Working with doctors Working for patients

 

Introduction

Dr Sharma has recently been appointed a Consultant Physician based in the Stroke Unit of the general district hospital where she was previously a Specialist Registrar. She witnesses a number of incidents on the Unit where patients are not receiving basic care and has to decide how to act.

As she is leaving the ward on her way to see another patient she notices that Mr Johnson, who was transferred from intensive care two days ago, hasn't touched his food or drink. She stops to talk to him.

Dr Sharma

Dr Sharma

Good morning Mr Johnson. My name is Dr Sharma. How are you today? I notice you haven't eaten your breakfast. Weren't you hungry?

Mr Johnson

Mr Johnson

Hello...sorry, sleeping...didn't see them come by. Where is it?

Dr Sharma

Dr Sharma

On the table, by your bed. To your left, just there.

Mr Johnson

Mr Johnson

[Struggling a little to reach over and hand shaking]. Very weak on that side...can't reach...very tired...took it away yesterday too.

Dr Sharma

Dr Sharma

When did you last eat or drink something?

Mr Johnson

Mr Johnson

Can't remember...my wife helped me yesterday sometime...oh when was it? I tried to get a nurse...they were so busy...really can't remember...

What should the doctor do...?
(Select A, B, C or D)

A

Ask Mr Johnson what help he needs to eat his breakfast and feed him herself?

B

Report the problem to the nurse in charge of the Unit?

C

Reassure Mr Johnson that the nursing staff will come and help him and leave the ward, planning to check on Mr Johnson again later?

D

Find a nurse and ask them to help Mr Johnson to eat his breakfast?

Dr Sharma

See what the doctor did

Dr Sharma assured Mr Johnson that she would sort the problem out. She checked Mr Johnson's chart to make sure that there were no identified problems with his swallowing and that the food offered was appropriate.

Dr Sharma went to speak to the nursing staff. With some assistance Mr Johnson was able to feed himself but Dr Sharma was concerned to make sure that Mr Johnson got the necessary assistance at every meal. She asked the trainee doctor to check that Mr Johnson was helped to eat his afternoon and evening meals when she would be off duty, and to let her know if there were any problems. She also asked the nurses to make sure that Mr Johnson's food and fluid intake was recorded on his chart. Finally, Dr Sharma resolved to check on Mr Johnson again when she started her shift the next day.

References

You must take prompt action if you think that patient safety, dignity or comfort is or may be seriously compromised.
a. If a patient is not receiving basic care to meet their needs, you must immediately tell someone who is in a position to act straight away.
(Good Medical Practice paragraph 25a)

All patients are entitled to food and drink of adequate quantity and quality, and to the help they need to eat and drink...You should be satisfied that nutrition and hydration are being provided in a way that meets your patient's needs and that if necessary patients are being given adequate help to enable them to eat and drink
(Treatment and care towards the end of life: good practice in decision making paragraph 109)

If you are responsible for supervising staff, whatever your role, you must understand the extent of your supervisory responsibilities, give clear instructions about what is expected and be available to answer questions or provide help when needed. You must support any colleagues you supervise or manage to develop their roles and responsibilities by appropriately delegating tasks and responsibilities. You must be satisfied that the staff you supervise have the necessary knowledge, skills and training to carry out their roles.
(Leadership and management for all doctors paragraph 62)