Answers to SJT questions posted on our fb page
You are an FY1 on the ward. You have been asked to catheterise a middle-aged gentleman with advanced MS. He is currently clinically stable. Whilst you are alone, he asks you to help him die.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A Explain that you cannot help him to die but explore his reasons for wanting to die and document the conversation
B Put him on the Liverpool Care Pathway (LCP)
C Explain that you are simply here to catheterise him, and that you recommend he speaks to the consultant next time he is around
D Explain that you are only in your first year as a doctor therefore you will get someone more senior to talk to him
E Refer the patient with his consent to the palliative care team
Answer
AEDCB
Rationale
This question assess your ability to act within the law and demonstrate good communication of a difficult topic. It is illegal to help someone to die but you should explore his reasons for expressing this wish as it may be that there is something you can do to help him (A). Once you have explored the patient’s reasons it would be appropriate to refer him to experts in end of life care, such as the palliative care team (E), however, this has to be with his consent.
Placing the patient on the LCP (B) is not appropriate as the patient is not currently about to die and therefore does not require it, therefore doing so could be seen as euthanasia. (The Liverpool care pathway is a set of guidelines that may be implemented in the last hours or days of the dying patient to sustain comfort).
For the 3rd and 4th option it is understandable that a FY1 might not feel confident discussing these issues and arrange for a senior to do so (D) although there is little reason why you can’t explore the issues in general as an FY1 thus showing your support to the patient, explaining why (B) is better than (D). It is better to arrange this for his (D) than leaving the patient to ask the consultant at an unspecified time in the future (C).
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A Explain that you cannot help him to die but explore his reasons for wanting to die and document the conversation
B Put him on the Liverpool Care Pathway (LCP)
C Explain that you are simply here to catheterise him, and that you recommend he speaks to the consultant next time he is around
D Explain that you are only in your first year as a doctor therefore you will get someone more senior to talk to him
E Refer the patient with his consent to the palliative care team
Answer
AEDCB
Rationale
This question assess your ability to act within the law and demonstrate good communication of a difficult topic. It is illegal to help someone to die but you should explore his reasons for expressing this wish as it may be that there is something you can do to help him (A). Once you have explored the patient’s reasons it would be appropriate to refer him to experts in end of life care, such as the palliative care team (E), however, this has to be with his consent.
Placing the patient on the LCP (B) is not appropriate as the patient is not currently about to die and therefore does not require it, therefore doing so could be seen as euthanasia. (The Liverpool care pathway is a set of guidelines that may be implemented in the last hours or days of the dying patient to sustain comfort).
For the 3rd and 4th option it is understandable that a FY1 might not feel confident discussing these issues and arrange for a senior to do so (D) although there is little reason why you can’t explore the issues in general as an FY1 thus showing your support to the patient, explaining why (B) is better than (D). It is better to arrange this for his (D) than leaving the patient to ask the consultant at an unspecified time in the future (C).