What are the reasons for the duty of candour?
Regulatory duties (CQC)
Professional duties (GMC)
Which ethical principles underpin duty of candour?
Autonomy: requires sharing of information and complete openness
- Necessary for informed consent
- Information about diagnoses/prognoses/errors/things that have gone wrong.
What are the different conceptions of truth telling?
Respond honestly when asked questions
Do not lie
Provide all relevant information without prompting
Why is honesty in the healthcare profession important?
To establish trust between patients and healthcare professionals, lack of honesty compromises trusting relationship. May cause patient to avoid seeking medical attention.
To respect patient autonomy; requires sharing of information:
- Openness at all stages of contact with patient:
- Information about diagnosis and prognosis
- Information necessary for informed consent
- Information on progress
- Information on things that go wrong
Describe the professional duty of candour
Statutory institutional duty
Formal process triggered by incident result in harm to a patient.
“Every healthcare professional must be open and honest with patients when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress”
When may errors not be disclosed to a patient?
If an error or system failure that reaches the patient but does not result in harm, e.g. 'near miss'.
Define 'low level' of harm
What is the consequence for the duty of candour if a 'low level' of harm is caused to a patient by error?
Low level of harm = Any patient safety incident that required extra observation or minor treatment (first aid, additional therapy, additional medication) and caused minimal harm
DoC: Must be disclosed to NRLS and patient.
What is the definition of significant harm?
What is the consequence for the duty of candour if a patient is caused 'significant harm' as a result of error?
Significant harm = Corresponds with NRLS ‘moderate’, ‘severe’ and ‘death’, and with incidents notifiable to CQC with harm explicitly defined to include ‘prolonged psychological harm’ in line with CQC reporting practice.
DoC: Disclosure would be required under both the professional and the organisational duties of candour, with proportionate regulatory consequences for a failure to disclose harm of this kind
What are the key points outlined by the GMC regarding raising concerns about patient safety and professional behaviour?
What does the duty to raise concerns consist of?
–“All doctors have a duty to raise concerns where they believe that patient safety or care is being compromised by the practice of colleagues or the systems, policies and procedures in the organisations in which they work.”
–“They must also encourage and support a culture in which staff can raise concerns openly and safely.”