General Medical Council
Regulating doctors, ensuring good medical practice
Seek information about the patient’s wishes, preferences, feelings, beliefs and values, consulting:
Take the views of those consulted into account in making a decision about what would be of overall benefit for the patient
Mrs Julia Young is 80yrs old and living in a care home. She is quite frail but has no underlying chronic medical conditions.
Mrs Young recently became poorly and seemed to lose her appetite. On Saturday morning she was complaining of a sore throat, high temperature and nausea. The care home manager Mrs Field called the out of hours (OOH) GP and they decided to visit.
On examination, Mrs Young had an inflamed, swollen throat; she was very weak and confused and probably was dehydrated. When the OOH GP Dr Morgan said he wanted to admit her to hospital for further assessment and treatment, Mrs Young became quite agitated but wasn’t able to speak.
Mrs Young’s daughter Anna had arrived and she told the GP that her mother feared being admitted to hospital. Some months ago, her husband was admitted after a fall and died in hospital after getting an infection.
Her mother had been very distressed because it had happened so quickly and unexpectedly. Anna would prefer it if her mother could be treated at the home. The care home manager agreed that Mrs Young was fearful of going into hospital; adding that she had been a bit depressed since a friend of hers in the home had died.
Dr Morgan asked Anna about what had happened when Mr Young was admitted to hospital after his fall. Mrs Field checked the information in the care records about Mrs Young’s recent general health. Between them, it was agreed that while Mrs Young’s fears were understandable, it would be of overall benefit for her to be admitted to hospital for treatment.
Dr Morgan believed her condition was reversible with antibiotics and fluids which the hospital could provide by using a drip or tube. This was highly unlikely to involve a long stay in hospital, as was necessary to treat her husband after his fall.
They explained this to Mrs Young, assuring her that Dr Morgan would ask the GP practice to visit once she was settled back at the care home, so she could have a chance to discuss any worries that she had about her future care. She seemed to become more settled and Dr Morgan arranged her admission to hospital.
All paragraph numbers in the vignettes refer to the GMC's guidance Treatment and care towards the end of life: good practice in decision making (2010). You can download the guidance here (486 kb, pdf) for reference.
Assessing Mrs Young’s capacity to make a decision about whether to go to hospital and maximising her ability to make a decision (Paragraphs 11-12)
What steps should the doctor and other members of the team take to make a decision if Mrs Young is not able to make the decision for herself (Paragraphs 15-16)
How to take account of the information from Mrs Young’s daughter and the nursing home manager (Paragraphs 15-16, in particular 16 (f), 17-21)
Making a decision about what action would provide overall benefit to Mrs Young (Paragraphs 41 and 43)
How to deal with Mrs Young’s general fears about dying in hospital (Paragraphs 33-36)
Helping Mrs Young to talk about her fears and her wishes and preferences for treatment and care at the end of her life (Paragraphs 50-55).
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