Revision 101

Coping with Pressure

• Recognises own limitations
• Calm under pressure
• Prepared to ask for help
• Manages uncertainty – don’t give false reassurance
• Deals with stress effectively
• Deals with confrontation appropriately
• Whenever in doubt, ask ICE!
 Gillick and Fraser Competency
• Gillick – a child has the maturity to make their own decision.
• Fraser – contraception.
• <12 years old – escalate to senior.
• <16 years old – assess maturity – understand the risks and benefits,
confidentiality, cannot be persuaded to inform parents.
• Detour – called to A&E to see patient suspected child abuse – escalate
to consultant, social worker, police etc
If the young person has informed their parents of the treatment they wish to receive but their parents do not agree with their
decision, treatment can still proceed if the child has been assessed as Gillick competent.

If you don't think a child is Gillick competent or there are inconsistencies in their understanding, you should seek consent from their
parents or carers before proceeding.
My slides
Duty of Candour
• If a mistake was made when prescribing:
• Explain what happened to the patient and apologise.
• Analyse the potential effects of the mistake and correct accordingly.
• Apologise to any colleagues involved.
• Fill in a incident report form.
• Reflect on your portfolio.
Learning & Development
• A Foundation doctor is expected to:
• Take responsibilities of their own learning, (1 day/month for SDL)
• Learn from others and from their experience,
• Be open and accept feedbacks by peers,
• Communicate effectively and raise concerns,
• A good teacher – must be able to teach medical students or do teaching in
your own department.
Mental Capacity
• Ability to make a decision
• Decision-specific and time-specific
• PRESUMED CAPACITY UNTIL PROVEN OTHERWISE
Mental Capacity Act (MCA)
A person has capacity if they can do all the following:
1. Understand information relevant to the decision in question
2. Retain that information
3. Use the information to make their decision
4. Communicate a decision
No capacity?

1. Determine what decision needs to be made

2. Advanced directive
3. Legal proxy
4. Treating doctor to decide which option(s) would be of overall benefit
• Consult with those close to the patient and other members of the healthcare team
• Consider which option aligns most closely with the patient’s needs, preferences,
values and priorities
• Consider which option would be the least restrictive of the patient’s future options
Child Abuse:
Female Genital Mutilation (FGM)

• FGM is child abuse and against the law in the UK

• Mandatory duty to notify the police if FGM is disclosed/identified in a girl under
18
• This is a personal duty of care and cannot be transferred to another professional
• Does not breach data protection laws or confidentiality
• Speak to seniors and local safeguarding lead!
Jehovah Witness
• Patients who decline allogenic transfusion due to religious faith
• Includes whole blood, blood components, using blood for cross match
• Some may be OK with blood derivatives (e.g. coagulation factors)
• Ask whether refusal extends to situations where loss of
life/limb is likely without transfusion
Emergency In children
■ Competent (Gillick if child)/advance ■ Involve senior → court order if in
directive → MUST FOLLOW best interest of child
■ Otherwise, based on best interest ■ Have doubts? Ask senior and
but try avoid transfusing Jehovah Witness Hospital Liaison
Working as a Team
• No hierarchy.
• Everyone has the right to speak up!
• Any concerns? Talk to your CS/ES.
• Not our job to apologise on behalf of someone.
• Not ideal to ask around if your colleague has behaving oddly.
• Speak to the person directly.