Q1) I've seen a patient a few times in clinic and we shared a lot of common interests. They sent me a friend request on Facebook. Should I:
a. accept their request and have a good look at their profile to see what else we have in common
b. accept their request, as it might seem rude to ignore it. But to maintain some sort of professional boundary I'll limit them from seeing most of my profile and activity
c. ignore the request. When I see them next I'll thank them but politely explain that I can't accept due to my professional obligations.
Q2) A patient I'm quite attracted to asked me out for a drink. The appropriate response would be:
a. to ascertain beforehand who will be paying, in the hope it avoids any awkward misunderstandings
b. accept, but make it clear that it would not be a date, as that would be unprofessional
c. thank them but politely decline, as you must maintain a strictly professional relationship.
Q3) An elderly patient with whom I've had several long conversations is really grateful for the time I've spent with her. By way of thanks, she's given me an envelope containing £100. I should:
a. thank her for her generosity, and tell her that while she really didn't have to, it's much appreciated and I'll spend it wisely
b. thank her but explain that I can't accept such a generous gift. If she insists on giving me something, I'll ask that she gets a box of chocolates for all the staff on the ward
c. take it, but make sure it's shared with the other members of the team that looked after her too.
Q4) My best friend has asked me to prescribe her some antibiotics as she has had a chesty cough for a couple of weeks and doesn't have time to get to her own GP. I should:
a. sympathise with her but impress upon her the importance of seeing an objective clinician so they can assess and treat her appropriately
b. explain that I can't prescribe them to her without having had a quick look at her and checking she has no allergies or contraindication to whatever I prescribe
c. write the prescription, as she sounds like she needs them and I want to be helpful.
Q5) I'm suffering from diarrhoea and vomiting but can't miss any more of my clinical attachment. The best thing to do would be:
a. go in to hospital while keeping my distance from patients in case I infect them, but stay close to the toilet facilities at all times
b. be aware that I may be infective to both patients and colleagues. Seek advice from my GP or the relevant Occupational Health department about how long I need to be clear of symptoms in order to safely return to a clinical environment
c. take something for it and soldier on.
Q1) Answer: C
The MDU has seen an increase in the number of queries regarding social media, as it has the potential to generate plenty of medico-legal issues. The GMC has issued specific guidance on this topic which covers various aspects of doctors using social media, including that of maintaining boundaries.
As interacting with patients via social media can blur the boundaries between the private and the professional, it's safest to explain, in line with the GMC guidance, that you're unable to mix your social and professional relationships.
Q2) Answer: C
Maintaining an appropriate professional boundary between doctors and their patients is important in preserving trust in the profession. Engaging in a close emotional or sexual relationship with a patient may leave the doctor open to accusations that they have taken advantage of their position, or worse still, a vulnerable patient.
The GMC offers clear guidance on this point in paragraph 53 of 'Good medical practice' (2013): 'You must not use your professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them.'
Q3) Answer: B
Gifts may be tempting and make you feel valued, but it's important to consider the repercussions of accepting them. While it's not absolutely forbidden, the GMC is clear that doctors must not accept gifts from patients, or colleagues, that may affect or be seen to affect the way that person is treated.
In this context, £100 is not an insignificant amount of money. Accepting it could leave a student or doctor open to criticism that they've taken advantage of a patient.
The value of this gift is also significant. Any medical students who go on to become GPs will need to be aware that under the General Medical Services contract, GPs are required to keep a register of gifts valued at £100 or more.
Q4) Answer: A
Doctors should generally avoid treating themselves or those close to them. Paragraph 16g of 'Good medical practice' (2013) is explicit that you must, 'wherever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship.'
You should also be aware that as a doctor there is no such thing as a 'quick look'. Regardless of the context, you should apply the same standards when exercising your clinical skills and knowledge to any clinical interaction. Similarly, your ethical duties in relation to consent, confidentiality and record keeping remain unchanged.
Q5) Answer: B
Doctors and medical students get ill like everyone else. But there is an expectation that they will act professionally, and that includes prioritising patient safety. Taking the appropriate amount of time off is better for everyone involved, rather than turning up to work and potentially triggering an outbreak of gastroenteritis amongst your colleagues and patients.
The GMC are clear that you must not rely on your own assessment of the risk you pose to patients. Seek guidance from a suitably qualified colleague and stick to the measures put in place to protect patients.