Working with doctors Working for patients

Good medical practice in action
 

Introduction

Mrs Melville, who is 69 years old, has come to discuss a second face lift (she had her first eight years ago). Mr Yannis is a cosmetic surgeon working in the independent sector.

Mr Yannis is concerned that further surgery may not have the desired cosmetic outcome and that the risk of surgery could outweigh the benefit. Mrs Melville's GP, who made the initial referral to Mr Yannis, has said she is not in favour of further surgery and Mrs Melville has said that she doesn't want her GP to be informed.

Mr Yannis

I really would be more comfortable, Mrs Melville, if you would let me contact your GP. We need to make absolutely sure that there are no additional risk factors involved in having the surgery that you might have forgotten to tell me about since the previous operation.

Mrs Melville

But she won't support my decision. I think she's being over cautious and I really don't want her to be involved if she's going to make things difficult for me. I don't understand why you can't just take me at my word - I'm paying for the operation myself, I understand the risks and I'm prepared to take them. Surely this is my decision?

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

A

Say he will consider carrying out the procedure but only if Mrs Melville will agree to his discussing it with her GP?

B

Refuse to carry out the procedure because he doesn't think its in her best clinical interests?

C

Agree to carry it out and that he won't inform her GP - its her decision after all and she's aware of the risks?

See what the doctor did

Mr Yannis does not rule out a further operation, but is not comfortable going ahead without consulting Mrs Melville's GP. He tries to persuade Ms Melville to let him contact her GP and she reluctantly agrees.

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References

You must recognise and work within the limits of your competence.
(Good Medical Practice, paragraph 2)

In providing clinical care you must:
d. propose, provide or 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 will meet their needs
(Good Medical Practice, paragraph 7d)

You should ask patients about any other care or treatment they are receiving – including over-the-counter medications – and check that any care or treatment you propose, provide or prescribe is compatible.
(Good Medical Practice, paragraph 39)

Continuity of care is important for all patients, but especially those who may struggle to navigate their healthcare journey or advocate for themselves. Continuity is particularly important when care is shared between teams, between different members of the same team, or when patients are transferred between care providers.
a. You must promptly share all relevant information about patients (including any reasonable adjustments and communication support preferences) with others involved in their care, within and across teams, as required.
(Good Medical Practice, paragraph 65a)

You must communicate clearly and respectfully with patients, listening to their questions and concerns and considering any needs they may have for support to participate effectively in decision making.
(Cosmetic interventions, paragraph 14)

If you believe the intervention is unlikely to deliver the desired outcome or to be of overall benefit to the patient, you must discuss this with the patient and explain your reasoning. If, after discussion, you still believe the intervention will not be of benefit to the patient, you must not provide it. You should discuss other options available to the patient and respect their right to seek a second opinion.
(Cosmetic interventions, paragraph 18)

You must consider whether it is necessary consult the patient's GP to inform the discussion about benefits and risks. If so, you must seek the patient's permission and, if they refuse, discuss their reasons for doing so and encourage them to allow you to contact their GP. If the patient is determined not to involve their GP, you must record this in their notes and consider how this affects the balance of risk and benefit and whether you should go ahead with the intervention.
(Cosmetic interventions, paragraph 27)

You should give patients written information that explains the intervention they have received in enough detail to enable another doctor to take over the patient's care. This should include relevant information about the medicines or devices used. You should also send this information, with the patient's consent, to their GP, and any other doctors treating them, if it is likely to affect their future healthcare. If the patient objects to the information being sent to their doctor, you must record this in their notes and you will be responsible for providing the patient's follow-up care.
(Cosmetic interventions, paragraph 39)

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