NZREX Patient Communication & Informed Consent 2 β Questions and Answers
Question 1: A patient with schizophrenia refuses antipsychotic medication during a voluntary admission. What is the most appropriate initial response?
- Explore the reasons for refusal, address concerns, and attempt to negotiate β do not impose medication without legal authority (Correct answer)
- Administer medication covertly in food
- Immediately apply the Mental Health Act for compulsory treatment
- Discharge the patient from hospital
Correct answer: Explore the reasons for refusal, address concerns, and attempt to negotiate β do not impose medication without legal authority
A voluntary patient retains the right to refuse treatment. The clinician should explore reasons for refusal (e.g., side effects, insight, fears), attempt therapeutic negotiation, and only consider the Mental Health Act if the patient meets criteria for compulsory assessment.
Question 2: When using an interpreter for a patient who does not speak English, which approach is most appropriate?
- Use a trained professional interpreter, ideally not a family member (Correct answer)
- Use a family member as it is more convenient and culturally appropriate
- Speak directly to the interpreter, not the patient
- Use online translation tools for clinical consultations
Correct answer: Use a trained professional interpreter, ideally not a family member
Professional interpreters ensure accuracy, confidentiality, and neutrality. Family members (especially children) should not interpret as they may filter information, lack medical vocabulary, and compromise confidentiality or create conflict of interest.
Question 3: A patient asks for a copy of their medical records. Under the Privacy Act 2020, what is the general obligation of the health provider?
- Provide access to records within a reasonable time, subject to limited exceptions (Correct answer)
- Refuse if the information may distress the patient
- Only allow access in the presence of a health professional
- Charge a substantial fee before releasing any records
Correct answer: Provide access to records within a reasonable time, subject to limited exceptions
Under the Privacy Act 2020 (Information Privacy Principle 6), individuals have a right to access information about themselves. Health providers must respond within 20 working days and provide access subject only to limited grounds for refusal.
Question 4: Which of the following best describes 'therapeutic privilege' and its standing in NZ?
- Withholding information believed harmful to the patient β this is not accepted under the NZ Code, which requires full disclosure (Correct answer)
- A doctor's right to treat without consent in an emergency
- The right to prescribe off-label medications without consent
- Prescribing placebo without disclosure
Correct answer: Withholding information believed harmful to the patient β this is not accepted under the NZ Code, which requires full disclosure
Therapeutic privilege (withholding information to prevent distress) is not accepted under the NZ Code of Rights. Right 5 guarantees patients the information they need to make decisions. Information should be delivered sensitively, not withheld paternalistically.
Question 5: A doctor is about to perform a lumbar puncture. Which elements must be covered in obtaining informed consent for this procedure?
- Purpose, process, risks, benefits, alternatives, and the right to withdraw consent (Correct answer)
- Only the purpose and expected outcome
- A full written consent form without verbal discussion
- Assurance that the procedure is routine and safe
Correct answer: Purpose, process, risks, benefits, alternatives, and the right to withdraw consent
Informed consent requires explaining: why the procedure is needed, how it is performed, risks (including uncommon but serious risks), benefits, alternatives (including doing nothing), and confirmation the patient can change their mind.
Question 6: A 10-year-old child is brought in by one parent who consents to a tonsillectomy. The other parent (with equal guardianship) has not been consulted. What is the most appropriate action?
- Attempt to contact the other guardian before proceeding with elective surgery; emergency surgery can proceed with one guardian's consent (Correct answer)
- Proceed immediately with one parent's consent
- Postpone surgery indefinitely until a court order is obtained
- Ask the child to decide
Correct answer: Attempt to contact the other guardian before proceeding with elective surgery; emergency surgery can proceed with one guardian's consent
For elective procedures, both guardians should ideally consent. If one guardian cannot be reached and the procedure is not urgent, surgery should be deferred. In emergencies, one parent's consent (or implied consent if neither available) is sufficient.
NZREX Patient Communication & Informed Consent 2
A patient with schizophrenia refuses antipsychotic medication during a voluntary admission.
What is the most appropriate initial response?