Professional Dilemmas The paper focuses on your approach to practicing medicine. The paper lasts 90 minutes. You are presented with scenarios you might meet when practicing as a doctor. Each scenario encapsulates a professional dilemma and you are asked about dealing with it. The paper is designed to assess your understanding of appropriate behaviour for a doctor in difficult situations and allow you to demonstrate the application of competencies such as professional integrity, coping with pressure, and empathy and sensitivity. It does not require specific knowledge of general practice but does assume general familiarity with typical primary and secondary care procedures. Your responses should represent appropriate behaviour for a second year Foundation doctor.

GMC: Good Medical Practice Good clinical care Maintaining good medical practice Relationships with patients Working with colleagues Teaching and Training Probity Management Activity Research Health

Dealing with emergencies You are a GP registrar during a busy monday morning surgery. You are in the middle of examining a child. The reception calls you and says a patient has just rung in complaining of chest pain. What do you do. Rank each option in order. A. Ask the patient to call an ambulance for the patient B. Finish seeing the patient you are with and do an urgent home visit C. Ask the patient to come to the surgery D. Ring the patient back immediately and assess the situation over the phone. E. Ask the receptionist to get some more details about the pain.

A request for contraception A 14 yr old female comes to see you alone. She would like to start the COC. She has 1 sexual partner who is also 14yrs. They do not want to use condoms anymore. She does not have any medical CI. She refuses to discuss this which another adult despite your advise Rank the following options. A. Refuse. Inform her parents as she is underage. B. Refuse but do not inform her parents. C. Give her the COC as you have assessed her as competent. Continue to encourage her to discuss it with another adult. Refer her to a FP clinic

A complaining patient You are seeing a “minors”patient in casualty. They have been waiting 2 hrs and are angry by the time you see them. They say they want to make a complaint about you. Choose the 2 best options. From the following A. Apologies for the delay and offer them an explanation. B. Refuse to see them. C. Get a senior colleague to see them instead D. Advise them of the complaints procedure in the department E. Explain the patients are seen on the basis of priority and they have a “non-serious” problem so they should expect to wait longer.

Prioritising Tasks You are the busy gynae Dr on the ward. Your senior is not answering their bleep. Rank the following tasks in order of priority A. Certifying a death. The ward needs the bed and the tearful relatives are waiting B. Catching up on the weeks discharge letters C. Checking your D. Seeing a patient in AE who as a ? Ectopic preg. The nurse says she is well E. Seeing the lady whose scan has just shown a missed miscarriage. Her and her partner are very upset and want to speak with a dr now. The nurse says they may complain.

Patient Choice You are looking after a 70yr old patient with terminal Ca. They are due some further palliative chemo with an oncologist. They are not keen due to SE and have decided to use some herbal therapies instead. Choose the 2 best options. A. Advise them against herbal treatments. Not proven and can interact with conventional therapy. B. Offer some suggestions to reduce SE associated with the chemo C. Advise them to stop the chemo. They are dying. Why suffer the SE unnecessarily. D. Advise them to discuss this in detail with the oncologist as some herbal treatments can interact with chemo.

Trusting our colleagues ? A 85yr old patient being investigated for blackouts tells you that they have seen the nurse on the ward stealing another patients money. Rank in order the following options A Advise the patient to call the police B Speak with the senior nurse on duty and ask them to investigate C Speak with the nurse yourself. There may be a simple explanation. D Ignore the patient. They are most likely to be confused. You trust this nurse. E Ask the other patient if any money is missing.

Criminal Activity You are a GP. Between patients the receptionist calls to tell you she has overheard your next patient, who is a known drug-addict, arranging a “drug deal” on their mobile phone in the waiting room. Rank in order the most appropriate actions to take. A Inform the police Immediately B Refuse to see the patient. You do not tolerate criminal activity in the building. C See the patient. Don’t mention anything to them. Discuss it with your partner after surgery and decide how to proceed. D Do nothing. You have no proof E Discuss it with the patient when they come in. There may be a simple explanation.

Accepting Gifts You are a GP. A grateful patient gives you a cheque for £30 and asks you to “treat yourself for once”. Rank the following actions in order of highest ethical principles A Thank them but refuse to accept the gift. B Use the money for a treat. C Use the money to improve the waiting room. D Share the money with your partners as per the partners contract. E Use the money towards a new coffee machine for the practice

Breaking Confidentiality It is a Saturday. You are in Asda. You see a pt of yours with epilepsy parking her car. You remember recently having spoken with her about not driving and she assured you she was not. Which action should you take. Rank in order. A Inform the DVLA B Call her on Monday and ask her to come in and discuss the matter C Discuss this with the MDU D Nothing as you noticed this outside of your contracted hrs.

Treating our relatives Your relative has come to the UK on a short holiday from USA. Unfortunately their Salbutamol inhaler broke on the journey.They only carry it “just in case”. They ask you to provide them with another. Rank the following in order of most appropriate action A. Refuse. They are not eligible for NHS care B Give them an FP10 script C Give them a private script D Tell them not too worry, unlikely to need it. If acutely unwell they can go to AE for free emergency Rx. E Refuse. You can not treat a relative. Suggest they see a GP.