should put their patients first
 However, it can be argued that the duty of care to patients is dependent on the ethical duty to one’s self of self-
care, if the personal welfare of a doctor is affected it will have detrimental effects on patient safety
 Junior doctors were on strike after talks over new contracts broke down
 Can be argued that workers have a right to strike and that for healthcare professionals it would be a last resort
after trying for everything else
 Not only do doctors strike for pay, there were also deeper concerns such as patient safety which was a major
concern for the strike
 Until 2016 there was only one strike in 40 years from doctors which means events like this is an extreme measure
when no other options were left
 Striking can be ethically acceptable but depends on the reasons and circumstances

Should vaccinations be mandatory?

 Important to realise that vaccinations has been a controversial issue and there are arguments on both sides e.g
Andrew Wakefield case
 Making vaccinations mandatory allows for eradication of diseases such as polio and smallpox, generally vaccines
are highly safe and effective
 As vaccination rates decline, the number of infectious diseases increases especially with the Wakefield problem
 Some people argue against the vaccinations as they believe that the government should not be able to control
such health-related decisions
 Some people have huge needle phobias and react very badly to them but this can be responded to with nasal
spray vaccinations given to primary school children
 There may be alternatives to mandatory vaccinations such as educational interventions which will teach children
and adults how important vaccines are
 Making vaccinations mandatory, can be argued to overruling one’s autonomy
 For: When vaccines control disease, parents are less likely to witness the devastating effects of vaccine
 The number of people taking vaccinations may be falling as some people are exposed to negative messages
online about vaccinations, it’s been a long time since the mumps and measles have arisen to a serious level and
therefore, they don’t feel urgency to vaccinate their children.
 Vaccinations are usually given for herd immunity, if enough people become immune to a particular infection or
disease through vaccination, those who can’t be vaccinated are protected such as the young or the old or those
who are immunocompromised
 Mass protection, has saved many lives and prevents 2-3 million deaths a year, with the improvement of global
coverage it could save a further 1.5 million lives per year
 Most vaccines provide long-term immunity except the flu vaccine
 Some people don’t trust the science behind vaccines and they believe toxic chemicals are being injected to
humans which may track their activity and of such
 Some people are scared to vaccinations of the severe side effects that are very rare
 Human right of choice is given here, making it mandatory can cause controversy as everyone has their right to
their own body and choice to how it is treated
 Talk about COVID-19 vaccinations

Euthanasia

 Euthanasia is the act of deliberately assisting or encouraging another person to kill themselves and is illegal in the
UK currently
 Passive euthanasia is considered to be part of palliative care and is therefore not technically considered as
euthanasia in the eyes of the law
 Voluntary euthanasia is euthanasia which is conducted with consent
 Non-voluntary is euthanasia conducted on a person who cannot provide consent due to health problems and the
decision is then made by another person based on the patient’s quality of life and suffering
 Involuntary means euthanasia performed on a patient who has the ability to provide informed consent but does
not (this is murder)
 Passive euthanasia = light sustaining treatments are not given or when a patient is given increasing doses of
medication that become toxic such as strong painkillers
 Active euthanasia is when something is done to a patient to make them die more quickly e.g giving drugs with
the intention of bringing about death
 Is legal in switzerland
 The 4 medical pillars:

FOR AGAINST
 Autonomy A person has the right to choose if When considering autonomy, we
they wish to end their life before need to consider if a person has the
their terminal illness progresses any capacity to make their own
further, if they choose to have a decisions, whether they are in sound
loved one or relative assist them mind, whether they legally able to
with this then who are we to say make their own decisions with
they shouldn’t regards to their healthcare
Beneficence If a person believes that losing all It could be considered that by
ability to move (e.g) and leave them assisting in a patient’s death as a
unable to talk, eat or even breathe practitioner you are not being
unassisted would be detrimental to helpful to the patient, in fact you are
their own mental health then are we harming them, preservation of life is
really being good to our patients something that doctors believe is
letting them become depressed or very important
worse and then slowly die, the
patient may feel its beneficial for
them that their family doesn’t see
them like that
Non-maleficence It is part of a doctors oath to do no
harm and therefore it cannot be
right to assist in someone’s death
Justice Assisted suicide is legal in some It is currently illegal in the UK to
countries, therefore why should assist in euthanasia
patients not be allowed to use
euthanasia in the UK

 Consequentialist response: Would argue that as patients have the right to refuse life-saving treatment, and
doctors cannot force them to receive it, the result of both is the death of the patient and therefore euthanasia
already exists
 Deontological response: However, would say that this is not the case as it is the intention of the doctor that is key
and it must be considered whether the doctor was aiming to bring about the patient’s death or simply just
foreseeing it
 Euthanasia cases: Dr. Cox gave lethal injection of potassium chloride to patient who was suffering from pain due
to rheumatoid arthritis, charged for attempted murder and not murder because it was unclear to see what killed
her (whether it was the dosage of potassium chloride or the illness itself)
 For:
o Always will be some patients whom their illness causes intolerable suffering, helping those patients to
end their life would be the most compassionate thing
o Autonomy allowing patients to decide for themselves when to end their lives at a point
o A change in the law would provide comfort to the dying knowing that the option is there
o Allow people to make their own decisions about their health and lifestyles as long as they do not harm
other people
 Against:
o Doctors turning into executioners
o If law on assisted dying changes now, makes more space for law to change and apply to more people
e.g with children euthanasia
o People may feel pressure to spare their carers the burden of looking after them or might be bullied into
choosing death
o Autonomy, doctors can refuse treatments they believe is not in the patients’ best interests

Example responses:
1. Euthanasia is a controversial topic for a multitude of reasons that come from a variety of different backgrounds.
One of the reasons for controversy lies in the very definition of euthanasia. Euthanasia is defined as the ending of
life to alleviate suffering. This almost makes it sound like a form of treatment. The controversy arises when one
considers the very meaning of being a doctor. It is the doctor’s duty to safeguard and protect life, not to end it.
On the other hand, the idea of duty of care and patient well-being is the very thing that may justify the ending of
life to alleviate suffering. In essence, the controversy on an ethical level arises in part from the conflict between
safeguarding life and ending it to reduce suffering. Other causes for controversy lie in issues such as
communication where the question is asked how, for example, a comatose or paralysed patient can
communicate their wish to live or die. A further point to take into consideration is the idea of life not worth
living. Once we accept that there is a life that can be declared as not worth living, where does that lead us? Some
fear that it will lead to a slippery slope where definitions of unworthy life become increasingly arbitrary.
The GMC code of good medical practice and UK law currently don’t permit euthanasia.”
2. The difference between euthanasia and physician-assisted dying is that in the former, the doctor is actually doing
the act that kills the patient, whereas, in the latter, the doctor is merely assisting the patient to kill themselves.
There are several important differences between the two. For example, in physician-assisted suicide, the
patient’s desire to die is, by definition, a requirement. This is not necessarily the case for euthanasia, which can
be voluntary, non-voluntary or involuntary. It is because of this that some people argue that physician-assisted
suicide is more morally acceptable because it is in accordance with patient autonomy whereas euthanasia is not
necessarily. However, it is sometimes argued that this discriminates against those who are too disabled to
commit suicide, even with physician-assistance, and that in these cases, active voluntary euthanasia should be
allowed as ultimately the intention is the same. Legally, there is also a big difference – active euthanasia is
regarded as murder or manslaughter whereas physician-assisted dying is not, though it is still illegal.”

Organ donation opt in and opt out

 Can donate organs when alive but mostly dead

 Very high in demand as there is a long waiting list for organ transplants
 Only small % of deaths allow organ donations as some deaths don’t allow viable organs to be used e.g circulatory
death in which the organs are starved of blood
 A larger challenge is that the BAME community experience longer waiting times for organ transplant as there is a
lack of suitable organs from BAME donors.
 Opt-in system
o Doctors can only use a person’s organs after death if that person signed up to an organ donation
register during their life
o However, there is major issues that potential donors don’t register and are unaware that they have the
option to register
o 2020 study showed 80% people supported organ donation but only 38% had opted in so didn’t
translate into a high number of potential donors
o Those in favour of an opt-in system argue that this type of consent (informed consent) is more valid
and ethical as nothing is being assumed
 Opt-out system
o If a person has not registered a decision to either become an organ donor or not become a organ donor
they are considered to have no objection to being an organ donor after death (known as
deemed/presumed consent)
o This increased the number of people on the NHS organ donor
o Those opposed to an opt-out system argued that the deemed/presumed consent is less valid as people
could be unaware that they are automatically signed up to donate their organs
 Medical ethics for opt -out, against opt-in:

FOR OPT-OUT AGAINST OPT-IN

Autonomy Everyone has the right to decide, Everyone has the right to decide if
however surveys have shown that they wish to be on the organ
many wish to donate their organs or donation list, they will choose to
wouldn’t be bothered if their organs register for it
were donated after death, yet have
no registered to be an organ donor
Beneficence Having an increase in available
donated organs will be beneficial to
patients waiting on the transplant
waiting list
Non-maleficence By not finding a way to increase the Some people do not wish to donate
number of donated organs available, their organs or to receive donated
it could be considered as doing harm organs, or even blood products from
to those on the transplant waiting another human. Many of these
list individuals put this down to religious
grounds, such as Jehovah’s
witnesses while others have this as a
personal view. Therefore, it would
be detrimental to these individuals
to donate or receive another organ.
Think about the social and mental
health implications on individuals
 Justice Wales currently have an opt-out
organ donation system that works
very effectively

 The altruistic nature of donating a kidney is taken away, and so, a) please maybe less inclined to donate and b)
there maybe a greater chance of the transplanted organ being rejected from the body by the patient (due to
psychological reasons).
 The opt-out system may take the pressure of an immediate decision away from the family/friends, who (under
the current system) are burdened with this choice after the patient’s death. On the other hand, it might create a
tension within the family members, if the patient’s donor status conflicts with what the relatives want.
 Although the organ donation register (ODR) is supposed to be confidential, there might arise an element of
shame within the patient if he choose to opt-out. (I’m not sure if this is a valid point). Conversely, the patient
might feel pressured to donate even if they don’t want to, due to their decision on the ODR.
 Could lead to more cases such as the Alder Hay scandal, when organs maybe mistakenly removed against the
donor’s or relatives wishes.
 Patients may want to change their decision on the ODR, but may not have had the time to do so. This may cause
additional stress for the family, with regards to respecting the ‘supposed’ wishes of the deceased or following the
information on the ODR.
 Patients/families might feel that the doctor only wants to harvest the organs of the patient, leading to a sense of
distrust. Moreover, they might feel that the doctor has ‘killed off’ the patient too quickly, when there might be a
possibility of recovery.
 The news of the change may not be read/understood by everyone in the country (particularly in remote and rural
communities), and so people won’t realise to register to opt-out before they die.

Privatisation of NHS

 The main idea of privatisation comes from the fact that the current model is no longer working due to the
financial pressures on the NHS as its become so expensive and with so many current advancements in technology
the care is so much to fund
 The funded healthcare is not sustainable in the long term as last several decades life expectancy has rapidly
increased
 Pro:
o More choice for patients
 NHS often seen as a one-size-fits all system, privatised service may allow patients to better
choose where to be treated and what treatment to have
 Patients value their right to choose which hospital to go to and what treatment they receive
 However, some patients will only want to visit their nearest hospital and it may be impossible
for them to travel anywhere else
o A lot more competition
 Ability to drive down costs
 Private companies will be more motivated to make savings if it impacts their profit which
means decreased cost for taxpayers, commissioners and MPs
o Could reduce waiting times
 There are such long waiting lists waiting for treatments
 Privatisation reduces backlog and increases surgical capacity
 Privatisation would result in greater patient choice and more better outcomes
 However, this can be an advantage as healthcare outcomes could be shaped as not by need
but whether you have enough money to jump the queue
 Just because lists have been creeping up for years doesn’t mean it should be private
 Distributing services to private companies mean reduced waiting times benefiting the patient
leading to faster treatment and quicker recovery
o Concerns raised about poor working conditions
 Healthcare professionals may lead to overworking and burnout
 Privatisation may mean better working conditions, employment benefits and financial
incentives which NHS cannot provide
 Can contribute to increasing doctors’ morale, which could further improve standards of
patient care and safety

o Cons:
  Moral argument
 NHS was meant for free health care
 It should deliver free care to everybody regardless of wealth or status
 Equality act
 Public healthcare is more efficient
 Patients in countries with a government-controlled system have greater trust in its
healthcare in systems than America which has private healthcare
 Continuity of care
 Private firms will not carry on providing an unprofitable service any longer than
they have to
 Lack of continuity means some patients find their health providers change during
an illness
 Concerns on motive
 Private providers are motivated solely by profits and then may be less likely to
provide effective and safe care which means corners may be cut with patient safety
in order to reduce costs
 If a service is not financially beneficial they may choose to abandon it which may
leave patients without access to lifesaving medical treatments

NHS MENTAL HEALTH + FUNDING

 Mental health services have been overstretched and underfunded in the NHS which means that many people
with mental health problems haven’t got the help they need to stay well
 Therefore in 2018 the government announced it was increasing investment in the NHS and therefore set out
vision for transforming mental health services
 The 4 priorities were set out in the report are:
o Preventing people from developing mental health problems where possible
o Improving access to support for everyone who needs it
o Supporting people to recover and lie will in the community
o Tackling inequality
 1. Prevention
o In the report it said that they are trying to build targeted public health programmes that prevent
mental health problems from developing and such programmes can be delivered through the NHS,
schools, workplaces, community groups
 2. Recovery
o They said its important for the mental health support for those in recovery which means they had
access to good quality accommodation, having the right help to get back into work, education or
training, full support and care, effectively meeting whatever needs people may have
 They have introduced projects across the country and many schemes to help promote positive wellbeing
including most deprived local authority areas, it also has a 24/7 NHS open access urgent mental health helplines
 There are also mental health schemes being rolled out in schools and colleges offering early mental health help
to children and young people
 Before COVID-19 hit, mental health services were under pressures and going through a pandemic has made
things much worse, a lot of people are not being taken seriously for their mental health which affects their
overall performance in school/work

AI/ ROBOTICS AND TECHNOLOGY IN HEALTHCARE

 Artificial intelligence is the ability of computer or other machine to perform actions thought to require
intelligence
 Being used in Medicine
o E.g. systems being designed to accurately diagnose diseases from medical imaging scans and
microscope slides
o Cancer and other diseases can be detected at earlier stages = offering better long-term outcomes
 o AI is also used to assist screening processes such as IVF to determine how likely a fertilised embryo is to
result in a successful pregnancy
 Radiotherapy uses generic dose prescriptions that doesn’t consider the specify of individual tumours however an
AI framework has been developed to use a patients CT scans and electronic health records to create a dose
specific for the individuals
 Vital nursing is also a type of AI = designed to monitor health
o E.g wearable devices offering advice and guidance to patients in their own homes as well as reminding
people to take their medications on time
o Current device = measures a patient’s pulse, temperature, respiration and oxygen saturation giving
doctors regular updates on their patients’ health and can be used both in hospitals and at home
o Could be implemented in the NHS 111 service as it could reduce waiting time however public opinion
may be against talking to a robot
 Robotic surgery = robots have been developed which are able to carry out routine operations
o Means decrease in staff required and time saved, decreases surgical complications
o Uses robotic technology to help with certain operations such as knee and hip replacements and
prostate cancer surgery
 Offers information services: e.g by working with amazon Alexa to offer health information by just voice search
o It integrates the NHS website content directly into Alexa’s core knowledge and you dont have to enable
this skill in advance
o It helps reduce demand on doctors and provide special benefit elderly people e.g blind people and
people who cannot easily search for health advice on the internet
o Confidential data concerns have been reassured by Amazon as they are encrypted
 Practical uses of AI:
o Earlier diagnosis
 Computers can be programmed to read data using algorithms, very subtle changes can be
detected
 Radiologists will look at x-ray images and may find it difficult to spot something earlier on
 Finding something earlier on will lead to earlier diagnosis which means a more effective
treatment plan can be put in place
o Data collection
 NHS reliant on paper files which limits the exchange of data and information across the NHS
 All patient records are processed through the data protection act (2018), they have a law of confidentiality,
cannot give personal information out, ensure what individuals know what they are consenting to
 AI in healthcare has helped greatly in streamlining tasks, from setting appointments and tracking patient records
and medical histories
 It is cost efficient and resourceful
 Can integrate other sources of information based on research
 Cons:
o Requires human oversight as AI is not perfect, AI does not have empathy and human doctors will still
need to weigh up the final decision depending on each specific patient
o AI doesn’t take into account of socioeconomic background of patients and whether the patients feel
comfortable going to the facility produced by AI
o Compatibility issues with mobile platforms and devices, doesn’t take into account of what we are all
capable of having
o Patients may want more of a hands-on care experience
o Possible security risks, security breach with data privacies, susceptible to data collected being abused
and taken by the wrong hands
o More costs may need to be used to increase data security for hospitals invested in AI
o Cyberattacks can be greater threat in manipulating and giving erroneous diagnosis
 AI in antibiotic resistance earlier diagnostic challenges
 AI made diagnosis tools that can detect malignant tumours invisible to naked eye
 Cognitive computer systems making tailored treatment plans for cancer patients

DISEASE PREVENTION AND PUBLIC HEALTH (PREVENTION VS CURE)

 Prevention Is better than cure as identifying health issues at an early stage allows them to be managed better
and prevent them from occurring
o Lives can be saved and money too
o Curing diseases may need use of mediations which could have severe side effects
o Some diseases in which cure is not available
o Disease will always cause some harm onto the body
 o Viral diseases and STD are hard to cure once contracted and can be life-threatening
o Stops us from having to deal with consequences of contracting it in the first place (saves money and
resources)
o Prevention provides certainty that something wont happen
 Much of ill health can be prevented and prevention is crucial to improving health of whole population
o It also secures the health and social services we all value and rely on
o It will also boost the health of the economy
 There is an ageing society and people living with multiple complex conditions and its important that prevention is
just as encouraged as care
 This will save money as prevention will keep people well living in the community and out the hospital for longer
 Treating single acute illnesses requires greater funding for primary and community care as well as the support for
the staff who work in these services.
 There is a long history of prevention = Edward Jenner developing first smallpox vaccine in 1796, link between
contaminated water and cholera
o Pencilling being discovered by Sir Alexander flaming
o British scientists who led medical science was able to establish the link between smoking and cancer so
it became illegal to smoke in closed spaces (2007)
o 2015, England introduced a national publicly funded vaccination programme to protect children against
meningitis type B
 There are advancements in AI intelligence helping staff to diagnose and treat conditions quicker and more
effectively, giving more time for patient care
o New technology (preventative medicine) called predictive prevention (offers more earlier diagnosis,
targeted treatments)
o Supported self-managements of conditions, which makes medical environments more convenient as it
joins data across services to deliver better and more personalised care
 Need to focus on future e.g. rising levels of obesity, mental illnesses, age-related conditions such as dementia,
diabetes, asthma
 a and arthritis
 Preventative medicine helps support people to live longer healthier and more independent lives which also helps
guarantee our health and social care services for the long-term
 Prevention = helping people stay healthy and happy and independent for as long as possible
o Stops problems arising in the first place
o Giving people the knowledge, skills and confidence to take full control of their lives and care
o Helping make them more healthier choices
 Better health reduces pressure on the NHS, social care and other public services
 What has the government done?
o A lot of advancements in health care e.g new meds, drugs, tests and treatments
 Helping diagnosis and treating more diseases
 Allowing more access to psychological therapies for treating anxiety and depression
 Allowing a broader range and number of imaging tests e.g x-rays and CT scans
o Changing attitudes
 Put campaigns such as Time to Change, Dementia friends, be clear on cancer
 Increased awareness, reduced stigma and discrimination
 Seen more people reach out for help and support
o Improvements in the environment
 Important in where we grow up and live and work
 Important sanitation to nutrition
 Housing standards to safety at work
 Less risk from physical, emotional and environmental harm
 Put more money into cleaner streets
 More food charities out there to feed people and more support schemes
o Antibiotics and mass vaccination
 Helped reduce the harm of many diseases
 E.g polio and diphtheria
o Healthy lifestyles and public health programmes
 Lead to widespread improvements e.g. many benefits from NHS health checks
 Rates of smoking has fallen rapidly after showing the negative effects of smoking
o NHS supported mayors that propose ultra-low emissions zone charging in order to cut nitrogen dioxide
and small particulate air pollution affecting school playgrounds, GP surgeries
 HOWEVER not all solved, significant people still smoke, has highest obesity risk in kids, drinking high levels of
alcohol and behaviour factors such as insufficient sleep and cyber-bullying & environment such as overcrowded
homes, not clean houses, damp mould and rotting floorboard, not enough light in houses (can trip)
 Air pollution still an issue as can worsen asthma affecting lung functioning which can lead to more complications
and unnecessary admissions to the hospital
 What more can the government do?
o Encourage healthier pregnancies (e.g stop smoking before so it can reduce infant mortality)
o Improving dental health in children
o Protecting and improving children’s mental health
o Schools’ role in the terms of food they serve, opportunities to be active and supportive of mental
health
o Supporting healthier food and drink choices
o Change4life campaign = supports children to eat well and move more reducing obesity
o Encouraging active travel (walk or cycle more)
o Way jobs are designed e.g good work-life balance
o Government put plan to reduce harmful emissions from road transport
o Action to tackle ammonia produced by farming (by investing money in equipment that will reduce
emissions)
 NHS long-term plan helps a lot of prevention
 NHS work on prevention
o Treatment of tobacco dependency
 People who smoke will be offered the NHS-funded tobacco dependency treatment
o Alcohol care teams in district general hospitals
 Providing NHS-funded treatment for people who are alcohol dependent
o Obesity
 Facing obesity epidemic
 NHS supporting individuals to achieve and maintain a healthy wait
 Building confidence in people so they are able to comfortably discuss their weight
 Testing at large communities for any issues
 Building new interventions and support
 Action to deliver healthier foods across the NHS for staff patients and public

PUBLIC HEALTH AND WHAT THEY HAVE DONE?

 There is a lot of evidence that lifestyle choices e.g smoking, alcohol and obesity increases the risk of obtaining
cardiovascular diseases and diabetes
 Public health measures: Sugar tax
o Introduced in April 2018, increased prices in drinks over 8g of sugar
o Has been successful in raising awareness of impacts of taking excess sugar
o Manufacturers adapting and reformulating drinks so they fall below sugar tax threshold
o Amount of sugar in drinks fell by 10% but the purchasing of soft drinks stayed the same
 FAST Campaign = aims to spread awareness of the symptoms of stroke and helps people to know when to call
999
o Face, arms, speech and time to call the ambulance
 Obesity is a huge issue and the NHS is extremely concerned by childhood obesity, because of the concern that
this is likely to cause major healthcare problems, have increased risk of developing type 2 diabetes
o Public health measure: Local council trials
 Government gave 5 local councils 100,000 pounds over a year
 Use money for addressing childhood obesity and health inequalities
 Bradford: partnered with local mosques to help south Asian children (obese) by giving the
places and fun ways to exercise
 Blackburn: work with local restaurants to improve menus and include healthier options
o Public health measure: more opportunities to exercise:
 Government ensured more children has opportunity to do physical activity
 Department of education committed money into training more PE teachers
 Enable schools to open facilities during holidays and weekends
 Sport England gave 2 mill to create new after school clubs in disadvantaged areas to
encourage children to get active
o Example: leeds (first city to see a drop)
 Staff who worked with children and healthcare professionals were all trained to encourage
healthy eating
 Charity called Henry, parents offered 8 week programme
 Had lessons on how to make healthy food options from scratch
  Push to encourage families to reduce sugar intake
 Get children more active through dance
o Public measure: Fat tax
 New and not implemented
 Pros:
o Obesity costs government more than any other lifestyle factor
o Leads to health problems such as type 2 diabetes, heart disease
o Money spent could be spent in other places
o Reduce consumption and encourage people to choose healthier foods
 Cons:
o Many people obese because of medical and mental health issues such as
hormonal issues/depression
o Most disadvantaged people face greatest obstacles in overcoming this
o Hard to eat healthy when stressed
o Denying autonomy is a step backwards for developed society such as the
UK
o Price manipulation is seen as a form of control (drives people to decisions
and they may not be responsible for it)
 Public health measures: After Covid
 It was seen that 8% of critically ill patients with COVID-19 was morbidly obese
o Banned unhealthy food advertisements on TV and online before 9pm
o Ending buy, one gets one free on promotions of food with high in fat and
sugar
o Calorie labelling required by law for large restaurants and cafes
o More apps and online tools available

GLOBAL WAMRING AND ITS IMPACTS ON HEALTHCARE AND POLLUTION IN THE AIR

 Global warming causes climate change as well as average global surface temperatures rising which is being
caused by rising greenhouse gas levels in the atmosphere
 Greenhouse gases include: sulphur dioxide, water vapour, carbon dioxide, carbon monoxide, and nitrous oxides
 Emissions from fossil fuels which are burned causes a very dangerous rise in greenhouse gases
 Warming heats, the ocean and causes changes in timing, geography, intensity in weather and rising sea levels =
climate change
 Climate hazards
o Extreme climate and weather events e.g. droughts and floods and heatwaves
o Many weather disasters have caused a large amount of deaths
o Heat-related illnesses such as heat stroke, heat exhaustion, and chronic kidney disease
o Has effect on maternal and neonatal health, mental health and chronic noncommunicable diseases
such as asthma and diabetes
o Spread of infectious diseases due to flooding/warmer climates
o Disruption of food systems caused by extreme weather
 Malnutrition, under nutrition
 Food and water
o Has effects on food systems and water supply
o Rising temp = threatens water security as it boosts evaporation, changes rainfall patterns and more
snow and rain
o Causing bad conditions for crop and livestock farming
o Yield of staple crops e.g., rice and wheat and soybean are decreasing due to hotter temperatures
o Losses of food production and access to food + decreased diet diversity = undernutrition
o Warmer climates = food borne and water borne diseases to thrive e.g. cholera, salmonella (bacteria in
food)
 Disease
o Helps survival, reproduction and distribution of pathogens and vectors by increased heating
o Extreme weather = ideal conditions for infectious diseases such as cholera can spread
 As climate changes, mosquito can carry diseases such as malaria which can spread and
survive at higher latitudes and altitudes
o Vector borne pathogens pose risk to human health and on rise
 Air quality
o Increase in allergens and harmful pollutants in air
  Longer warmer seasons and higher CO2 in air means higher levels of pollen = more allergic
reactions and asthma episodes
 Larger wildfires will reduce air quality, increase smoke exposure = cause more respiratory and
cardiovascular issues
 Burning fossil fuels (e.g for transport/manufacture) increases air pollution, prolonger
exposure can cause chronic conditions e.g cardiovascular and respiratory and lung cancer
 Social impact
o Many mental health impacts
o A lot of working hours lost as due to extreme heat exposure
 Low and middle-income countries get affected the most as well as urban areas which experience extreme rainfall
and urban flooding
 Reducing air pollution is on the NHS long term plan
 Causes a lot of beds being used, a lot of resources being wasted and a lot of costly treatments and equipment,
decreases life expectancy
 Air pollution increases respiratory infections, heart disease and lung cancer
 Air pollution = affects people’s ability to exercise = leading to health conditions/ obesity
 Air pollution comes from burning wood and coal in open fires, road transport, solvent use and industrial
processes, vehicle emissions, natural gas to heat homes, coal-fuelled power plants
 Prevention and protection:
o Transition from using fossil fuels to renewable energy that is sustainable e.g solar, wind, turbine,
hydraulic
o Stop deforestation and restore natural habitats
o Gov launched clean air strategy setting plans for dealing with sources of air pollution developing new
guidance on things that create pollution e.g., tyres
o Prioritise walking, cycling and public transport over cars in urban areas
o Create green spaces in cities to remove some pollutants
o Moving from coal and gas power stations and diesel generators to solar, wind and hydropower
o Spreading awareness
o Promoting active travel
o Enabling zero and low emissions travel
o Designing buildings and spaces to improve air quality
 Ways to avoid air pollution
o Avoid spending long periods of time in places where pollution builds up
o If so, travel on food
o Parents use covers on buggies to protect infants
o When pollution in air is high and you have lung condition do exercise inside
 How can we prevent global warming?
o Replace light bulbs with LED lights/fluorescent light bulb
o Drive less
o Recycle more
o Check your tires are inflated as can improve gas mileage, saves petrol = saving co2 out of atmosphere
o Use less hot water = takes lots of energy to heat water
o Avoids products with a lot of plastic packaging to reduce CO2
o Plant a tree, encourage gardening and will increase uptake of CO2
 WHO is working with countries to identify and monitor air pollutants with greatest impact on people’s health
o Review and analyse scientific evidence to draw conclusions on how much different air pollutants affect
health and identify effective measures

OBESITY UK RATED AND HOW ARE THEY BEING TACKLED

 WHO defines obesity as = abnormal or excessive fat accumulation that may impair health
o In adults, overweight = BMI of over 25
o Obesity = BMI over 30
 Obesity can be correlated with depression, feelings of isolation and low confidence and self-esteem, may be
unable to go work anymore, stops themselves from socialising, feeling unmotivated
 1 in 4 adults in the UK is affected by obestiy, therefore that many people are unable to work putting the
economic stability under a lot of strain
o Treating all conditions at once will put burden on health system that will ultimately affect entire
population
o 1 in 5 secondary school aged children are obese,
 What causes obesity?
 o Food, activity, stress, sleep, health and medication, environment and genetics
 Case study: Prada-Willi Syndrome
o Genetic condition caused by a loss of function of certain genes on chromosome 15, affects
hypothalamus leading to hormonal changes
o Leads to insatiable appetite = driving obesity
 Consequences of obesity to the individual
o Increases risk of various chronic conditions such as fatty liver disease, heart disease, cancer, etc
o Associated with worse mental health outcomes and poorer quality of life
o Affects quality of care, many studies showings that doctors are being bias and treating them in a
different way as some people associate negative personality traits with obesity
o Can affect ability to perform exercise and participation in certain activities
 Consequences to the NHS:
o Overweight and obesity-related conditions are costing the NHS 6.1 billion per year
o There is an increase every year in hospital admissions due to obesity
o Seeking to prevent obesity campaigns are very costly too
 Government doing things to prevent this
o Educational programmes implemented on the benefits of healthy eating and exercise and dangers of
smoking and excess alcohol consumption and drug use
o Catching diseases early before having a fatal impact
 Doing this by monitoring pre-diabetic and pre-hypertensive conditions
o Put sugar tax
 Sugar tax is an example of public health campaign catching eyes of the press and general
population
 Pros:
 Increased revenue that can be spent on other areas that require funding in the NHS
 Reduced spending on treatments for conditions associated with obesity e.g Type 2
diabetes
 Reduction in the level of tooth decay
 Cons:
 Negatively impact those with lower socioeconomic status
 May not lead to a reduction in obesity as there are multiple contributing factors to
obesity
 Strips people of their autonomy by pricing sugary drinks about what they can afford
o Also put higher tax on cigarettes, alcohol
o Rolled out programs by NHS to tackle obesity such as Couch to 5k helping to motivate people to learn
how to run 5k in the span of 9 weeks
o On the NHS long-term plan
o NHS England launched a national diabetes prevention initiative referring adults at high risk of diabetes
to lifestyle change programmes.
o Local authorities, in partnership with general practice, already undertake health checks and offer high
risk individuals’ referral to behaviour change programmes.
o There is good evidence to support these interventions, but weight is a sensitive issue.
 Patients do not appreciate discussing their lifestyles with their GPs, and this makes health
care professionals reluctant to talk about these socially awkward topics.
 Preventing obesity rather than treatment?
o Successful prevention is typically much cheaper for the NHS than treatment e.g bypass surgery
o Prevention avoids many of the long-term consequences of obesity such as mental health struggles
o Treatment of obesity is not always successful and weight regain is very common
 Treatment is better rather than preventing it?
o Prevention is rarely effective, not all types of obesity can even be prevented e.g genetic forms of
obesity
o Educational and social campaigns to prevent obesity are hard to justify when the money could go
towards, e.g life-saving surgeries
o Treatment is highly effective and simple in some cases e.g leptin replacement in leptin deficiency
o There is a very fast rise in childhood obesity, it is increased rate in our very young children
o Introduction of sugar tax in 2018, issues with is being effective, brought to tackle the obesity crisis
going on

Example questions:

 What are some of the public health issues facing the NHS at the moment?
The NHS currently faces a global pandemic – COVID-19, alongside ongoing issues like understaffing, lack of
 investment, and an aging population. There is also an ongoing mental health crisis, with mental health
deteriorating faster than ever before. However, of notable concern as well is the fast rise in childhood obesity. In
2018-19, 22.6% of children aged between 4 and 5 in England were found to be overweight by the National Child
Measurement Programme. When looking at 10 to 11 year olds, one finds a third of children are obese. The NHS
knows that obese children are more likely to become obese adults. Additionally, they have an increased risk of
developing type 2 diabetes.


Why is obesity such a problem in the UK today?
There are a variety of reasons for obesity being an issue today. Increased reliance on home entertainment, with
decreasing rates of exercise, and poor dietary choices, are chiefly to blame. We can also – versus previous
generations – consider the ease of access to both food in general, and to processed foods that can be either
ordered, delivered or prepared in minutes, at any time of day. The British population, alongside these dietary
issues and its sedentary nature, is also hugely fond of fizzy drinks, with the average Britain drinking 232.9 litres of
fizzy drinks in 2015.

 Why is childhood obesity such an issue?

Childhood obesity is an issue, primarily, because an obese child is likely to be an obese adult. An obese adult is likely
to suffer a variety of ongoing health problems and comorbidities – be it heart disease, breathing problems, or high
blood pressure. Additionally, obesity hugely increases the risk of developing type 2 diabetes, and the number of
children with diabetes in the UK has increased almost 50% in the last 5 years. Diabetes costs the NHS a huge amount
of its funding each year, as do obesity and its complications – reducing childhood obesity now will have huge positive
benefits further down the line.


What are the causes of the increased prevalence of diabetes in the UK?
When considering increased rates of diabetes, we are chiefly looking at type II diabetes as diabetes type I is an
autoimmune condition. Type II diabetes’ causes are multifactorial in the majority of cases – meaning that more than
one cause is involved. In fact, a family history of diabetes is the most common cause. However, there are various risk
factors which may lead to an increased risk of developing the condition, and we can see easily how they align with
recent public health problems in the UK. They are: obesity, living a sedentary lifestyle, aging and bad dietary choices.
Pregnancy and illness may also increase the risk of developing type II diabetes.


What is the Sugar Tax?
The Sugar Tax was passed in April 2018 and decreed that sugar sweetened drinks which contained more than five
grams of sugar per 100ml would be taxed 18 pence per litre. If the drink contained more than eight grams of sugar per
100ml, then the tax would rise to 24 pence per litre. Pure fruit juice is excluded from the sugar tax. The money raised
from the Sugar Tax (originally forecast to be as much as £500m a year) ought to be used by the government on
children’s sports and food and was intended by the government to be used as such – although it has yet to be.


Do public health interventions like the Sugar Tax work?
Looking specifically at the Sugar Tax, we find that there was a 3% reduction in the average amount of sugar per 100g
in drinks sold in 2019 compared to those sold in 2015, according to a government review. However, the number of
consumers who say that they would stop buying sugary drinks has since fallen to only 1%, from 11% initially.
Additionally, the number of people expressing an intention to continue buying sugary drinks grew from 31% in
February 2018 to 44% by June 2018. However, it has improved awareness of both obesity and the importance of good
diets, as well as bringing these issues into the news more than ever before.


What public health intervention would you support, or instigate, if you were Minister for Health?
The continuation of free school meals in the holidays has recently been a topic of much debate. I believe that
continuing this – providing children access to healthy food, with fruit and vegetables, adequate protein, and avoiding
salt, sugar and fizzy drinks – is a crucial move for the government to make. This is a step that would not just provide a
healthy diet but would actually provide food to many children whose parents may be struggling to provide it – leaving
them hungry, affecting their ability to concentrate, to grow healthily, and to enjoy their life as a child.

SOCIAL MEDIA AND MEDICINE

 Pros:
o Patients use social media
 There are large users on social media and this will only ever increase
 Many people who use social media often make healthcare-related searched (80% of people
who was surveyed said this)
 63% chose one provider of another because of a stronger online presence
 Idea is to get into patient’s social media feed to offer advice and lead people to networks that
meet their needs the best
 Must focus on the business aspect of their healthcare practice
o Easily to build relationships with patients
 Patients want to feel that they have close relationships with their doctors, communication is
crucial
 Many adults want to follow their doctor on social media, ability to educate others is
paramount here
 Patients feel that the internet is the place they can connect with their friends
o Cost-effective marketing
 There is no start-up costs associated with social media marketing
 New patients gained from appropriate marketing can lead to more revenue for the company
 Can promote useful information and be shared with friends which is informative
o Showcases accomplishments and activities through social media platforms
 Patients want to know what their doctors are involved in community
 Posting information shows you care about patients and wellbeing = more likely to visit you
and value practice
 Including achievements shows it’s a trustworthy organization as well as showing doctors
belong to state medical boards
 Patients can use social media to find more about organization itself = gives peace of mind and
feel confident about choice of doctor
o Can attract healthcare professionals to the work place
 Can recruit a lot of doctors
o Can help people in situations of emergency from reliable websites
o Lets people become more educated about their own help
o GP does online bookings making it more convenient, also fewer waiting times
o Online consultations meaning less travelling and less hassle
 Cons:
o Security risks
 Scared of patient records getting leaked
 Patients scared of how their data will be used and whether it is confidential
o False information
 False information popping up in healthcare social media causing more worry
 Promoting inconsistent information
 Can offer alternative medical treatments which can be quite dangerous
o Self-diagnosis
 Can cause self-worry and negative mental health impacts
 May diagnose yourself of the wrong thing
 Doctors themselves:
o Using social medica can benefit patient care by
 Engaging people in public health and policy discussions
 Establishing national and international professional networks
 Facilitating patients access to information about health and services
 Important to create boundaries, must maintain a professional boundary between you and patient
 If patient contacts you about their care or other professional matters through private profile you should indicate
you cannot mix social and professional relationships; direct them to professional profile
 Careful not to share identifiable information about patients
 Sum of published info may be enough to identify a patient and therefore breaches confidentiality
 No accessible social media to discuss individual patients or their care
 No posting public medical advice on forums
 All online discussions around patient care must be anonymised
 Dont take clinical images with your smartphone and upload them

COVID-19 AND ITS IMPACTS

 COVID-19 has had wider impacts on the NHS as the pressures placed on hospitals was immense (185k people
died with 20million cases)
 Patients suffering from the illness are placing demands on acute care especially in ICU’s
o Therefore there has been efforts to increase the resources available to NHS hospitals in treating these
patients
 Dealing with COVID patients against a backdrop of shortage
o Increased demand for acute care and ICU’S facilities
o Stretching hospitals to capacity, but was very hard as due to staff shortages
 Effect on care volumes:
o Due to the COVID patients, the number of resources available to the non-COVID patients were already
reduced
o A lot of patients were urgently discharged as they were assessed to medically fit to leave
o A lot of elective operations were postponed and cancelled and a lot of them were delayed
 Used a lot of resources
 A lot of money was lost
 A lot of ventilators were used, not enough resources, a lot of deaths occurred because of this
 Not enough PPE for staff and not enough staff even to administer care, so a lot of shortages in bedding
 Effect on care quality
o COVID left a lot of nurses with long-term impacts that have unfortunately led to a reduced availability
of hospital staff due to either illness or being reassigned anywhere else
 Long-term affects
o Staffing issues will loom large as many staff have come out of retirement to deal with the immediate
crisis so they have all returned to their retirement
o As a lot of staff couldn’t be protected against the virus and a lot of staff actually caught the virus due to
the lack of supply in PPE, it may reduce the attractiveness of work in the NHS in the future
o A lot of people may have dropped out, resigned as the pressure put on them affected their mental
health very severely
o Worldwide nature of pandemic may mean NHS’s ability to recruit from overseas may fall
o Waiting times for elective care will rise
o Backlog in appointments and surgical procedures, some people’s conditions may have become worse
or they may have gone to get privatised care and had major complications which the NHS has to deal
with
o Some people are still scared of coming into hospitals as they are old and are cautious about their
health, they don’t see it as a comfortable environment anymore
o Used a lot of funding to employ new healthcare workers and a lot on PPE supply and equipment such
as ventilators
 Lack of funding in the first place means that the NHS was unprepared for a major health crisis
like COVID-19
o COVID had a lot of negative mental health effects on healthcare professionals and some affects still
may be affecting their life, they may have felt tired, stressed and under pressure as well as working
long hours
o People may not trust the government/NHS response to COVID-19 as they believe they did not respond
in the right matter/ in a late matter e.g., should have implemented the necessity of facemasks earlier
on, or should have enforced a lockdown earlier on to decrease the transmission in spread
o A lot of vaccination programmes were rolled out that proved to be quite effective
 However, there was a lot of false information in the media going around which has increased
the spotlight shone upon anti-vax programmes which can have severe long-term effects e.g.
maintaining herd immunity
 Government should have been quicker to implement lock down and bring in measures of face-coverings and so
on, use more campaigns to increase people taking the vaccinations, making people more aware of the symptoms
o Give advice to those struggling with mental-health as well, open more online available numbers so
people can contact them if they need help as suicide rates due to COVID was at an ultimate high
o They could have also promoted healthier eating as well as I assume that as everyone was home it may
have made them more lethargic increase obesity rates
 o They could have also promoted more exercise at home (the government/public health themselves) and
educating people about the advantages of them, although they did do a good job of this
o Should have been able to formulate a plan in case this happened beforehand so the response was more
efficient
o They also could have supplied more PPE to hospitals as the hospitals are the key to healthcare, given
them a bigger budget
o Supplied specific help to the mental health of nurses/doctors
o Open more food banks to the poor and provide people with free facemasks to those who are homeless
on the street as they are more vulnerable
 COVID-19 making the crisis worse
o Unsustainable strain on general practice
 GP practices are on the forefront of the response to the COVID-19 outbreak, stress and
workload is mounting
o Redeployment and cancelled operations
 Pandemic called for reallocation of resources so that critical care for COVID-19 patients was
available
 Contributed to the large backlog that the NHS must now work through
o Infection control measures
 Infection control measures placed limits on the number of patients that could be seen
physically
 Limited patient numbers showed need for investment in NHS funding

ANTIBIOTIC RESISTANCE

 Antibiotics important for treating bacterial infections = random mutations in DNA means bacteria can develop
resistance to antibiotics
 Antibiotics resistance = reduces effectiveness
 Survival of bacteria allows resistant genes to be passed to the next generation producing colony and infection
 Drug resistance is so widespread that doctors have to prescribe multiple antibiotics to combat a single infection
o Drug-resistance blood stream infections increased by 35% from 2013-2017
 Why is antibiotic resistance increasing?
o Often prescribed in hospitals in developed countries
o Livestock is dosed with antibiotics so eating meat and dairy products = multiple drug resistance
o GP’s feel pressure to prescribe the antibiotics as patients are demanding of it
 Investigations shown that GP who prescribe fewer antibiotics have the fewest satisfied
patients
o Lack of education = people thing antibiotics can help with viruses
o Patients fail to follow the full course of their treatment
 They stop antibiotics because 1. Too much commitment or 2. They stop when they feel better
 Most resistance bacteria survive, persist and multiply and alternative antibiotics must be
prescribed all over again
 Solutions for antibiotic resistance
o GP encouraged to prescribe more sparingly
o New guidance for professionals to prescribe antibiotics more appropriate
o Reduce infections contracted from surgery
o Farmers restricted in which antibiotics can be given to live stock
o CCG’s reduced number of antibiotic prescriptions and use of broad-spectrum antibiotics
o Public health England = education of infection preventing by public hygiene such as hand washing
o Push for new drugs
 Developing and researching new drugs
 2 drugs found to be safe and effective and selected to undergo health technology assessment
by NICE department
 Teixobactin = found effective against common bacterial infections
 Made by using an electronic chip to grow antibiotic producing microbes in soil
 BUT YEARS AWAY FROM BEING TESTED ON HUMANS, may not even work against
bacterial infections in humans
o New therapies
 Combination therapy = fighting antibiotic resistant bacteria by using two or more drugs
together in order to increase effectiveness of both drugs against bacteria
 Working together may be effective against colistin-resistant bacteria
  Phage therapy = killing bacteria with a virus that lives inside bacterial cells but is so far
unused
o Boost to research
 More funding has been given from health and social care to help identify patterns of
resistance
 UCL and UCLH are going to use artificial intelligence to tackle antibiotic resistance
 Helping enable earlier diagnosis and treatment with appropriate antibiotic dose
o Instead of prescribing broad-spectrum antibiotics
 They focus on exact cause of infection and give targeted antibiotics to treat this infection
 E.g urinary tract infection, test sample of urine then decide on most appropriate antibiotic
o Document dose, duration and indication for each antibiotic
 Allow traces back to source of any resistance organisms, and can identify antibiotic resistant
patterns to stop over prescription in antibiotics
 Positive result = total consumption of antibiotics in primary and secondary care declined by 9% from 2014-2018
 Antibiotics important in performing major surgery e.g. organ transplants and chemotherapy
o They are given after surgery to avoid post-surgical infections/ complications

SHOULD NHS PAY FOR SELF-INFLICTED ILLNESSES?

 Self-inflicted illnesses include smoking, alcohol usage in excessive, misuse of drugs, self-harm and cosmetic
complications
 Diet and lifestyle issues costing NHS in England more than £11 billion each year
o Increasing as a result of ageing population
o A huge number of diabetes type 2 which over half cases can be preventable
 Illnesses may have been influenced by deteriorating mental health, unhealthy coping mechanisms such as
excessive alcohol consumption
 May be due to high unemployment rates, spiral or decline especially in deprived areas
 Can form unhealthy addictions
 Pros:
o NHS has constitutional values in which they aim to address delivering care to nation
o Ensuring it meets needs of everyone = free at the point of delivery
o Should be based on clinical need, no ability to pay
o Imposing fines on patients with self-inflicted illnesses, causes violation to all three core-values
 Cons:
o A lot of money is used and could be invested into new drug development or new research
opportunities
o A lot of resources are wasted
 This is a topic of debate
o A lot of people has said that people who had abused alcohol should not get a liver transplant
o A lot of people said that they know a lot of people who have lied about being depressed in bid to get
plastic surgery on the NHS
 Last year it cost NHS £136 million using NHS drug and alcohol services including rehabilitation
 NHS should provide care for everyone indiscriminately as that’s supposed by the fourth ethical pillar of justice
 Also in line of ethical principle of autonomy = meaning patients have the right to make decisions for themselves
 BUT NHS Has limited resources, ideal world, treatment would be funded for all patients but this is just not
feasible
 Utilitarianism application = best way to maximise the use of resources for the greater good
 Some people feel that their illness is self-inflicted so these patients are less worthy of being funded vs those who
had no control over their disease
o Doesn’t take into consideration the complex psychosocial factors leading to smoking
o Smoking is common in low socioeconomic groups, ignoring to treat these people would worsen health
inequalities that already exist in society
 NHS has already imposed some restrictions on certain treatments for smokers and those that regularly consume
alcohol
o Helps increase more responsibility for their health
o Prioritizing resources
o E.g CCGS in Hertfordshire banned patients from surgery unless they stopped smoking
 Smoking and excessive alcohol use are linked to increased risk of a wide range of illnesses at considerable
additional cost to the health services
 Smoking related diseases cost a lot, collecting cigarette butts is more and extinguishing smoking related house
fires
 o Loss of work from smoking related illness = loss in productivity and tax revenue
 Some people say that the money could be in better use if its being diverted to other treatments such as
immunotherapies for various cancers
o BUT it is very hard to stop addiction and shouldn’t be penalised as it alters neurobiology and affects
dopaminergic pathways within the brain
 Many reasons why people even start self-inflicted illnesses such as peer pressure, socio-demographic factors and
mental health problems
 Hard to consider what is self-inflicted
 Risk losing trust in health services and doctor-patient relationship if principle of beneficence in biomedical ethics
is applied inconsistently, positive steps should always be taken
 Solutions discriminatory against genetic predispositions which were the primary trigger or who have been
secondary smokers
 Opportunity cost= money could be used elsewhere, NHS has only finite resources

MOST IMPORTANT DEVELOPMENTS IN MEDICINE

 Say you saw this in your work experience as well, MUST choose one at the end, acknowledge that there are many
useful discoveries
 Vaccinations (1976)
o Edward Jenner’s attempt in 1796 to use vaccinations to tame the smallpox virus, the usefulness and
popularity of vaccinations grew very quickly
o Other vaccinations were used e.g. smallpox, rabies, tuberculosis and cholera
o After the vaccination for smallpox the disease was eradicated
o New technology called mRNA which has created new possibilities for future of healthcare
 Very effective, capacity for rapid development
 Low production costs
 Was used in COVID-19 pandemic as two mRNA vaccines were developed and approved for
use in just a matter of months
 Anaesthesia
o Helped with excruciating pain during surgery
o William T.G. Morton made history in 1846 when he successfully used anaesthetic during surgery
o Chloroform was used but also considered high-risk as several fatalities were reported (Used for queen
Elizabeth’s birth to her son)
o Safer anaesthetics been developed saving millions of lives
 Germ theory
o Before germ theory came out, it was believed disease can come out of thin air (miasma bad smelling
air)
 Instead of being air or water borne or transferred through skin-skin contact
o Louis Pasteur 1861 proved through experiment that infectious disease was due to invasion of specific
microscopic organisms called pathogens into living hosts
o This new understanding showed significant turning point in how diseases were treated, controlled and
prevented
o Helped prevent epidemics that were responsible for many deaths e.g plague, dysentery and typhoid
fever
 Medical imaging
o First medical imaging machines were X-ray
o Made by Wilhelm Rontgen accidentally
o In 1895
o Done by experimenting with electrical currents through glass cathode-ray tubes
o Ultrasound discovered many years, first used in 1955 for medical diagnosis
 Uses high frequency sound waves to create digital image
o CT was discovered in 1967, uses X-ray detectors and computers to diagnose different types of disease
o MRI created by Paul Lauterbur, helped create detailed images and detect life-threatening conditions
 Antibiotics
o Penicillin and Alexander Fleming
o It was used in WWII and proved to be very affective
 o Helped save millions of lives
o BUT many bacteria have become resistant to antibiotics
 Organ transplantation
o First successful kidney transplant carried by Dr Joseph Murray and Dr David Hume
o In 1954
o Saves thousands of lives
o BUT long waiting list, very hard to tissue type, immunosuppressant drugs can only be seen as a later on
issue
 Stem cell therapy
o Found in 1970, stem cells found in human cord blood
o They were unspecialised cells and can be renewed through cell division even after being inactive
o Been used to treat leukaemia, and other blood disorders
o Used in bone marrow transplantation
o Further research still going on to how to treat Alzheimer’s, Parkinson’s and strokes
o MANY ETHICAL ISSUES SURROUNDING EMBRYONIC STEM CELLS (e.g not consent, taking away a
potential baby’s life)

RECENT DEVELOPMENTS IN MEDICINE

 Gene therapy could stop the development of blindness

o Topic 8, learning about eye and macular degeneration
o Gene therapy targets underlying genetic cause of age-related macular degeneration
o No actual treatment for dry AMD
o It is resulted from a genetic defect causing the immune system to attack normal photoreceptor healthy
cells
o Gene therapy injects into back of the eye with harmless virus carrying an artificial gene
 After the eye starts to deliver the DNA into the eye’s retinal cells
 Triggers synthesis of protein which stops the immune system from attacking photoreceptor
cells

 Novel drug for the treatment of type 2 diabetes

o One potential therapy is injecting weekly GIP (glucose dependant insulinotropic polypeptide) and
(glucagon-like peptide receptor agonist) GLP-1 which aims to control blood sugar
o Once injected the GLP and GIP receptors cause pancreas to release insulin and block glucagon hormone
o Limits blood sugar spikes
o Slows digesting helping individuals remain full longer and eat less
o Supports weight loss as well
o Could be potentially effective in obesity as well

 AI development (implantable for severe paralysis)

o Many people have some form of paralysis
o Cost of treatment is very high
o Patients experiencing paralysis = decline in overall health
o Uses implanted brain-computer interface technology
 Recovers lost motor control and enabled patients to control digital devices
 Uses implanted electrodes to collect movement signals from brain and decode them into
movement commands
 Shown to restore voluntary motor impulses in patients with severe paralysis (due to
brain/spinal cord)

 Regrowing gecko tails (neural discovery)

o Lizards drop tails to distract predators when making their getaway and then they regrow the tail
o But the tail regrown has no skeletal structures or neutral structures
o Biologists engineered neural stem cells to be unresponsive to signalling molecule = encourages
cartilage production
o Injected this into lizards tails and the tails grew back with perfect skeletal and neural structures
o Can help spinal cord injury patients to form new nerves one day

CHALLENGES FACING THE NHS

 Chronic understaffing
o Inadequate workforce planning and lack of government accountability
o Insufficient funding and infrastructure to train enough new doctors
o A lot of people are exhausted from working on front line with such high demands = affects level of
workload
 Declined wellbeing
o Delivering care whilst there is constant shortages delivers an environment of chronic stress
o Requires overstretched staff to fill in gaps that should not exist
o Emotional and mental toll e.g., rising in stress, fatigue, burnout and moral injury as well as suffering
mental health
 Growing pressure on general practice
o Needs to manage ageing and growing populations
 Insufficient funding
o Need more money on resources and new technology
o Dealing with backlog of care and upgrading facilities to ensure they are capable of dealing with future
challenges again such as COVID
o Need more protective equipment
o More funding needed for social care as some elderly people remain in geriatric wards because care
homes lack capacity
o More funding for mental health care
o Primary care funding
o Particular regions which are rural/urban
o More funding needed in preventative medicine
 Social care
o Underfunded social care as due to cuts in money because of more funding needed elsewhere
o Social care and health care is intrinsically linked
o Good social care support can help reduce the rate of hospitalisation (keeping people out of hospital)
o Can help them return to community sooner (reducing problem of bed shortages and strain on the NHS)
 Inadequate space
o Not a lot of bed space
o Sites being too small or not enough sufficient space for training new doctors, prevents staff from
delivering the care they would like
 Outdated IT
o Causes delays and eats in valuable staff time
o Hard to share patient records creating blockages and duplication of work
 Falling NHS bed numbers
o Beds been rapidly decreasing, insufficient care
 Long waits and waiting lists for patients
o Waiting longer for emergency, routine and cancer treatments
 Backlogs
o Takes years to fully clear
o Due to pandemic, many surgeries and referrals put on hold & patients were too scared to visit GP
o Long waiting list for certain procedures
 Ambulances
o Main measure of performances for ambulances is their response time from the point when someone
has dialled the emergency services
o Ambulance wait times are huge and very long
o They are long because of the shortage of paramedics
o A&E departments are overcrowded which slows down ambulance crews, ambulances are having to
wait with patients until space in the emergency department becomes available
o Backlog of NHS, number of people in waiting lists have increased
 Many people would have just presented themselves for treatment but now chooses not to or
had it cancelled (hidden backlog)
 This is more of an issue because they will present themselves later to the service with more
issues
 Why are patients waiting longer in A&E?
o Rising A& E attendances
o Fewer hospital beds
o Age of patients
o Unnecessary A&E attendances
 o Delayed discharges, hard to discharge as they may need additional home
support or a place in a nursing home
o Staffing shortages and increased workload
 Consultant led elective care waiting lists are very long
 A&E waiting times are very long, the number of people waiting for more than 12 hours in surgery has increased
by 14%
o 4-hour metric can help measure and compare the performance in A&E departments
o But is criticised for promoting targets instead of clinical priorities
 Causes of care staff shortage
o Low pay
o Bad mental health
o Brexit regulations = impossible for someone from the EU to gain work in the UK in the care sector, had
relied on EU workers to provide labour
o Many workers move to countries with better working conditions
o International workers coming to the UK has decreased due to Brexit
 Ageing population
o Longer life expectancy is good but also burdens on the healthcare systems
o NHS will have to treat more chronic conditions associated with ageing such as heart disease, type 2
diabetes, arthritis, and Alzheimer’s
o Cost of support with daily activities to help people with their care and dementia can be very high
o Cut in social care lead to increase A&E admissions in older people place increased pressure
o Can be bed-blocking (older people may take a while to get discharged if they have inadequate social
care leaving them with infections, falls and dehydration)
o Has numerous medical conditions which requires more than one speciality
o Requires more time, resources and energy from physicians
 How to overcome this?
o Healthy life expectancy = number of years a person will have very good or good health
o Government has ambition to increase this by:
 Increasing public health education
 Support around alcohol
 Smoking
 Better nutrition
 Improved physical health and fitness
o WOULD OVERALL REDUCE RISK FACTORS THAT CONTRIBUTE TO CONDITIONS SUCH AS HEART DIEASE
AND DEMENTIA
 Brexit
o UK decision to leave the EU means that there was more staffing issues regardless of the increased
funding the NHS may receive
o One of the main way the NHS was battle understaffing in the first place was with international
recruitment
o Brexit affects ability for the NHS to full these vacancies anymore
 Pros:
 More money
 Potential to have more money in the NHS budget
 Cons:
 Increased healthcare cost
 Less staff, 1 in 20 NHS staff members are from the EU
 NHS reform = more partnerships between integrated care systems and allows health and care services to work
together more effectively

NHS INEQUALITIES BAME

 Many inequalities within the NHS that impact BAME staff and patients
o BAME = Black Asian minority ethnicities
 BAME staff
o Some inequalities faced by the staff include:
 Unequal representation amongst board members, only 8.4% of board members are from a
BAME background
 Recruitment problems
 Lack of diverse representation at a senior level produces for BAME staff
 White applicants are 1.46x likelier to be appointed from shortlisting
  Less likely to be supported
 BAME staff are likelier than white colleagues to enter a formal disciplinary process
 GMC’s report shows doctors from diverse groups did not always receive effective,
timely or honest feedback due to difficult conversations being avoided where the
manager is from a different ethnic group to the doctor
 Culture of blame amongst organisations, creating extra pressures on the BAME staff
 Likelier discrimination
 What is the NHS doing to address this issue?
o Has action points to increase BAME representation across the workforce, including at senior level
 Makes NHS more reflective of the patient population that it serves
 Structural racism and unconscious biases still need be addressed
o NHS is striving to engage in further staff networks so more BAME staff can be heard and share their
experience and offer action points they feel need to be taken
o More webinars establishing stronger networks, attended by over 240 heads of BAME staff networks
 BAME patients (also face inequality when asking to seek NHS services)
o Death during childbirth
 Black women are 5x likelier than white women to die in childbirth
o Detrimental health outcomes
 Associated with their socio-economic statuses
o COVID (Disproportionate mortality and morbidity)
 85% of NHS doctors who died of COVID-19 were from BAME backgrounds
 Disproportionate death rate in staff is only partially explained by age, socio-demographic
factors and health conditions
o COVID (Staff scared to raise COVID-19 concerns)
 Fear of raising concerns or asking safer alternatives
o What is the NHS doing against this?

KEELE UNIVERSITY OVERVIEW

 “Keele adopts a modern, spiral curriculum”

o Spiral curriculum is an approach to teaching and is a learning theory
o It means that fundamental ideas are repeatedly presented throughout the curriculum but with
increasing complexity every time = this reinforces previous learning as well as active recall
o It has 3 key points
 It’s a cyclical approach as the learners have to keep returning to the same topic many times
 It increases depth as every time a concept is returned to, the level of more complexity is
explored and be learned at a deeper level
 Prior knowledge = previous knowledge must be used when the learner comes back to the
same concept so you build from the very basic foundations instead of having to start from
right the beginning
o It is grounded in cognitive science, encourages reinforcement which allows information retention for
future learning opportunities
o Same topic is taught over time but it increases complexity
o Spiral-based, problem-based is that it continues exposure of wide variety of topics until they master it
by reviewing it constantly
o Learners re-engage with concept over and over again, it is an open-ended nature of understanding,
leads to long-term learning
o Disadvantages may be: teachers may need to re-teach concepts that were forgotten or not taught well
enough the last time the concept was taught

 “Keele adopts a modern, highly integrated”

o Connects different areas of study by cutting across other subjects and then unifying the concepts
 o It allows students to make connections between topics and engage in practical application activities e.g
clinical experience
o GMC’s recommended approach to medicine e.g instead of teaching anatomy and physiology as
separate courses, the idea to join them into systems (systems-based approach) where you will take a
bodily system such as the circulatory system and consider the anatomy and physiology all at once
o Also encourages early patient contact and self-directed learning
o It connects the theory learned in the classroom with practical and real-life knowledge and experiences

 “It adopts a range of learning strategies: early clinical experience + clinical skills teaching”
o Helps medical students acclimatize to clinical environments, it allows professional development as you
they are able to build confidence with patient interactions as well as developing self-reflection and
appraisal skill which overall contributes to the development of a professional identity
o Can be a source of motivation for students which is important as it leads to best professional growth
and proper development
o Motivation is important with self-regulation, it facilitates the development of the independent study
skills, improves retention as well
o Provides students with a larger perspective to medical education, it doesn’t only give an insight into the
career but an overarching purpose that organises and propels and individuals learning
o Gives extensive experience of clinical placements in both primary and secondary care settings

 “It adopts a range of learning strategies: practical activities e.g dissections”

o Practical activities may include dissections, blood typing, measuring BP, ECG
o It is effective way of learning as you can apply prior knowledge to practical applications and deepen
your understanding of the concept
o Helps also develop manual dexterity which is an important skill for surgeons (precision and accuracy is
key as the human anatomy is delicate) and doctors, being able to develop a calm and controlled
movement with the hand provides confidence to patients as well
o It allows appreciation of the complexity of organisms in a hands-on learning environment (dissections)
o Allows active acquisition of knowledge, provides a sensory experience
o Helps them appreciate three-dimensional relationship of different anatomical structures

 “It adopts a range of learning strategies: problem-based learning”

o Students are given medical cases to resolve and learn from
o Advantages:
 Is a student-centred approach in which students learn about a subject by working in groups
to solve an open-ended problem
 It uses complex real-world examples and problems to promote student learning of concepts
and ideas
 Differs from traditional learning as you are told what you need to know and memorize it
whereas you get assigned a problem, identify what you need to know and learn and apply to
solve the problem
 Develops skills such as working in teams, holding leadership roles, written and oral
communication, self-awareness and evaluation of group processes, working independently,
critical thinking and analysis, explaining concepts, self-directed learning, applying course to
real-world examples
 It allows more student engagement and evolvement and is often group-orientated so allows
teamwork to occur
 Help grow relationships with other people
 Gives you a chance to define your own learning objectives and give yourself a broader
understanding of topics
 Allows opportunities to discuss real-life issues, and some may be social and ethical issues
surrounding a case which can be hard to get from lectures
 Helps develop, communication, team work, time management which are skills that are not
only invaluable during time at medical school but also in life in general
 Helps you become more self-motivated as it a self-directed learning approach
 Gives you ethos and skills to teach yourself and continually update knowledge which
increases information retention in the long run
 Less didactic teaching so a student will require a lot of commitment and dedication to self-
directed learning
 Helps you learn life-long learning techniques, increases adaptability as the face of medicine is
always changing
 Open inquiry approach where facilitators play a minimal role
 o Disadvantages:
 PBL effectiveness depends on the group dynamic, e.g. having an enthusiastic group where
there is a lot of debate and discussion can greatly aid learning
 To some extent you are reliant on others for some of your learning, if some members of the
group decide not to pull their weight it may have a negative impact on your learning
 It requires a lot of self-motivation and therefore wont suit those who have more of an
academic way of learning, some topics may be best taught formally through lectures and
seminars

 “It adopts a range of learning strategies: practical activities: lectures and seminars”
o Lectures offer a good way to provide a large amount of information to a big group in a short space of
time
o The person holding the lecture is also very knowledgeable and a lot of topics may be best explained by
someone who has adequate knowledge on it
o Able to ask questions and receive detailed responses as they hold a wide range of ideas and
information
o Seminars allow group discussion so is more of a discussion opportunity to interact with others or with
the tutor
o Seminars allow learning of new aspects and other perspectives but also provide a good way of
networking
o Type of case-based learning
o Lectures provide opportunity to hear from experts in a field, helps teach up-to-date information in an
efficient manner
o Disadvantage: not self-motivated, cannot concentrate for long periods of time, auditory ways of
learning are not suited to the individual
 “It adopts a range of learning strategies: inter-professional learning”
o Provided with other health students including nursing, midwifery, paramedic science, physiotherapy,
radiography
o Defined from WHO as: two professions learning from and about each other to improve collaboration
and quality of care
o Helps develop students’ ability to communicate and work with other professionals
o Helps students to build awareness of other professionals’ roles and responsibilities and gives a valued
opportunity for shared learning and finding a common language
o Inter-professional learning focuses on not only the subject matter but also on the way in which
practitioners work together
o It may include aspects on developing respect for other professions, appreciation of different ways of
working, trust and communication skills in working with other professions, can also see the strengths of
a diverse work force

 “Also provides intercalation”

o Allows individual to pursue an additional qualification
o Is a year out of undergraduate medical studies to study a subject area in greater depth before returning
to complete the medical course
o It allows an opportunity to gain an addiction qualification in a medicine-related subject which is of
interest to the individual (increases self-motivation and organization skills which are invaluable life
skills to develop not just for medicine but for the world in general
o Helps you acquire a better understanding of basic biomedical sciences, medical humanities or research
methodologies, public scientific papers and present at conferences
o Helps you focus on what you particularly enjoy and getting valuable insights into where you want your
career to go
o Helps self-reflection on whether your chosen area of study is the right one for you
o Gives an opportunity for networking, making new friends and establishing new relationships and
contacts outside of medical school
o Gives good break from medicine and can work on something else, and good to refresh yourself, pursue
extra-curricular activities
o Helps build CV, can aid application in the future
o Great opportunity to get involved in research and Academica which can be difficult to do in your
medical course, helps you develop writing skills, critical thinking which is useful in the future as a
clinician with the research being a fundamental part of medicine
o Helps you provide a foundation upon which you can build on as a doctor
o Disadvantage: expensive, losing touch of medicine, graduating a year later

 “Key course content + structure”

 o Study a range of topics including:
 Professional and ethical responsibilities
 Patient safety and quality improvement
 Diagnosis and medical management
 Prescribing medication safely
 The health service and healthcare systems
 Health promotion and illness prevention
o Year 1: health and disease, body’s defence, emergencies
o Year 2: revisit many aspects with increasing emphasis on complexity and pathology (spiral curriculum),
learn integrated units such as mechanism of disease, inputs and outputs
o Year 3 +4: enable to build on the foundations of clinical knowledge and skills through immersion in
clinical placements
o Year 5: Preparation for professional practice as foundation year 1 doctor, undertake extensive student
assistantships

 “Large societies to sign up to”

o Philosophy society
o Medical union + concert band
o Religious societies e.g. Islamic/ Christian societies
o Medical societies as well

 What if someone isn’t pulling their weight in the PBL group?

o Address the solution first
 Knowing their workload
 Setting clear, specific expectations (maybe they were unaware)
 Eliminating potential hurdles (maybe they are struggling with something)
 Diving large assignments into smaller one’s brooks law, helps people that struggle with
procrastination to feel greater sense of urgency and to follow through in a timelier manner
 Giving reasonable deadlines with priorities (assigning realistic timeframes ensuring they know
what to focus on first)
o Don’t make snap judgements
 Maybe ask questions e.g can I take weight off your shoulders
 Could be dealing with time-management problems/overwhelmed
 Don’t assume laziness/incompetency
 Don’t get sideswiped, must also focus on your own work
o Offer assistance
 Offer guidance and feedback
 Sharing productivity hacks
 Lending an ear for them to listen
 Assist them with less important tasks
 Show them how to prioritize their time
o Rotate responsibilities
 Let team members take on new roles, helps pursue interests and passions
 If they fail = learning opportunity on where they went wrong
o Recognise what motivates them
 Maybe grant them more autonomy
o Learn and grow as a team
 Maybe they feel a bit left out?
o Use SPIKES method
 Don’t talk to the person about this in a open environment
 Ensure you ask the person to meet you in a closed/respectful environment
 Don’t speak with an accusatory tone
 Remember to be empathetic to allow effective communication
 Maybe give them time to reflect
 If something is going on, offer them support or provide them with options of student support
o Don’t raise the nature of the discussion straight away, have a general conversation and ask about how
everything is going on
o Approach with angle of care and love
o Maybe try encourage them to reach out to people in university
o Summarise, help them with an action plan
o Identify the issue first, maybe they are dealing with more personal issues
 GENERAL QUESTIONS ABOUT DOCTOR

 Why do you want to become a doctor? Why medicine?

o Love science, especially biology, medical degree is a great way to further interest in a field, allows you
to constantly be learning new things and become an expert in a vital field of science
o Enjoy working in a fast-paced environment, constantly changing with new medical discoveries, constant
challenges and diverse days, requires fast and frequent problem-solving daily
o Have opportunity to help people at some of their most vulnerable times in life
o Vocation has a huge scope for different work depending on your interests
o Incredibly varied day to day work in clinical medicine
o Diagnostic challenge posed by patients can be extremely rewarding to solve
o Put in position to put the latest advances in medical research into practice improve patients lives
o Provides ample opportunity to advance human knowledge through participating in medical research
o Helping others whilst remaining mentally stimulated
o Unique nature of doctor is to form intricate relationships between patient and doctor
o Surgical aspect: art, symphony of science
 Link to how your personal skills such as empathetic, caring, emotional intelligence can you
help with all this

 Why not a nurse?

o Foreshadowed nurses in work experience and saw how interesting the job was but I want to know
what caused the disease and illness in a person, the science behind the problem
o Nurses are more about delivering patient care as their primary concern rather that the scientific basis
o Medicine offers a larger scope for specialisation than nursing
o Education system is very different, doctors formally trained in medicine and spend years studying how
diseases work and how they are managed but nurses are trained in providing holistic cares
o Nursing is more hands on and you have to deliver the care yourself e.g giving patients their medication,
setting up IV lines, carrying out regular observations, performing bedside tests
o Doctors’ role is more to do with directing the treatment than necessarily carrying it out personally e.g.
it is the doctor who decides whether a patient needs to be taken down to have an x-ray but the porters
who actually take the patient
o Doctor prescribes a medication but nurses actually give it
o Doctors tackle diagnostic challenges, synthesis information from multiple different sources and wight
up possible diagnosis which is thrilling
o Increased responsibility bringing a far deeper sense of satisfaction, more responsibility as it the doctors
decision making and choices that directly affect whether this patient in front of you is going to get
better or not
o Medical degree much longer therefore able to cover more scientific theory (providing a broader
knowledge base), gives doctors a solid grounding in human physiology and mechanisms of action
behind many medical treatments whereas nursing degrees have a much larger clinical focus and a lot
faster

 Why not a nurse practitioner?

o A nurse practitioner is essentially a very experienced and qualified nurse, taken many postgraduate
exams and so on which allows them to see patients independently, diagnose them and prescribe
treatment
o Medicine is much quicker, to become a nurse practitioner you have to have many years’ experiences as
a nurse then have to do master’s degree
o Medicine provides options for further progression, nurse practitioner may be confined to operating as
a mid-level practitioner, but doctors have extremely robust training pathways that can see them reach
the top consultant posts, helps develop a depth of expertise that’s needed to recognise and treat more
complex conditions (nurse practitioner wouldn’t have the necessary training for treating these more
challenging patients)
o Medicine offers domains that are unavailable to nurses e.g. surgery, nurse practitioner scope of
practice can vary considerably between employers as different NHS trusts will have different rules for
what you can and can’t do depending on your qualification levels, levels of practice are more
standardised in medical training because the pathways have been established for much longer and
necessary regulatory bodies are in place

 Why not a physician associate?

 o Medical experts who support doctors and work with multidisciplinary teams to provide medical care for
patients, can do many tasks such as physically examining patients, taking medical histories, developing
treatment plans and even performing diagnostic procedures
o Doctors may practice independently whereas physician associates cannot, therefore doctors are
specialists and have more privileges e.g., prescribing rights
o Doctors are specialists whereas physician associates are generalists, physician associates can pursue
specialities and subspecialities but also require general medicine experience and knowledge to
maintain their certification, they may work independently but often they collaborate with medical
supervisors
o Doctors specialise in particular areas of medicine to provide the best possible care for patients as its
impossible to master all aspects of healthcare provision
o Doctors have more responsibilities, can legally practice independently, even with input of supervisors
they can make their own decisions

COMMON SITUATIONS QUESTIONS

1. A patient diagnosed with HIV reveals to their GP they have not disclosed this information
to their partner
 Doctor must fully inform the patient of the risks associated with not disclosing this information and
encourage the patient to disclose this information to their partner
 Doctor has duty to protect and ensure the safety of society (justice) and may choose to make disclosure to
patients partner about patient HIV status
o This would be the last option
 Autonomy = Doctors must respect the decision made by a patient but patient autonomy BUT if patient
autonomy is not absolute (especially if society/another patient is at risk)
o Confidentiality may be broken affecting the doctor-patient relationship
 Beneficence and non-maleficence – Doctors must continue to provide the best care in the patients best
interests
o When making disclosure, important to weigh up benefits (protecting patients health) against harm
(affecting doctor-patient relationship and future disclosures)
 Useful to consult GMC ethical guidelines
 Step 1:
o ACE Method
 Assess the ideas, concerns and expectations of the patient
 Find out why they don’t want to disclose their diagnosis (What do they fear about it?)
 What do they think about HIV and what is their understanding of the condition
and how it comes about?
 Step 2:
o If they have misconceptions clear them up and inform them of what HIV is and the risk it may pose
to their partner
o Ideally you want the patient to reveal it to themselves
 This is good because it maintains trust between you and patient
 Best for the long term and HIV is a chronic health condition
 If patient loses trust in healthcare profession, they are less likely to adhere to the
treatment/management they are offered which means it results in a poorer outcome
o But if they are refusing to reveal the information:
 You believe that there is a potential risk to their partner, which there will be because
then you may have to initiate the process of breaking confidentiality
 First you need to inform the patient that you are going to have to inform his
wife because of the risk to her and explain why it’s necessary
 Offer the patient another chance to break the news for themselves
 If not, proceed with the process of breaking confidentiality
o Best to seek another opinion from a senior and/or your defence
union (always have support in medicine)
2. What would you do if you saw a colleague making a mistake with a patient’s medication?
 GMC guidelines in place for doctors
 GMC guidelines state that you have a duty to raise concerns if you believe that patient safety or care is
compromised
 First step is to report the mistake, the best way to do this is to actually talk to the colleague who made the
mistake and encourage them to reports it themselves
o This should be done in a non-confrontational way= making clear that it is matter of patient safety
and continual professional development rather than a personal attack
 If not comfortable doing this or colleague refuses to report their mistake = escalate situation to a senior
colleague
 NHS encourages candour and transparency in the work environment
o Relies on non-threatening policies around errors, based on openness and continual development,
rather than the blame and punishment
 GMC has guidelines on raising and acting on concerns about patient safety

3. You are a consultant working on a ward and you’ve had a long day. You promised you would take your family
out for dinner and are about to leave, but notice that one of the patients has had the incorrect dose of their
medicine. What would you do?
 First thing to do is acknowledge is that patient safety is upmost concern
o Biggest thing emphasised in the GMC guidelines
o Incorrect dosage = detrimental consequences
o Patient could be at risk of life/death, action needs to be quick
 Same time show acknowledgement that in the back of your mind there is commitment you need to uphold
o Don’t talk about this too much, just show acknowledgement
o Duty of the patients under care transcends all so you need to stay back and deal with situation
 First thing is to actually make sure a mistake has been made
o Might not remembered what the patient was actually supposed to be prescribed = review patients
notes and check prescribing chart and see if it was a mistake
 Monitor and observe the patient
o If the patient hasn’t actually had the drug given to them yet, then take action to stop it
o If they have, you need to do whatever needs to be done to manage OD
 If patient has had the incorrect dose and you’ve managed the acute situation, find out how the mistake
happened
o E.g. could be miscommunication between members of the team
o Don’t be non-judgement of anyone, non-accusatory, treat it as a learning experience
o Chance for everyone to reflect on their practice
 Duty of candour= if mistake happened then the patient has to be informed
 Don’t leave patient until you’re satisfied, they’ll be looked after and situation is under control, colleague
taking over shift is fully informed of the situation
 Acknowledge the commitment you had to your family, call/text them and let them know you’re running late
and try to reschedule things

4. You are a GP and your patient confides in you that they are regularly using illicit drugs
 You do not have legal obligation to report illegal activity unless you believe patient/ someone else is in
immediate danger
 GMC guidelines (section 115) = permits disclosure to organisations such as police, local authorities
o BUT does not create a legal obligation too
 Information should only be disclosed if the patient consents, if there is an overriding public interest or if its
in response to a court order
 Course of advisory should be advisory rather than legal
 Duty to ensure patient is aware of the health risks associated with illegal drug use and explore whether they
have considered stopping
 Making aware that drug services are available and refer them as needed
 Important to find out whether the patient is experiencing any adverse health effects
o Advise or treat the patient accordingly e.g advise the patient about needle exchange
programmes
 If patient has a child and you feel like they are at risk of being harmed then this changes course of action
o Safeguarding issues arises, duty to inform social services

5. You are a junior doctor working on ward rounds and you spot a consultant drop a bag of cannabis, what would
you do?
  First thing to do is to take into account that this is during ward rounds so patient safety may be at risk if
consultant is intoxicated and responsible for looking after patients
 Can ask with the consultant directly in a private room away from patients and raise concern
o Superior may not take you seriously so it may be good idea to inform another consultant
who you trust who can deal with the situation
 If concerned/scared to raise concern with doctor, there is a GMC confidential helpline for doctors to raise
concerns
 When talking with consultant explore the reasons why and concerns- may be going through a hard time/
causing them to take cannabis for stress relief
o Well-being is an important factor
o Good idea to suggest doctor tries to help with issue there are many support groups
available to help
 Need to tell the consultant that this will need to be reported and it’s a better idea to urge to report it
himself
 If hes still intoxicated, its important he goes home
o Good idea to order a taxi if he is unable to drive home safely

6. One of your friends confesses that he cheated on an essay, but you’re aware that they are having family
problems at home, what would you do?
 Cheating in a coursework is an issue of professionalism and academic integrity, regardless of the
circumstances going on in someone’s life, no matter how adverse they are it has to be taken seriously
 University staff should be informed of this as it is clearly against codes of conduct/ academic integrity
 But at the same time, you have to remember that you are this person’s friend
o Not your job to scold/police them, best to support them through whatever is going on
o Have to approach it from the angle of care and love towards your friend
 Awkward position as don’t want to snitch on your friend but you also know they should inform then
university about it
 Realise that the reason they are confessing the fact that they cheated to you is likely because of the guilt
they are feeling, they’ve told you confidence as a way to lighten their feelings
 Best thing to do would be to have a sensitive conversation with your friend and understand what exactly
they did and why it was wrong and convince them to report themselves to the university
 Try and also talk about what’s going on at home and see if you can help/encourage them to reach out to
people in university etc who can
 If they agree to report themselves, that’s the ideal response but if not then you might have to do it yourself
o Need to realise this will be a difficult decision because it could put a strain on your
friendship
 Realise that you’re looking out for your friends’ best interests and also your own= you know academic
integrity has been breached and you’ve done nothing to report it, then you could also be held responsible
and your degree could be at risk too
 If friend urges you to not tell anyone, or report them, you cannot guarantee this to them also it would be a
false promise

7. You’re a medical student in a WhatsApp group chat with other medical students at your uni, one of the
students starts messaging and laughing about a patient who had schizophrenia during their placement. What
do you think of this situation?
 This is professionalism issue as it isn’t acceptable for medical professionals to be making fun of patients, its
just not the right culture to have in healthcare and if members of the public were to find out about things
like this happening behind the scene, it would really have a detrimental effect on trust in the profession
 The best thing to do is send out a message on the group chat, being polite and non-judgemental to remind
everyone of their responsibilities and inform them of why it would be wrong to be making fun of dead
patients in that way
o Encourage the offending messages to be deleted
 Raise concerns privately with your year reps and ask them to send the messages out if you don’t want to
seem like you’re on a high horse to others
 It would good to speak to someone in this university about the situation and see whether it needs to be
escalated or not

8. Your medical student friend on A&E placement is frustrated and decides to take a selfie of the busy waiting
room and post on social media, what would you do in this situation?
 Exposing patient confidentiality = even if there are no names/information in being exposed on the image,
someone might be able to identify the people in the image and this could be wrong as it is without their
consent
  Reputation of the medical school/medical students = depending on whether your friends account is
public/private, it could alter public perceptions of the profession and isn’t likely to reflect well
 Speak to your friend and help them understand why posting content like that on social media is wrong and
encourage them to delete it themselves, be non-judgemental, supportive and don’t come across as self-
righteous
 Knowing if it needs to be reported or not, ask an advisor of studies/tutor in this uni whether this breach of
confidentiality needs to be reported

9. You are a GP and in your next appointment the patient bursts into the room, clearly furious and starts
shouting and swearing at you for giving them the wrong medication. What do you do?
 First thing to do is to calm the patient down- agree with them and acknowledge their problem and tell them
you’re there to help and try to sort this out but you can only do that if the patient is calmer
o Don’t shout back at the patient or be aggressive about it
 Mirror the patient’s body language, offer them a seat and maybe a glass of water
 Apologise profusely about the issue and accept what has happened once they’re calm
 Explore the patients ICE through a proper discussion- ask if they are in pain as a result of the wrong
prescription or have had any adverse side effects
o Ask what they expect from you as a GP in order to leave satisfied
o Spend a lot of time listening and nodding to know you have acknowledged the issue
 Try to find out why the issue was caused and reflect on that, if it was your fault then the important of CPD
and reflection can be talked about to identify the root cause and make sure it doesn’t happen again
 If the problem was by someone else = worth bringing it up with them to assess if there was a particular
reason that mistake occurred and if that other physician needs to do some self-reflection
 Worth debriefing after the incident with the colleagues to discuss what happened and what to do if it
happens again
 If patient is remaining to be angry and is getting violent
o If patient doesn’t calm down and may be getting violent and you think there is a risk to
yourself or others in the clinic, then calling for help is important

10. A high school friend of yours started to tweet worrying messages, you haven’t talked to them in months so you
don’t know the contexts of the tweets. The tweets are along the lines of ‘What’s the point of life anymore’ and
‘death is a blessing’. What do you do?
 This is a worrying scenario, because the person is posting things that are suggesting that they might be
having suicidal thoughts, but not just that, they’re promoting these views amongst their following… so
something’s got to be done.
 But at the same time, this is someone who you’ve probably not spoken to for a while, so there’s probably a
barrier/resistance to reaching out to them…
 Maybe first thing you could do is speak to a mutual friend who’s more comfortable with them and raise the
issue. Find out what’s going on and see if everything’s okay. If they’re not there then, maybe a family
member you know etc.
 If this isn’t possible, then you could reach out to your friend directly. Don’t raise the nature of the content
straight away - you don’t want to aggravate anything. Have a general conversation and try to catch up with
them, and then raise the question of their tweets and find out what’s going on.
 If there’s a serious underlying issue, then you’re going to need to take more active measures like reaching
out to someone involved in their life like a parent/partner, and tell them your concerns, or reach out to
helplines like Samaritans and see what advice they would have for this situation.
 Remember you’re not a superhero! You can’t deal with everything by yourself always use the facilities
around you.

11. You are a registrar on a ward when you notice a patient with 2 tablets in their hand that they are about to
consume. The medication was prescribed to him that morning and his case notes said 'take one tablet twice
daily'. The patient doesn't speak English. What do you do?
 The immediate issue is patient safety, as it commonly is in these scenarios It is important in the here and
now to stop the patient taking the drugs or else it could have adverse effects on their health and put their
health at risk.
 After stopping them, it is important to try to educate them properly so they understand how to take the
drugs properly so this mistake doesn't happen again when they are by themselves Every patient should be
offered a translator where possible since they don't speak English
 It may not be appropriate to use drawings to explain to the patient how to take the drugs since it could be
open to misinterpretation, so that by itself wouldn’t be the only way to communicate to them.
 You can increase awareness about this situation by discussing it with the staff involved in the patient's care
12. You are a student at medical student and see one of your students putting medical equipment from the stock
room into their bag and when you ask they say they want to practice their clinical skills and ask you not to tell
anyone
 Explain dangers of the situation
o Practicing clinical skills without supervision could lead to the student seriously harming
themselves
o Taking equipment from hospital is a serious breach in ethics and could risk lives (if
equipment is needed or may lead to a shortage of supplies)
o Students’ actions are not in keeping with the professional standards of a doctor
o If you do not report it, you are not acting in accordance with the standards of a doctor, risk
being sanctioned/removed from medical school
 Acknowledge that you are a student not a doctor, approach in a calm and supportive manner
o Don’t threaten them with negative out comes
 “ I would encourage the student to see the danger of their actions and to come clean about what they have
done. I would make an effort to support them emotionally with any difficulties that may have led them o do
such a thing in the first place. If the student refused to come clean, I would them approach a faculty
member and discretely report the situation”

13. A depressed patient who has refused treatment has mentioned having suicidal thoughts and you are
concerned about his wellbeing
 Important to consider the four pillars of medical ethics
 Important to ensure the patient is aware of and understands the treatment options available to them so
they can make an informed decision
 Autonomy = In this case, the patient has chosen to refuse treatment and in general, their decision should be
respected
 Beneficence and non-maleficence = In this situation, you are concerned about the patient being a danger to
themselves, this means that the risk of their wellbeing must be weighed against the harm that could come
from breaching patient confidentiality in order to protect individual
o E.g. patients may be less open about their mental health issues in the future with their
doctor
o Moral necessity and practical one
o Reducing public engagement with the healthcare services

14. Ethical arguments for Jehovah witness giving blood

 Beneficence = Whilst a blood transfusion is undoubtedly in line with the patients’ best interests from a
medical point of view, we have to always consider what is beneficial and acceptable for the human being we
are treating
 Non maleficence = doing psychological harm-distress, acting against their religious beliefs can negatively
affect them, as a result they may be expelled from their religious community or carry the burden of sin
through the rest of their life
 If patient is unconscious and can’t see patient’s wishes there you have to act in the power of the patients’
best interests
 Overall- must consult with the MDT and make unanimous choice, get their perspective and always consult
to senior if legislative views are involved

15. Who gets the organ, X or Y?

 Think about consequences
o Inquire what the consequences of not getting the transplant are, as the information given
is quite limited, we shouldn’t assume that both patients will suffer equally dire
consequences if they don’t receive transplant
o One may be able to wait a few days/weeks until another organ becomes available
 Clinical aspects of care
o Is one of the patients more likely to benefit from a certain treatment than other?
o Do they have same type, no rejection?
o Which patient is a better match for the organ to be transplanted
o Determine which transplant will be successful may be an important indication
o Biological match or not
o Size/shape of donor organ would suit the patient and whether procedure would be more
difficult in one of them
1. E.g if one patient had haemophilia
 Age
o Higher likelihood that young patients will live longer after a transplant
 o Younger patients less likely to suffer from complications due to treatment = increases
chances of it being successful
 QALYs
o Metric refers to the number of years in perfect health that the intervention is predicted to
give
o When dealing with limited resources it is useful to determine how to allocate the resources
to maximise the number of QALYs for the patients
o Important factors to consider is the age, current health state and health predispositions
(e.g if any comorbidities that would limit their quality of life)
o QALYs are used by the NICE in decisions regarding the introduction and allocation of new
treatments and technologies in the NHS
 Circumstantial factors
o E.g. if a patient already received two liver transplants but continued to pursue unhealthy
lifestyle choices e.g. binge drinking
o They might not use their donated organ as effectively as a healthy individual may do which
brings them lower on the priority list
 Hypothetic discussion: UTILITARIAN APPROACH
o May choose to maximise the positive effect of our resources by helping the largest number
of people e.g. the mother with two kids
 Won’t constitute realistic in arguments as all NHS decisions should be based on clinical
need
 Social impacts
o e.g. very bad emotional health for a young child not knowing she hadn’t been able to live
the best life which would seem like great injustice
 Consult a senior colleague before making the decision= hard decision to make
 Some information may be lacking e.g., age, if they match the organ
 Rephrase it to the interviewer at the beginning
 DO NOT BASE IT ON SELF INFLICTED DISEASE
o ONLY WHAT IS ON CLINICAL CURRENT NEED FOR TREATMENT NOTHING ELSE
 Doctor should never be judgemental and never value any one life above the other
o Who gets transplants are solely on
 Clinical urgency (who needs it most)
 The best match (whose tissue type is most similar and least likely to reject)
 Length of time they have been on the waiting list

SITUATION QUESTIONS AND RESPONSES

 You are a lead consultant in the gastro-department of a hospital. A patient has recently passed away, leaving
behind a healthy liver suitable for donation. You have two candidates that require a liver transplant. A 67-
year-old grandfather and a 13-year-old girl. You have to decide who receives the liver.

o Explain complexity of the situation, many factors to be considered

o Consider empathy and talking to the patient, have a conversation with the patient, do you know their
ideas, concerns expectations
 ICE method
o Do they know about the transplant details and the risks?
 If one patient realises the transplant is not for them it makes your decision a lot easier
o Factors considered must be only clinical factors:
 Clinical factors
 Time on the waiting list
 Organ matching
 Needs to be antigenic match to donor or high change of rejection
 Age
 Impacts success rate of surgery, more prone to infection, injury and recovery is
longer
  Less age difference between donor and recipient less is better
 Lifestyle
 If they are excessive drinkers, they may also damage the new kidney so its
important to think about the sobriety
 Patient’s wishes
 Dont forget to ICE patients out after talking to them you both agree a transplant
isn’t the best option = decision is easier
o WHAT CAN WE NOT CONSIDER
 Ethnicities
 Life situation
 Gender
 Religion
 Race
 Lifestyle choices
 Age
 Sexual orientation
 Marital status
o Cant make the decision alone, bring MDT to discuss both systems
 Might want to consult haematologist, anaesthetist, immunologist, occupational health,
physiotherapist
o Once you’ve made decision you must break the bad news and you must have an empathetic
conversation and discuss any alternative solutions
o QALYS

 A patient comes into the A&E while you are working. They have just been involved in a car crash and lost a
considerable amount of blood. They refuse to take a life-saving blood transfusion. What would you do in this
situation?
o Ask patient about their ideas, concerns and expectations and ask why they are refusing this treatment
 Don’t assume that its because of religion reasons/ may be due to misconception or confusion
or don’t know what a blood transfusion is or maybe they don’t have capacity.
o Test the patient’s capacity
 Inform them about what a blood transfusion is what its used for and why in this situation is
vital
 Do they understand, retain and recite this information back to you?
 (You are resting their capacity which may not be resent due to loss of blood, shock from crash
or not fully conscious and you are asking for valid consent for the treatment)
o If they lack capacity
 Find out other ways of finding their wishes
 Can be in form of advanced directive, lasting power of attorney or contacting next of kin
 If none of this is available, resort to the MDT to make best interest decision
o If they have capacity and still refuse
 Iron out any misconceptions or give alternatives, such as artificial blood
 Capacity is important for autonomy, if no alternative treatment you have no choice but to
respect their autonomy and make things as comfortable for patient as possible and do
everything else in your power to help them
o Beneficence = Whilst a blood transfusion is undoubtedly in line with the patients’ best interests from a
medical point of view, we have to always consider what is beneficial and acceptable for the human
being we are treating
o Non maleficence = doing psychological harm-distress, acting against their religious beliefs can
negatively affect them, as a result they may be expelled from their religious community or carry the
burden of sin through the rest of their life
 No justice involved, autonomy is respecting the patient’s wishes if they have capacity and is
competent


 A baby is offered a very expensive novel therapy for a rare condition which only has a 50% chance of
succeeding. Discuss the ethical issues present here.
o First is the fact that this is a baby and not an adult who can consent, Gillicks competence comes into
play but still because its baby, turn to parents and legal guardian
o Parents themselves may be emotional & irrational can add to the issue as they will still want to do the
procedure even if the success is low, which = more harm than good
 Important to solve this issue whilst working with the parents instead of them, be empathetic
and explain reasoning behind clinical decisions made
 o Therapy is new and has low chance of success = causes more damage to the baby than good, every
decision made by doctor must be in patients’ best interest
o Complex case so if parents in disagreement, seek medicolegal help would be useful for the doctor
whilst extensively discussing with the MDT- getting a court order
o Autonomy doesn’t apply as baby can’t consent and justice isn’t relevant
o Don’t want to cause more harm to the baby than good, important to look at QALY and see how much it
would take to keep the baby alive
 Doing good by finding alternative treatments
 Link to the Charlie Gard case

 You are a GP and your patient has a disease that means his sister has a 50% chance of also having it. He refuses
to tell her as they ‘don’t speak’. What do you Session 5 - Interview Questions and Ideal Responses (Medical) 8
do?
o This is a sensitive topic to discuss with patient = time, space and empathy requires
o 1. ICE Patient
 Ask about ideas, concerns and expectations
 Ask open ended questions = allow patient to control convo
 Understand where patient is coming from and reasoning behind not wanting to tell sister
 Explore his understanding of the disease
 Does he know the seriousness of disease?
 Is he embarrassed about the disease?
 Does he completely understand the fact that there is a 50% chance?
 Does he want to talk about his relationship with his sister?
 THESE ARE QUITE SENSITIVIE QUESTIONS = REQUIRES TIME AND SPACE
o 2. IF they did have misunderstanding talk it with them
 Go through condition again and emphasis things that the patient didn’t understand
 If hes embarrassed, slowly and sensitively explain the seriousness of the issue
 If the relation with sister is not strong enough, talk it out with him further in a more extended
setting might be best next approach
 Goal is so try and get patient to tell sister himself
o If it did not work, break confidentiality
 Last resort, break confidentiality
 This is serious and may want to consult MDT
 Follow caricott principles when breaking confidentiality
 Let patient know you will be breaking confidentiality
 Make sure you only reveal the relevant information
 Make sure you only share the information with relevant people e.g
sister/authorities

 Is euthanasia ever the answer?

o Define euthanasia = active ending of someone’s life
o UK legislation = euthanasia is illegal and regarded as manslaughter/murder (suicide act 1961)
o Withdrawing treatment to accelerate death is not regarded as euthanasia
 E.g withdrawing life support after time
o Why it is not the answer
 Pain management has greatly advanced in recent times and more treatments are being
developed
 End-of-life care is a great alternative which allows patient to live their last few months/years
enjoying their friends and family with relative low pain
 Non-maleficence = causing someone to die could be seen as the ultimate harm
 ICE the patient
 Why do they want it
 What do they think their options are
 What do they expect if they continue to live
 Some patients may only see euthanasia as the only answer
 Due to lack of education, easy to lose hope when in pain
o Important to educate patients on the options they have = helps them look
into the future in a much more positive light
 In scenario where options don’t seem ideal and in a world where euthanasia was
not illegal as a doctor I would never be able to decide on my own, such a decision
will be made alongside the rest of the MDT
 FOR AGAINST

Autonomy A person has the right to choose if When considering autonomy, we

they wish to end their life before need to consider if a person has the
their terminal illness progresses any capacity to make their own
further, if they choose to have a decisions, whether they are in sound
loved one or relative assist them mind, whether they legally able to
with this then who are we to say make their own decisions with
they shouldn’t regards to their healthcare
Beneficence If a person believes that losing all It could be considered that by
ability to move (e.g) and leave them assisting in a patient’s death as a
unable to talk, eat or even breathe practitioner you are not being
unassisted would be detrimental to helpful to the patient, in fact you are
their own mental health then are we harming them, preservation of life is
really being good to our patients something that doctors believe is
letting them become depressed or very important
worse and then slowly die, the
patient may feel its beneficial for
them that their family doesn’t see
them like that
Non-maleficence It is part of a doctors oath to do no
harm and therefore it cannot be
right to assist in someone’s death
Justice Assisted suicide is legal in some It is currently illegal in the UK to
countries, therefore why should assist in euthanasia
patients not be allowed to use
euthanasia in the UK

 For:
o Always will be some patients whom their illness causes intolerable suffering, helping those patients to
end their life would be the most compassionate thing
o Autonomy allowing patients to decide for themselves when to end their lives at a point
o A change in the law would provide comfort to the dying knowing that the option is there
o Allow people to make their own decisions about their health and lifestyles as long as they do not harm
other people
 Against:
o Doctors turning into executioners
o If law on assisted dying changes now, makes more space for law to change and apply to more people
e.g with children euthanasia
o People may feel pressure to spare their carers the burden of looking after them or might be bullied into
choosing death
o Autonomy, doctors can refuse treatments they believe is not in the patients’ best interests

 You are given a Chinese study that claims to have a drug that will help patients with late-stage dementia.
There is nothing else available for these patients. Do you prescribe the drug?
o Most important point = don’t prescribe anything to the patients that would cause harm or do more
harm than good
 Non-maleficence, patient safety and their health is number 1 priority
o Review quality and reliability of study, look for other trials or studies of the drug and correlation is good
as well
o Even if nothing else is available, it may be best not to give this patient the drug as it may cause even
more harm
o There are other ways to help the patient e.g support thing ensuring they are cared for, well fed and
perhaps put in a care home if they are at home without support
 If its late-stage dementia = can arrange a palliative care package
o Discuss with the MDT
o MUST REVIEW THE STUDY

 Should doctors treat patients differently who have conditions from ‘self-inflicted’ causes e.g. excess smoking
or alcohol consumption?
o Many people make the decision to continue to drink and smoke knowing that it will cause them harm
and their health can suffer because of it
 Despite being educated through life and by public health efforts
  But educating about managing your health isn’t everywhere, low socio-economic
backgrounds in the country may not know the consequences of drinking/smoking
excessively
 Engaging in those activities may not be out of ignorance, may be addicted/use as
coping mechanisms and have other underlying issues
o Against the NHS values and constitution
o Activities like smoking and drinking have multifactorial causes
o NHS is still underfunded and resources aren’t plentiful so better to allocate resources to those who
need it the most
o Issue of legality an choice
 Drinking/ smoking are legal and people’s choice, may be ethically wrong to punish them from
acting out of free will
 Bias may occur
 Doctor bias if system was put into place since the amount, they consider a patient’s
smoking habit have affected their health may be different to another doctor (NO
WAY OF OBJECTIVTITY)
o GMC says = must treat patients fairly and with respect whatever their life choices and beliefs
o Doctors’ duty to educate each patient they see about how to look after their own health and encourage
them to reduce/quit harmful activities
 Only main times doctor would treat a patient differently is if it would clinically affect the
patient [Link] someone who has a long history of smoking and isn’t stopping until they do stop
since operating could kill them

 There is only one more bed available in the homeless shelter but three homeless people are left to
accommodate. One was an ex-drug addict, one is an immigrant who can’t speak English, and the other had to
go to the hospital last month for an infection in his leg. Who would you give it to?
o Firstly 3 people should be checked to see who needs the best the most, need objective way of
measuring
 Can use clinical input e.g. if patient is ill/deteriorated of health if he sleeps outside
o Whoever is chosen at the shelter, main point is to make sure others are dealt with
 Direct the other 2 to other homeless shelters in local
 Offer to escort hem
 For immigrant see if there’s a translator to help him as well
 Can offer blanket/food/water if there’s not a bed

 Do you think abortion based on gender should be allowed?

o Cons:
 Increase discrimination and cultural divide between girls and boys
 Especially in cultures where girls are already looked down upon
 May draw a blurry line, where does selection end, gender, hair, height potential?
o Practice of sex-selective abortion is prevalent in some cultures such as in India where female foeticide
is more common
 Sons bring money into family through work and can support parents
 Girls will need to have a dowry to be married off
 Sons may be preferred for manual labour

EXAMPLE INTERVIEW QUESITONS

2. Tell me the importance of IT in medicine
 IT is useful in medicine and is important
o Surgery
1. Robots being used
a. Because of fewer complications
b. Less human error
c. Robots never get tired
o Wards
1. Hospitals have digitalised patient notes
2. All of the patients’ investigations such as scans, bloods are online
 3. Monitoring of patients is done with machines e.g obs and ECG
4. Why?
a. More time efficient when doing ward rounds
b. Easier to share results with the members of the MDT
c. Easier to handover patients between medical staff e.g between GP and
medical doctors
o Internet
1. A lot of research published online e.g PubMed for doctors to access and learn from
2. Information and resources online are being constantly updated whereas books take
time to update through new editions
a. Important for doctors to be up to date with their medical knowledge for
CPD = helps provide optimum level patient care
3. Websites like mayo clinic is useful for patients for gaining knowledge on conditions
and when to see the doctor
4. NHS app can be used by patients, medical students and doctors alike
o Telemedicine
1. Because of COVID-19 a lot of GP consultations switched to online
2. Primarily protects patients and doctors from covid and helps reduce transmissions
3. Easier for doctors and patients at times
4. Can be more efficient at times so doctors can see more patients
o Social media
1. Can be used for educating public = preventative medicine
2. Could be used to spread false info on the other hand e.g. anti vaccinations
3. If doctors aren’t careful and discuss patients on social media, could reveal
confidential info leading to breach of confidentiality and trust between patient and
doctor
o I DONT THINK GP WILL BE REPLACED BY TECHNOLOGY AS GP CAN ONLY SHOW EMPATHY

3. What’s the impact of global warming going to be on healthcare in the UK?

 Infectious disease
o Higher temperatures mean bacteria thrive more and replicate along with vectors like
mosquitoes who can carry diseases like malaria
o Lead to infectious disease outbreaks with multiple patients getting ill as these diseases
spread
 Heatwaves
o Can cause health problems, especially in the elderly and the sick
o Can cause hyperthermia or heatstroke, can be fatal if left untreated
 Asthma/respiratory diseases
o People with heart problems are more vulnerable in increased temps
o Hot temperatures increase ozone concentration which can damage lung tissue and cause
complications in asthma patients
o One cause of global warming is air pollution causing respiratory pollutions
 All issues would increase pressure on the already pressured NHS especially in COVID
 Harder to manage due to lack of beds and staff shortages NHS is already dealing with

4. What is the NHS focussing in itself development on going forward into the future
 The NHS Long Term Plan perfectly summarises everything the NHS is focussing its development on over the
next few years:
o Shift of care systems towards integrated care systems (ICS) which will focus on population
health- NHS needs to work with local authorities, the voluntary sector and other partners
to improve this
o Mental health
1. Increased investment by 2.3 billion a year by 2023/2024
2. Creating a more comprehensive services system (esp those in mental health crises
with 24/7 support)
3. Expansion of services for children and young people e.g creation of mental health
support team in schools
o Improving care for people with learning disabilities e.g increasing access to support for
children with autism
o Trying to get patients admitted into A&E to be discharged the same day by implementing
same day emergency care, apply for up to 1/3 admitted to A&E
o Aim to reduce vacancy rate in nurses and increases medical school places
 o Need a shift from specialised to generalist roles in line with needs of patients with long-
term conditions
o Focussing on prevention and promoting behaviour change in the top 5 risk factors, e.g
smoking, obesity, high bp, poor diet, alcohol + drug use
o Reducing inequalities in healthcare e.g greater continuity for midwife care for BAME
women and increase in physical health checks for people with severe mental health
 I think they should utilise the growing power of social media (not stated in long term plan)

5. What does the term ‘inequalities in healthcare’ mean to you?

 Health care inequalities are unfair systematic differences in health provision between different groups of
people
 Can be seen in differences in area of levels of deprivation in life expectancy, behaviour habits and access to
healthcare
 Deprived areas life expectancy is 10 years lower than those in lest deprive areas
 Those in deprived areas are more likely to take multiple health related risks and behaviours e.g smoking,
poor diet and drinking
 Inverse care law= those that need healthcare the most are least likely to receive it as they have less access
to healthcare and they may engage in more activities that harms help
o Affluent patients have quick access to high quality care from doctors and private
healthcare
 Health inequalities can be caused by income, housing, transport and environment
o Children being closer to green areas allows them to be physically active and socially
connected in deprived areas are 9x less likely to have access to these
o Children in cold homes are more likely to suffer respiratory problems vs those in warmer
homes
 North England has overall lower health standards than those in south England
o Due to economic factors
 BAME communities face health inequalities
o Poor access to services, higher rates of mental health and metabolic illnesses e.g type 2
diabetes and cardio vascular diseases
o Most often harder to access GP services, CCGS have been trying to combat this issue in
addressing needs to patient at community level
 Can improve this by improving access to healthcare, educating population in deprived areas
o Bigger focus on primary care access as it’s the front door to healthcare services

6. Consider the COVID pandemic and what do you feel like are the lasting impacts on the NHS and society as a
whole
 Biggest hit is the supply of care and waiting lists for elective treatments, backlog has grown
o 6 mill on waiting list compared to 4million before pandemic
o Waiting longer for treatment = conditions can get worse for patients meaning more
complicated treatment being needed, quality of life reduced
o Health issue affecting their work/school travels then it can affect their independency
maintenance or motivate them to keep going to school which can have life-long
consequences on their development
o Can affect not only patients’ lives but any carers who look after them
1. They have to put their life on hold to care for the patient
o For NHS staff, more rise on work-related stress levels than there already was before
pandemic, lead to allows of nurse strikes and shortages
 On society, worsening diet and exercise habits may increase future demand for healthcare
o PHE estimated that more than 40% of adults in England gained weight during the pandemic
 Private health care seen to increase demand to deal with high waiting list
o Higher income individuals only been able to save more due to the pandemic to pay for
private healthcare
1. May release some pressures on the NHS but demand for private healthcare may
draw capacity away from NHS leading to worser outcomes for those seeking free
care
o Long COVID has affected patients’ quality of life e.g. losing sense of taste, reduced
significant lung capacity and so on

7. What challenges are facing the NHS in the next 20 years?

 Ageing population
 o Older people are more likely to have multiple coexisting health problems and also come to
hospital more often than younger people
o This is trying to be solved by helping focus on preventing illness and public health +
education to keep the public healthier even as we age
 Adapting to digitalisation of NHS
o As new technologies emerge, NHS must adopt technology improving the service for
patients and helps staff to do their jobs- there’s still a disconnect between different trusts
and hospitals across the UK as some operate heavily online with patients notes and such
while some are still heavily paper based
o Using technology could lead to exclusion of certain groups e.g older generation and those
from lower socioeconomic backgrounds
 COVID’s effect on elongating waiting lines for treatments
 Staffing shortages and staff burnout due to COVID
o Too many vacancies not being filled
 Healthcare inequalities, unless addressed, huge gap between high and low socioeconomic backgrounds in
terms of accessing healthcare will increase
 Obesity crisis, got worse with COVID as lockdowns

8. What do you know about the obesity epidemic in the UK?

 Increases risk of type 2 diabetes, CHD, cancer, stroke and more likely to suffer from mental health and
behaviour problems
 Its an epidemic, most adults were overweight 64% in 2019
 Childhood obesity is on the rise to, it’s very important for development and it can have long-term health
consequences
 Evidence linked to increased risk of severe illness and death from covid-19
o There are many reasons the obesity crisis I bad:
1. Availability and commercialisation of junk food, high sugar drinks and snacks etc
especially through ads on social media
2. Affordability of high fat high sugar food vs healthier options especially those from
lower socioeconomic backgrounds
3. Linked with mental health issued such as depression, anxiety which are also on the
rise in general population bringing obesity levels with them
 How is this being solved
o Role of dieticians within the NHS- GPs refer a lot of patients to them to help educate
patients on healthy living
o Giving more training to healthcare professionals across primary care networks
o Trying to ban ads for high fat and salt and sugar products on TV and limit deals like BOGOF
in stores
o Labelling all foods with calories along with the traffic light system to help educate
customers on what they are buying
o Sugar tax
o Campaigns like better healthy to promote healthy lifestyles and educate the public

9. What are the pros and cons for legalising cannabis?

 Pros:
o Health damaging effects are mild and the drug is less harmful than alcohol and cigs which
are both legal
o Crime would be reduced as the number of violent issues between criminals over drugs
would be minimized if drugs are taken out of the black market
o Cannabis legalization would mean that it could taxed which would create a lot of revenue
o Quantity of cannabis sold could be monitored for its strength, and safety by authorities
 Cons:
o Cannabis can act as a gateway drug and lead people to more serious drugs e.g cocaine and
heroin
o Cannabis use has been associated with psychosis
o Incidents of driving under the influence of marijuana would increase like drink driving
o Even though a minimum age limit would be imposed, more cannabis would inevitably end
up in the hands of children

10. What are 2 advantages and 2 disadvantages of remote consultations?

 Pros
o Very useful in COVID to keep patients and staff safe, especially those who are vulnerable
 o Transformed patient access to services, those less mobile can access healthcare easier
from their own homes
o Quick and easy for both patient and healthcare professional- can help manage long patient
waiting lists for doctors
o For smaller issues that can be managed over the phone, this is perfect for that and more
efficient
 Cons
o Important cues and signs may be missed, doctors are used to assessing patients visually
and in front of them e.g pain, non-verbal cues and pallor
o Maybe harder to read patients and pick up these cues, may get tunnel vision more easily
o Danger of taking patients at face value and relying on what they tell doctors since patients
have often formed an idea of what they think is wrong and doctors need to determine for
themselves what’s going on
o May be difficult for those with lack of internet or a telephone access this healthcare
1. Harder for old generation to use internet

11. Should the NHS put more money into preventative measures like public health schemes rather than curing
those who are already ill, what are the challenges of public health?
 Prevention means stopping problems from arising in the first place and keeping people healthy, not
just treating them when they become ill
o This means giving people the knowledge, skills and confidence to take full control of their
lives and their healthcare
 Trying to make healthy choices where possible
o Keeping healthy is important for many reasons
 To live longer, healthier, more independent lives
 Healthy nation is vital for a strong economy
 Better health reduces pressures on the NHS and public services
o Prevention is better than cure but it is not easy to say just put money into prevention
 Sustainable reasons need to balance short term needs of the UK’s health with the
long-term needs
 Short term wise, we still have people really ill and really long waiting lists for
treatments so cannot take funds away from that
 Emergency treatment cases which cant be foreseen so we need to put money into
that
o Balance overall though should slowly be put more money into public health schemes and
preventative measures to boost the overall health of the UK population
 E.g smoking rates are falling
o Examples of public health campaigns are better health, change4life, every mind matter
o Challenges to public health:
 Obesity, bad diets, low exercise levels, smoking, alcoholism, mental health,
screening for diseases such as cancer, climate change as human health depends on
healthy natural systems
 Reading & other knowledge
[Specifically stated on PS]

 Paul Kalanithi

Background:
 Paul Kalanithi was an American neurosurgeon and a famous author who wrote ‘when breath becomes air’, died at the age of 37 from metastatic stage 4 lung
cancer, His book was his perspective on facing mortality as a father, doctor and a patient

About his book:

 He describes his challenges he had to encounter after his diagnosis, the personal experiences are overwhelming as there is a constant navigation through an
alternative curve where there’s a continuous switch between hope and despair
 The book shows how fragile life is to spoil the long hours to hard work and fail you in achieving your goals, as well as how unpredictable it can be to diver t you
from the path that was leading to your dreams and aspiration
 It also shows Pauls views on how life should be lived as well as how death should be welcomed, but also the amount of effort it takes to have the integrity to
look at both concepts in the eye and fight it with dignity and dedication.
 Taught me that vulnerability is not a weakness, it takes real strength to reveal your vulnerable side
 Opened my eyes to our mortality, that the time in this universe is limited and that love and knowledge are immortal tools that we can use to our aid to make
our stay on this planet infinite
 Taught me how pain and suffering could be reduced by undying love, affection and care of one’s family, and that life shouldn’t be measured about the
quantity of years, but the quality of life and memories made
 Book divided into two sections, before cancer diagnosis and after cancer diagnosis
 The beginning of the book was both clinical and procedural and Paul revealed his sense of what it is to be a being, what it t ook for him to become a focused
man of medicine and science
 The second part of the book is concentrated on shifting his identity from a directing physician to the role of dependent pati ent, his knowledge of medicine
served him in a limited capacity as he fought against the cancer

Favourite/interesting part:
 Page 161 (CHECK WHAT CHAPTER) Talks about the 5 stages of grief, denial, anger, bargaining, depression and acceptance but it was interesting to see how his
was in reverse
 From accepting his fate, to slipping into depression at not being able to pursue his career, to cherry picking duties, to then getting angry at his lost mobility
and scarred vitality (state of being strong) to plunging into his surgeon duties with a vengeance placing his deteriorating b ody aside
 Was when he witnessed his first birth and his first death – in a labour and delivery ward, pair of twins were born prematurely through an emergency C-section
and placed in incubators, after delivering the good news the writer learns both the pair of twins ha d died
 The juxtaposition of life and death is quite distressing, he draws an analogy “a prophet returning from the mountaintop with news of a joyous new covenant
but when he hears this bad news, he is upset by this flip side of joy
 The inconsistencies of fate often manifest themselves in the hospital room, where birth and death intersect, the unpredictability of the future (anything can
happen) suggests both miracle and calamity (sudden distress) can exist within the same space
 This was really significant as one’s first direct encounter with birth and death is the most unforgettable experience, being mercilessly exposed to them both at
the same time gave the writer a whole new perspective on the world
 He learns that practicing medicine would require him to make judgement calls with moral clarity, putting patients at the centre of what he does and
developing wisdom over time
 Treating patients especially in a life-threatening situation, requires doctors to walk the tightrope between life and death, where a single misstep could change
the entire course of another’s future.
 The huge moral and professional responsibility he says can be daunting but it is what makes medicine worthwhile
 Death of the premature twins is a prelude to his own confrontation of his imminent death, cruelty of the situation is that death comes knocking at the door
when the writer is more vibrantly alive, when he is on the verge of reaching the optimum of his career and starting his own family
 Because the pair of twins die not long after taking their first breaths they died, it shows how unjust life can be and pushes us to appreciate each single blessing
as fleeting but precious gifts

Reflection:
 Book has made me much more aware of my vulnerability and fragility because of my age I have never truly considered death or world
departure as it seemed so distance and abstract, but if someone at the prime of his life can experience such trauma then there is every
possibility that I myself can fall victim to unforeseen catastrophes
 Revealed to me the extent of my blessings and the fact that I need to treasure them more as I bury myself too much in academic rigour, I
often forget the importance of nurture in human relationships which is something Paul explores, his relationship with his wife as well as the
unconditional love from his family which was the foundations of his courage and strength to carry on with his nauseating days of treatment.

My thoughts on his book:

The book ‘When breath becomes air’ has been an emotionally touching book. It is an autobiographical book written by Paul Kalanithi
who nearly became a writer but chose the path of being a doctor instead. The book is very well written and it is clear to see he had a gift
for writing the right amount of medical detail necessary, his explanations were precise when necessary. The book covers memories from
his childhood to his journeys within med school and more. The story is about the perception and management of life and death, a 36-
year-old doctor nearing completion of his neurosurgery training when he got diagnosed with stage 4 cancer. The parts where he describes
his hectic schedule, the burden of patient’ wellness and care and the thorough explanation of surgical procedures made me feel more
familiar with the man’s philosophies and research for whatever he was looking out in the universe. The book was capable of fully grabbing
the meaning and purpose of life, death and human existence, this love took him on an adventurous journey, through literature, then
medicine, then both. This book also provides an insight on how fragile life is to spoil the long hours dedicated to hard work and fail you
in achieving your goals as well as how unpredictable it can be to divert you from the path that was leading you towards your dreams.
Tears were present when reading this book as it was clear Paul Kalanithi invested enough energy to gain unlimited happiness during the
moments of delivery of his daughter, despite knowing the condition he was in. He taught me a lot from reading this book, not only has he
opened my eyes to our mortality, but also teaching me that vulnerability is not a weakness, and that pain & suffering can be reduced by
the undying love, affection of one’s family.

“Human knowledge is never contained in one person. It grows from the relationships we create between each other
and the world, and still, it is never complete”