Weekly SJT (sat 13th Oct)
Ranking Question
You are the surgical FY1. You have just been phoned by blood transfusion, who inform you that the bottle you sent has the wrong date of birth. The patient is scheduled for an elective abdominal aortic aneurysm repair first on tomorrow's theatre list. You are currently busy with a patient who has chest pain.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A Immediately go and retake blood from the patient.
B Add the job to your job list, and make sure the blood is correctly taken, labelled and received by confirming this with the lab.
C Call up the ward and speak to the nurse in charge, and ask them to take the blood.
D Fill in a blood form for the phlebotomist to take the blood first thing tomorrow morning.
E Take the blood yourself as soon as you have dealt with the patient with chest pain.
Answer: BECDA
This question assesses your ability to prioritise your patient's needs. You are currently dealing with a medical emergency, which takes priority and therefore leaving this patient to immediately take bloods (A) would not be appropriate. It is important to ensure that the patient for surgery has a valid cross match available, which as well as sending blood involves checking that it has been correctly processed. The only answer that does all of this is (B). Now you have your top and bottom answer the others can be ranked by whether they ensure patient safety - ie that the cross match blood is successfully sent. (E) doing it yourself after the medical emergency is dealt with is better than asking a nurse to take it (C) as you can be certain the blood has been sent. Leaving the form out for the phlebotomist (D) is less appropriate as you can't be sure there won't be another problem with the blood sample in the morning when it will be too late to rectify and the case will therefore be delayed.
Multiple Choice Question
As the F1 doctor clerking patients in the Acute Medical Unit the next patient you are due to see has a familiar name. As you approach the bed you realise that you used to attend school with her.
Choose the THREE most appropriate actions to take in this situation.
A Take history and examine the patient as normal without mentioning that you know her
B Approach the patient and explain that if possible you will ask another a colleague to take her history
C Return to your team members, explain the situation and ask if someone else would be able to take her history instead of you
D Approach the patient, she is happy to be seen by you so you continue as normal and offer to email her the test results
E Take the history from the patient but do not examine her to avoid her embassasment
F Approach the patient and ask if she is happy to be seen by you after reminding her that the consultation will remain confidential
G Take a brief history and examine the patient, you already know her background so it makes taking a history quicker and easier
H Call your mutual friend to let them know she is in hospital
Answer: B, C, F
This question assesses your knowledge of the GMC ‘good medical practice guidelines’. It is suggested that you should avoid treating patients that you know closely where possible. In this scenario it is either appropriate to not see her, however, if you have reinforced that the consultation will remain confidential and you act professionally then it is acceptable (B),(C) or (F). Patient confidentiality is key here – so it is not appropriate to email results (D) or to call a friend (H). It is unprofessional to either pretend that you do not know the patient as it is highly likely she will recognise you and then feel uncomfortable throughout the consultation (A). It is not appropriate to fail to take a full history or examination (E), (G) as you must put the patient’s care first.
You are the surgical FY1. You have just been phoned by blood transfusion, who inform you that the bottle you sent has the wrong date of birth. The patient is scheduled for an elective abdominal aortic aneurysm repair first on tomorrow's theatre list. You are currently busy with a patient who has chest pain.
Rank in order the following actions in response to this situation (1 = Most appropriate, 5 = Least appropriate)
A Immediately go and retake blood from the patient.
B Add the job to your job list, and make sure the blood is correctly taken, labelled and received by confirming this with the lab.
C Call up the ward and speak to the nurse in charge, and ask them to take the blood.
D Fill in a blood form for the phlebotomist to take the blood first thing tomorrow morning.
E Take the blood yourself as soon as you have dealt with the patient with chest pain.
Answer: BECDA
This question assesses your ability to prioritise your patient's needs. You are currently dealing with a medical emergency, which takes priority and therefore leaving this patient to immediately take bloods (A) would not be appropriate. It is important to ensure that the patient for surgery has a valid cross match available, which as well as sending blood involves checking that it has been correctly processed. The only answer that does all of this is (B). Now you have your top and bottom answer the others can be ranked by whether they ensure patient safety - ie that the cross match blood is successfully sent. (E) doing it yourself after the medical emergency is dealt with is better than asking a nurse to take it (C) as you can be certain the blood has been sent. Leaving the form out for the phlebotomist (D) is less appropriate as you can't be sure there won't be another problem with the blood sample in the morning when it will be too late to rectify and the case will therefore be delayed.
Multiple Choice Question
As the F1 doctor clerking patients in the Acute Medical Unit the next patient you are due to see has a familiar name. As you approach the bed you realise that you used to attend school with her.
Choose the THREE most appropriate actions to take in this situation.
A Take history and examine the patient as normal without mentioning that you know her
B Approach the patient and explain that if possible you will ask another a colleague to take her history
C Return to your team members, explain the situation and ask if someone else would be able to take her history instead of you
D Approach the patient, she is happy to be seen by you so you continue as normal and offer to email her the test results
E Take the history from the patient but do not examine her to avoid her embassasment
F Approach the patient and ask if she is happy to be seen by you after reminding her that the consultation will remain confidential
G Take a brief history and examine the patient, you already know her background so it makes taking a history quicker and easier
H Call your mutual friend to let them know she is in hospital
Answer: B, C, F
This question assesses your knowledge of the GMC ‘good medical practice guidelines’. It is suggested that you should avoid treating patients that you know closely where possible. In this scenario it is either appropriate to not see her, however, if you have reinforced that the consultation will remain confidential and you act professionally then it is acceptable (B),(C) or (F). Patient confidentiality is key here – so it is not appropriate to email results (D) or to call a friend (H). It is unprofessional to either pretend that you do not know the patient as it is highly likely she will recognise you and then feel uncomfortable throughout the consultation (A). It is not appropriate to fail to take a full history or examination (E), (G) as you must put the patient’s care first.