A) CAPACITY (Competence)

B) CONFIDENTIALITY
C) CONSENT FORMS
D) DRIVING ISSUES

1) It is the ability to use, weigh and understand information to make a decision,

2) Any person above 16 years of age is considered to be competent until proved
otherwise,
3) If the patient lacks capacity (e.g. In Coma) it is the treating physician who
should determine his best interest, but in conjugation with his family.
4) Competent patients can refuse treatment but cannot ask for treatment.

Special Conditions:

1) Incompetent Patients (patients who lack capacity), doctors work for the best
interest of the patients unless they left a living will or a power of attorney to
take decisions on their behalf.
2) The best interest of the patient is discussed with the multidisciplinary team,
the family, or the mental capacity advocate (If no family members)
3) In emergency situations, it is the role of medical team only to take decision.
A. Coma, Dementia, Schizophrenia

B. Confusion (temporary lack of capacity)

C. People committed suicide

D. Children <16

doesn’t mean only the best medical interest, it means the

whole patient`s best interest (Medical, Social and Mental)

The best interest is decided once the patient losses his capacity and no advance
directive or lasting power of attorney

What factors did you take into account when you deciding the best interest?

1- Identify all patient circumstances

2- Respect patient views
3- Consult your seniors
4- Avoid discrimination
In discussing DNR (Do Not Attempt Resuscitation), withholding treatment or
organ donation about a patient without capacity. It should be a formal written
witnessed paper

Do you have any idea about his wishes when he was alright?

Did he express his wishes before?”

Has he nominated any one to take decisions on his behalf?

Competent people don’t commit suicide.

People committing suicide are not competent (Their decisions cannot be
respected)
You should treat them even against their wish, as advance directive is not
reliable in suicidal patients
The drug overdose, “Did you take it by yourself? or any one has obliged/forced
you?
Did you Leave any letter or note? “Did you look the door from inside? Did you
keep the window open? Did you use any sharp instruments?
 This is a part of respecting the patient’s autonomy.
You should keep all the patient medical information and records confidential.
No one should know anything about his medical condition without his own
permission.

If patient has given consent

Best interest of the patient if patient lacking capacity and you need specialist advice.
Patient lacking capacity and you need to discuss his best interest with his family
Public interest (birth and deaths)
Public interest (court orders) (don’t breach a patient’s confidentiality for the police,
insurance companies and lawyers unless you obtain his consent)
Public Interest (Notifiable Diseases)

Always keep the public interest reason as a last resort, and try to obtain
consent from the patient

Never discuss the patient's case with anyone without the patient's permission

Never leave hard copies of forms or records with unauthorized persons

Build a security culture in your organization.

Encrypt ‫ تشفير‬all patient data.

Proxy Consent
Like a patient that agreed to tell you about his medical issues during history taking, or like
taking a blood sample from a patient. No a written form for these tasks.

Informed Consent
It is a written form that the patient should sign before any invasive procedure. “Informed”
means that the patient accepts to have the procedure done after explaining the Steps of the
procedure, the Benefits and the potential Risks that may happen during the procedure.

You should always enquire and ask if your patient drives a car.
Always ask the patient to inform the DVLA and get guidance from them.
Don`t gives the patient false information; If you don`t know for how long the patient will be
suspended from driving you should check the DVLA website.

Post MI, Private cars for 1 month, and Heavy vehicles for 6 weeks
1st attack of Epilepsy, Private cars for 6 months, Heavy vehicles for 1 year
TIA/CVA, Private cars for 1 month, Heavy vehicles for 1 year
Diabetes on insulin private cars Ok if no hypos, Heavy vehicles banned

If for any reason the patient refuses to inform the DVLA about his medical
condition that will ban him from driving, you need to explain politely that this
puts him and others at risk, and this puts the medical team in responsibility to
inform the DVLA about his condition and you may (break his confidentiality).
 During your consultation you should show sympathy and empathy
It Is not a problem if you say that i don’t know this medical issue and you will
seek a senior advice
Keeping eye contact

 Arteries/Veins=Blood conduits, Bacteria= Bugs, Radiology = Scans

 Immune System=General Defense System in Our Body
 Thrombosis=Formation of blood clots, Endoscopy = Camera test
 Myocardial Infarction=Heart Attack, Lung Fibrosis = Scarring of the lungs
 Blood investigations= Blood Tests, Esophagus = Gullet, Uterus = Womb
 Bronchi, Bronchioles =Airways, TIA = Mini-stroke

Break means bit by bit, layer by layer what do you know so far? Well, i am afraid things didn’t
go as we hope

Speak frankly but compassionately ‫تحدث بصراحة ولكن برأفة‬.

Avoid medical jargon.
Make eye contact.
Use facts, Use the words cancer or death
Allow silence and tears ‫اسمح بالصمت والبكاء‬
Offer help
I’m sorry to tell you that …. % might be affected by your condition, however
nowadays with the advanced researches, we can do a prenatal genetic screening
for the babies to see If they are affected or not and then you can decide whether
to keep them or not

We are hoping that he would regain his consciousness, and we did everything to
improve his condition, we put him on machines to support his heart and lungs, we
gave him drugs to help his heart to function better, so in such situations after all
this time of maximum support and he didn’t regain consciousness, the team
decided it is unwise to make him suffer more, and we think keeping him on
machines will prolong his days of suffering, also he may be subjected to more
hazards than benefits, so this decision is for his best interest to leave Him in peace
and to withdraw him of these machines; I can arrange for you another meeting
with our consultant, I can give you time to contact your family members & I am so
sorry for this hard time.

Don’t worry, in early pregnancy with advanced research nowadays we can do

prenatal screening to see if the coming baby have the same problem or not & to
decide whether to continue the pregnancy to better to terminated
I will refer you to a smoking cessation clinic

I am not in a position of judgment to judge other doctors performance

Avoid being at Home alone, avoid locking the bathroom from inside, avoid flashes
of light; Avoid watching TV Late at night, practice swimming whilst being
observed.

(Competent Patients Doesn’t Commit Suicide), I`m deeply sorry, i understand

things went very hard to let you in such situation, I`m here & all the team to help,
we want you to overcome this difficult situation, we can discuss your problem and
it will be strictly confidential, no one will know even your family, do you know the
name of the tablet?

Don’t worry about that, we can take your ova / sperms, store them in a special
bank, and when you finish the course of treatment, you can use it and do artificial
fertilization and have lovely babies,