MSRA Professional Dilemmas 1 — Questions and Answers
Question 1: A colleague confides that they have been drinking alcohol before clinical shifts. What is the most appropriate initial action?
- Express concern to the colleague and encourage them to seek help, while reporting to your clinical supervisor (Correct answer)
- Ignore it as it's their personal matter
- Confront them publicly during a ward round
- Report directly to the GMC without speaking to them first
Correct answer: Express concern to the colleague and encourage them to seek help, while reporting to your clinical supervisor
Patient safety is paramount. The initial step is expressing concern directly while also reporting to your supervisor or clinical lead, as patient safety cannot be compromised. GMC referral may follow if the issue isn't addressed.
Question 2: A patient's family member asks you not to tell the patient about their terminal diagnosis. What should you do?
- Explore the family's concerns but explain that the patient has the right to know their diagnosis if they wish (Correct answer)
- Agree to withhold the diagnosis as the family requested
- Tell the patient immediately without further discussion
- Refer the decision to the hospital ethics committee
Correct answer: Explore the family's concerns but explain that the patient has the right to know their diagnosis if they wish
While understanding family concerns is important, patients have the right to know their diagnosis (GMC guidance on consent). Explore what the patient wants to know and share information at an appropriate pace, respecting patient autonomy.
Question 3: You notice a senior colleague making a prescribing error. What is the most appropriate response?
- Raise the concern politely with the colleague directly and ensure the error is corrected (Correct answer)
- Ignore it because they are more senior
- Correct the prescription yourself without telling anyone
- File an anonymous complaint to the hospital board
Correct answer: Raise the concern politely with the colleague directly and ensure the error is corrected
Patient safety requires addressing the error. Speaking directly to the colleague is appropriate first, allowing them to correct it. If the error isn't corrected or there's a pattern, escalation to a supervisor is necessary.
Question 4: A patient refuses a blood transfusion on religious grounds despite being severely anemic. What is the correct approach?
- Respect their decision after ensuring they have capacity and understand the risks, and explore alternative treatments (Correct answer)
- Administer the transfusion when they are asleep
- Discharge the patient immediately
- Ask their family to override their decision
Correct answer: Respect their decision after ensuring they have capacity and understand the risks, and explore alternative treatments
A competent adult has the right to refuse treatment, even if it may lead to death. Ensure the patient has capacity, provide full information about risks, document the refusal, and explore alternative management options.
Question 5: You are asked to see more patients than you feel is safe during an on-call shift. What should you do?
- Raise your concerns with the on-call senior and document your concerns about patient safety (Correct answer)
- Work through it without complaining
- Leave the shift early to maintain your own safety
- See only the patients you feel comfortable with and ignore the rest
Correct answer: Raise your concerns with the on-call senior and document your concerns about patient safety
You have a duty to raise concerns about patient safety. Escalate to the on-call senior, clinical supervisor, or site manager, documenting your concerns. Never simply abandon patients or stay silent about unsafe conditions.
Question 6: A pharmaceutical representative offers you an expensive gift in exchange for promoting their medication. What should you do?
- Decline the gift as it represents a conflict of interest that could influence prescribing decisions (Correct answer)
- Accept it and prescribe whatever you think is best anyway
- Accept it but declare it to your department
- Accept it as it's a common industry practice
Correct answer: Decline the gift as it represents a conflict of interest that could influence prescribing decisions
Accepting gifts from pharmaceutical companies creates conflicts of interest and may bias prescribing. GMC guidance requires doctors to be honest about financial interests and avoid conflicts that could affect patient care.
MSRA Professional Dilemmas 1
A colleague confides that they have been drinking alcohol before clinical shifts.
What is the most appropriate initial action?