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INTERACTIVE SCENARIOS - PART 1
In this section of the module you can access multiple Interactive Scenarios. Test yourself by scrolling through the scenarios and questions followed by the responses of a supervisor from that health care specialty. There are links to relevant professional regulators for further information. You can also use the examples as the basis for discussion with colleagues at a multi-disciplinary team meeting or development event.
This is PART 1 of 3. Click the 'Next Section' button at the top of this page to progress to PART 2 once you have completed the Scenarios below:
At a job interview a physiotherapist claims that she authored a paper. The paper is located and shows that she was not the author; however, she was acknowledged in the credits.
Do you have any concerns about this physiotherapist’s professional behaviour?
Yes No Not sure
Make a note of your comments.
Please see below to compare your opinion with our supervisor's answer and comments.
Scenario 1 response
Supervisor answer: Do you have any concerns? Yes
Supervisor comments: Passing off others’ work as one’s own is plagiarism. The example relates to this in an indirect way. However, a situation like this may be an example of inadvertent wrongdoing. The physiotherapist may not realise that she is being dishonest and may just need to be reminded that claims like this may be considered unprofessional and could cause doubts in the minds of her interviewers as to her overall honesty. After consultation with HR there should be an investigation and disciplinary action may be advised. How she responds and reflects on the feedback will also act as a gauge of her professionalism. If the physiotherapist is dismissive of the seriousness of her actions referral to the regulator will need to be considered. Contributing to research is laudable, there is no need to compensate for absence of authorship by being dishonest.
Guidance from the regulators:
The Health Professions Council state (point no.12) that, “You should behave honestly and not pass others' work off as your own”. (www.hpc-uk.org/assets/documents/10002D1BGuidanceonconductandethicsforstu...)
The GMC document Good Practice in Research can be found at: www.gmc-uk.org/guidance/ethical_guidance/6005.asp
The Health and Care Professions Council research report on professionalism in healthcare professionals: https://www.hcpc-uk.org/globalassets/resources/reports/professionalism-i...
NMC: www.nmc-uk.org/Publications/Standards/The-code/Introduction
NPC: www.pharmacyregulation.org/standards
Points for reflection:
- Have you ever considered writing something on your CV that is not true?
- How would you approach the conversation with the physiotherapist about the false claims?
The National Institute for Health Research (NIHR) suggest that attendance at a Good Clinical Practice course may be of value and this is mandatory in some trusts for potential researchers: https://www.nihr.ac.uk/health-and-care-professionals/learning-and-suppor...
You may wish to undertake the e-learning module on Fraud Awareness on: https://portal.e-lfh.org.uk/
A core trainee who has been feeling tired lately asks a foundation year 2 doctor (FY2) to take his blood for haemoglobin. The FY2 takes the blood, writes a fictitious name on the form, and sends it to the laboratory with his name and bleep number.
Do you have any concerns about the professional behaviour of?
a) the core trainee: Yes No Not sure
b) the foundation doctor? Yes No Not sure
Make a note of your comments.
Please see below to compare your opinion with our supervisor's answer and comments.
Scenario 2 response
Supervisor answer:
Do you have any concerns? About the FY2: Yes, About the Core Trainee: Yes
Supervisor comments: The core trainee is more senior and should not ask the FY2 doctor to engage in what is dishonesty. The core trainee has recognised he/she is not feeling well and is seeking to do something about it. The correct course is for the core trainee to see their GP to have the tiredness investigated. The FY2 is put in a difficult position but should have refused the request from the CT. The CT is not the FY2's patient and therefore it is not appropriate for him to take blood. Writing a fictitious name is also a cause for concern on two counts; 1) his probity is called into question and b) the identity of the sample and person is not verifiable. This is a potentially serious situation and needs to be investigated. Doctors are notoriously poor at seeking help for their own health concerns. It can sometimes be difficult to judge when to take sick leave or to take time off for medical appointments. Healthcare professionals should not manage their own health issues and should not put colleagues with whom they work in a position which could compromise their relationship. A GP can offer a confidential medical consultation and arrange any necessary investigations and follow-up. They can also provide objective, independent advice which is in the best interests of the individual concerned.
Guidance from the regulator:
The General Medical Council advises that “you must make sure that your conduct justifies your Patient’s trust in you and the Public’s trust in the profession”, stating “You should be registered with a general practitioner outside your family.” [GMC Good Medical Practice 2013 paras. 28-30]
The General Medical Council advises that “If you have concerns that a colleague may not be fit to practise and may be putting patients at risk, you must ask for advice from a colleague, your defence body or [the GMC]. If you are still concerned you must report this, in line with [GMC] guidance and your workplace policy and make a record of the steps you have taken. [General Medical Council, Good Medical Practice, 2013, para. 25c]
Points for reflection:
- Think about a time when you were unwell. What worries did you have and how did you manage these?
- Think about the actual words that you might use to respond to a request, like that in the scenario above, from a colleague who is more senior to you.
- How might the FY2 have felt if the blood test showed a serious underlying condition?
A registered nurse asks a foundation year 2 doctor (FY2) on the ward if she will give her a prescription for Trimethoprim as she thinks she has a urinary tract infection and cannot get to her GP.
Do you have any concerns about this nurse’s professional behaviour? Yes No Not sure
Make a note of your comments.
Please see below to compare your opinion with our supervisor's answer and comments.
Scenario 3 response
Supervisor answer
Do you have any concerns? Yes
Supervisor comments: The nurse should not have made the request as it puts the FY2 doctor in a potentially awkward position as she is not this doctor's patient. The FY2 doctor should politely decline to issue the prescription and advise the nurse to consult her GP. Even if the nurse and FY2 doctor are certain that a urinary tract infection is the correct diagnosis, the FY2 doctor should not issue a prescription. There may be factors that the FY2 doctor does not know about or feel comfortable to ask about e.g. pregnancy, other medications, or health issues.
Guidance from the regulator:
“You must prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs.“ [General Medical Council, Good Medical Practice, 2013 para.16a. ]
Also see: General Medical Council, 2013, Good Practice in prescribing and managing medicines and devices] “If you assess, diagnose or treat patients, you must adequately assess the patient’s condition, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient.” [General Medical Council, Good Medical Practice, 2013 para. 15a]
Points for reflection:
- What are the pros and cons of treating colleagues as patients?
- If you have found yourself in a similar situation, what was good about the way that you handled it and what problems may have arisen?
A very friendly phlebotomist new to the UK arrives on your ward and mentions in passing that he qualified abroad as a doctor and is hoping to gain GMC registration. Every week he brings gifts such as chocolate and fruit to the ward. A few weeks later he asks you for a reference.
Do you have any concerns about this phlebotomist’s professional behaviour? Yes No Not sure
Make a note of your comments.
Please see below to compare your opinion with our supervisor's answer and comments.
Scenario 4 response
Supervisor answer
Do you have any concerns? Not sure.
Supervisor comments: It is not clear if this is an issue of culture or whether the phlebotomist is seeking to influence the reference. It would appear that the gifts were given to the ward rather than to the doctor personally. The doctor must give an objective and honest reference. If it is thought the gifts are inappropriate, a quiet word from the ward sister or doctor to explain the norm in the UK could be helpful for the newcomer.
Guidance from the regulator
The General Medical Council states that “You must not ask for or accept – from patients, colleagues or others – any inducement, gift or hospitality that may affect or be seen to affect the way that you prescribe for, treat or refer patients or commission services. You must not offer these inducements.” [General Medical Council, Good Medical Practice, 2013, Para 80]
The General Medical Council also states that” You must be honest and objective when writing references, and when appraising or assessing the performance of colleagues, including locums and students. References must include all information relevant to your colleague’s competence, performance and conduct.” [General Medical Council, Good Medical Practice, 2013, Para 41.]
Also see General Medical Council 2012 guidance on writing references: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/writing-references .
Points for reflection
- If you have been in a similar situation, what was effective about the way that you handled it?
- What words would you use to explain to the phlebotomist without making him feel embarrassed?
- How do you manage the issue of gifts from patients or their family?
- Do you know, or know where to find, your organisation's gifts policy?
An NHS hospital consultant receives a call at lunchtime from a patient on whom he operated in an external private clinic. The patient is very distressed as the wound is oozing and the consultant asks the patient to come to his NHS hospital outpatient clinic where he is working that afternoon.
Do you have any concerns about this consultant’s professional behaviour? Yes No Not sure
Make a note of your comments.
Please see below to compare your opinion with our supervisor's answer and comments.
Scenario 5 response
Supervisor answer
Do you have any concerns? Yes
Supervisor comments: If the patient is deemed to have an urgent clinical problem they need to be seen and treated urgently whether they are an NHS or private patient. However, the consultant should follow their trust's regulations on where and when he may see private patients. Most trusts will not allow a private patient to be seen during an NHS clinic. The doctor should either arrange to see the patient in the private facility or ask a colleague to see the patient instead. Seeing a private patient in NHS time and in an NHS, facility is a matter of probity and warrants an investigation.
Guidance from the regulator
The General Medical Council, states that “You must give priority to patients on the basis of their clinical need if these decisions are within your power.” [General Medical Council, Good Medical Practice, 2013 para 56.]
In addition, “doctors must be honest in financial & commercial dealings with patients, employers, investors and other organisations and individuals” [General Medical Council, Good Medical Practice, 2013 para 77.]
Points for reflection
- What experience do you have of any conflicts of interest between private and NHS work (your own or involving colleagues)?
- What are your views about private medical care? How might these impact on the way that you communicate with patients and healthcare professionals who work in the private sector?
You notice that a senior medical trainee habitually criticises several midwives in front of other team members when they ask for advice or request theatre times for patients. Her response is rude, dismissive, and often sounds arrogant and superior to others. Her behaviour clearly makes the rest of the team feel very uncomfortable.
Do you have any concerns about this trainee’s professional behaviour? Yes No Not sure
Make a note of your comments.
Please see below to compare your opinion with our supervisor's answer and comments.
Scenario 6 response
Supervisor answer
Do you have any concerns? Yes
Supervisor comments Team working and giving feedback are key skills for all healthcare professionals. A doctor who makes colleagues feel uncomfortable or belittled will adversely affect the efficiency and spirit of that team. This matter needs to be raised with the doctor and her educational supervisor. Although the doctor’s behaviour appears to be unacceptable it may be helpful to think about possible underlying reasons that could be contributing to it. The doctor may be under pressure herself and/or unaware of the effect she has on others. This can be addressed by her educational supervisor initially but may need to be escalated to the training programme director or head of school if the trainee’s behaviour remains unprofessional.
Guidance from the regulator
The General Medical Council states that “You must work collaboratively with colleagues, respecting their skills and contributions; you must treat colleagues fairly and with respect; you must be aware of how your behaviour may influence others within and outside the team. [General Medical Council, Good Medical Practice, 2013 paras. 35, 36, 37]
It also states: “You must tackle discrimination where it arises and encourage your colleagues to do the same. You must treat your colleagues fairly and with respect. You must not bully or harass them or unfairly discriminate against them. You should challenge the behaviour of colleagues who do not meet this standard.” [General Medical Council, Leadership, and management for all doctors, 2012 para7]
Points for reflection
- What experience of bullying or undermining do you have?
- What were the most effective ways of dealing with it?
- How could multi-source feedback be used constructively in this doctor's development?
Further resources
E-learning module - Undermining and Conflict in the Workplace: https://london.hee.nhs.uk/undermining-and-conflict-workplace-home
Giving feedback is included in the module 'Supporting and Monitoring Educational Progress' in the educator training resources on e-learning for healthcare: https://portal.e-lfh.org.uk/
https://www.acas.org.uk/discrimination-bullying-and-harassment
BMJ Careers article on bullying among doctors: https://www.bmj.com/content/342/bmj.d2403