New free advice app for doctors to help curb the rise in claims and complaints

appMedical students can now access free expert advice on the medicolegal and ethical issues that can arise from everyday practice.

MPS, our sponsors, have released a new app. The MPS Advice app has been designed in a simple and easy format to give busy healthcare professionals fast access to topical issues such as confidentiality and parental responsibility.

The app includes:

  • Advice on a wide range of medicolegal topics tailored to healthcare professionals in England, Scotland, Wales and Northern Ireland
  • Over 300 case reports from the flagship MPS publication Casebook.

MPS receives hundreds of calls a week from doctors seeking quick advice. Issues range from getting a minor’s consent to report writing, and with this app you can get the information you require at the touch of a button.

Dr Nick Clements, Head of Medical Services at MPS, says: “We believe this app could help curb the rise in complaints and claims. It is written and regularly updated by experts at MPS and puts our advice and guidance at your fingertips.”

The app can be easily downloaded for iOS or Android devices, and automatically updates with new material as it becomes available wherever the mobile or tablet connects to Wi-Fi. It can be set to wherever the person is in the UK – allowing healthcare professionals working in a busy clinical environment to have access to free medicolegal advice any time at the touch of a button.

Read more here.

Students re-sit exam over claimed use of App

Over 400 medical students at Kings College London have had to re-sit an exam paper over claims of cheating with an app.

Complaints arose over claims that the lecturer who wrote the paper had based a lot of the questions on information in an app that they had also designed.

The BBC news website quoted that the author of the paper had an app on iTunes which “a few students” had been told about.

“Over 60% of the final paper was lifted from this app,” the student said.

“Instead of conducting a full investigation, Kings College London is making the whole year, 400 students, re-sit their exam only a few days after their practical exams, causing a lot of stress.”

Have you experienced similar issues? Do apps help or hinder your progress as a medical student?

Book review: Research Skills for Medical Students

Guest poster Thomas Lemon from the School of Medicine at Cardiff University gives his review of a popular student text. Here is his review of Research Skills for Medical Students 1st Edition (Allen, AK – 2012 Sage: London ISBN 9780857256010).

Themes – Research Skills, Critical Analysis Medical Students

Thesis – Research and critical analysis are important skills as highlighted by Tomorrow’s Doctors

Allen, drawing on many years’ experience as a researcher and lecturer in the Institute of Education, at Cardiff University has bridged the gap in Research methodology literature targeted at medical students. Pushing away from comparative texts somewhat dry and unengaging tones, this book encourages student interaction, empowering the student from start to finish. Not so much a book as a helpful hand guiding the student through the pitfalls and benefits of research and critical analysis from start to finish.

Thesis Research…
Photo by bjornmeansbear
Part of the Learning Matters Medical Education series, in which each book relates to an outcome of Tomorrow’s Doctors, this book is written from the a lecturers standpoint, guiding students through making sense of research, judging research quality, how to carry out research personally, writing research articles and how to get writings published. All of these are now imperative skills in what is a very competitive medical employment market.

This concise book, through its clarity, forcefulness, correct and direct use of potentially new words to the reader, Allen manages to fully develop the books objectives, using expert narrative skills.

With Allen’s interest in Global health, it is little wonder why this books exposition is clear and impartial, Allen consistently refers back to the Tomorrows doctors guidelines at the beginning of each chapter, enabling students to link the purpose of that chapter to the grander scheme. This enables Allen to argue the relevance of each chapter to the student before they have disregarded it. Openly declared as a book aimed at medical students (and Foundation trainees where appropriate) the authors style remains formal, but with parent like undertones. It is written to encapsulate and involve the student reader personally, with Allen frequently using ‘you’ as if directly speaking to the reader, and useful and appropriate activities that engage the reader in the research process, in an easy to use student friendly format.

This book is an excellent guide for all undergraduate health students, not limited to medical students, and I thank Ann K Allen for imparting her knowledge in such a useful and interactive way.

Want to publish your review of a text? Get in touch!

No strings attached?

With Christmas just around the corner, doctors may find themselves being handed boxes of chocolates, fruit baskets and wine from appreciative patients. Charlotte Hudson examines the ethical issues surrounding accepting gifts from patients.

The New Zealand wine selection at Target in Columbia Heights, DC
Photo by Jonathan Ah Kit
It is December and over the last year you have provided good care to your patients, so how nice of them to show their appreciation by giving you a present? Accepting presents, however, can create conflicts of interest and threaten probity.

Individual GP practices and most hospitals will have their own gratuities policies, but as a rule the GMC states in its ethical guidance on conflicts of interest, that GPs in particular “must not ask for or accept inducements, gifts or hospitality which may be seen to affect judgements, nor should these be offered to colleagues”.

The guidance also states that GPs “must not encourage patients to give, lend or bequeath money or gifts that will directly or indirectly benefit them”.

Pallavi Bradshaw, MPS medicolegal adviser, says that all doctors need to be sensible and objective when accepting gifts from patients.

“GPs, in particular are more likely to be given presents as they have known their patients for longer. Care needs to be taken when deciding whether to accept or decline a gift as you don’t want to break the professional boundaries of the doctor-patient relationship.”

If you accept a gift from a patient you should say thank you and record it in your practice/hospital’s gift register. Keeping a record of all gifts offered or received and discussing the matter openly with colleagues promotes transparency. All GP practices should have a gift register and some individual trusts will have their own policies – so always check.

If you decline a gift be polite and explain the reason why you cannot accept it, and record in the gift register what you were offered.

Do not leave wine bottles in doctors’ rooms – this can look unprofessional and give the wrong message to patients.

In an article in the BMJ Dr Sean Spence wrote that the most appropriate advice is to take nothing for granted and reflect upon the gift and its timing. A polite refusal may be preceded by reference to the ethics of medical practice or could emphasise that declining a gift does not equate to rejecting the patient. He adds that whatever the outcome, a thank-you note is appropriate.

What if I am given an expensive gift?

Under the General Medical Services (GMS) contract GPs are obliged to declare any gift from a patient worth more than £100 to their local commissioning body. This rule also applies to gifts received by spouses of partners or staff. If you work in a hospital and a gift is of particular value, you should discuss this with your departmental manager.

“If you are given cash by a patient, I would be reluctant to accept it,” says Dr Bradshaw. “I would also encourage the sharing of gifts given to you with the rest of your practice, for example, a box of chocolates. There have been cases when patients have left large sums of money in their inheritance to their GP. I would advise you to be cautious about this, and if you do decide to keep it then maybe invest the money into the practice or give it to charity.”

Treat those patients who give you gifts the same as any other patient, but a nice gesture would be to send thank you letters to patients who brought you presents during the festive period.

Section 23 of the Health and Social Care Act 2001 requires practitioners providing family health services (GPs) to declare financial interests and the acceptance of gifts and other benefits. It also states that doctors and other NHS employees in the hospital sector are required to refuse all gifts from patients except those which are of low intrinsic value, such as diaries or chocolates.

NHS employees should not accept “substantial” gifts from patients or others and monetary gifts are not allowed.

What is the intention of the patient?

It is advisable for a doctor to judge the intention of a patient before making deciding whether to accept it or not. Some patients may attempt to influence care or secure preferential treatment through the offering of gifts or cash. Acceptance of such gifts is likely to damage the integrity of the doctor-patient relationship. Doctors should make clear that gifts given to secure preferential treatment compromise their obligation to provide services in a fair manner.

The nature of the gift itself must also be considered. Accepting a gift, such as lingerie would be inappropriate, as would gifts of large sums of money. Giving either of these gifts may represent an attempt to equalise the power structure of the relationship, or may be a conscious or unconscious bribe. Giving a gift to influence an outcome is a bribe, and as such, it is unethical. In most organisations the demands of probity require that employees decline gifts that might be seen to influence their judgment.

If you are in doubt about whether to accept a gift, seek advice from MPS.

Dr. Sean Spence (BMJ, December 24, 2005).

Answer to question of the day: Skin Rash

Question of the dayWe asked you about the treatment to this skin rash… and the answer is….

a. Coal Tar

This is the classic salmon pink rash of psoriasis. You can see the surface has a scaly appearance.

As the rash in psoriasis is palpable and spread over an area of >0.5cm it is called a plaque not a macule – (If it was an impalpable area of colour change it would be called a patch).

Skin psoriasis is treated by emmollients, vitamin D analogues, coal tars, dithranol, topical steroids and oral retinoids. Methotrexate and Anti TNF therapy in addition to other immune modulating therapies are used in severe cases. Remember the four main types:

  1. plaque (seen here)
  2. pustular (pustules often occuring on the hands and feet)
  3. guttate ( teardrop lesions -sometimes occuring following a streptococcal infection)
  4. erythrodermic (diffuse skin involvement – potentially lifethreatening)

Capsaicin is a Rubefacient: a topical skin irritant. Its use is based on the principle that irritation of the skin produces a “distracting” effect from the pain from OA/ neuropathy (e.g. post herpetic neuralgia).
It is used topically for osteoarthritis and neuropathic pain.

Capsaican is the “active” ingredient in chillies which gives them their heat. Its use over a rash like psoriasis would be liable to produce excruciating pain and significant inflammation.