An A to Z of Competencies

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Beyond the Med School Gates Life in the Real
World 18 Sept 2007
An A to Z of Competencies and Safety
Prof Richard Beasley Physician Director MRINZ
Dr Geoff Robinson Physician Chief Medical
Officer CCDHB
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A ACC

• A professional responsibility to assist patients
• Good compliance in some services
• ACC Treatment Injury (new)
• Every patient harmed by treatment
• (provided by a registered health professional)
  
• is entitled to a claim

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B Boundaries

• Be very clear on boundaries
• Patients becoming friends
• Patients providing services
• Beware the personality disordered/ difficult
• patient

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C Confidentiality

• Seek patient consent before disclosure
• eg. referrals, discharge summaries, relatives
• Statutory exceptions still mostly advise
• patients eg. driving, notifiable diseases

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D Deceased Patients

• Care of the deceased patient (and family) is
• important
• Certificates (death/cremation)-ask if uncertain
• Consultants should opine on need for coroner
• notification
• Communicate with relatives and give them
• phone details for later questions

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E Ethics

• Two fundamental guidelines that sometimes
• conflict
• - Respect patient self determination
• - Act in the patients best interest
• Usually Common sense rules!

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F Futility (medical)/ Fiscal constraints/
Failure
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G GP

• A patients GP has a wealth of knowledge and
• information call them!
• You must have your own GP get one!
• Do not treat your family or friends
• Do not self prescribe

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H Handover
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H Handover

• Clinical Medical Handover
• is a prerequisite for patient safety
• It must happen am, 4 and 11.
• Use patient lists and handover sheet

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DATE___________ Remember to JUMP! 1.) Handover
Jobs to do 2.) Handover Unclerked Patients 3.)
Handover Medical Contacts - names and
numbers 4.) Handover Patients to be aware of
Details
Subspecs reg Name________________
Pager________________
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I Informed Consent
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I Informed Consent

• Three essentials
• A competent patient
• Provision of adequate information
• Patient choice
• Beware consenting patients as an RMO, if you
  dont understand the investigation/ procedure/
  treatment

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J Judge not

• Be non- judgmental
• Patients and doctors

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K Knowledge

• You cannot know everything
• It is okay to ask
• It will be on your PDA, supplied by the
• hospital

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L Legislative requirements

• Lots!
• eg. - Privacy
• - Misuse of Drugs
• - Mental Health
• - HDC
• - ACC
• - Health Practitioners
• Competency
• Assurance (HPCA)
• Read Coles Book of
• Medical Practice (MCNZ)

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M Mistakes/ Medico-legal

• We all make mistakes
• Errors of omission are more common than
• errors of commission.
• ie You are more likely to make an error by not
  
• bothering to do something than by not knowing
• something
• Develop systems in your practice
• Ensure timely communication happens

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N Night shift
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O Open Disclosure

• When things go wrong in patient management
• open disclosure is encouraged
• Poor disclosure/ communication fuels
• complaints, HDC, and medico-legal issues

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P Prescribing

• What most doctors do
• Documenting admission medication-inaccurate
• Watch the dangerous drugs
• - anticoagulants
• - opioids
• - insulin
• - K
• Discharge medication management
• what has changed? - communicate
• O.C.D. needed!
• Protocols may ? acetylcholine

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Q Quality Improvement

• Everyones issue
• Report clinical adverse events
• Audits do them and enjoy

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R Respect

• The first tenant of HDC Code of Patient Rights
• Do you know the others?
• Lack of respect for colleagues is commonest
• cause of Human Resources complaints

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S Stress
Contributes to the Doctors Diseases Three
Ds - Depression - Drugs (alcohol) - Dimming
(burn-out)
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S Stress
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T Technology

• 21 DHBs with different systems
• Get inducted/orientated and trained-your right
• Electronic Health Records and Radiology
• Be clear who signs off what (reports)
• Ensure the electronic discharge summary gets
• checked and sent

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U University Medical Schools

• Consider the curriculum
• ? Is the balance diseases and therapeutics
• vs how to be a doctor

V Vocation of Medicine

• Consider why not just a job/ professionalism
• Choose your career carefully
• There is something for everyone

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W When things go wrong

• Clinical or administrative
• Seek advise soon and actively (from the top)

X Xenophobia

• Respect others cultures/ beliefs
• Cultural competence

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Y Yawn

• Recognise sleep deprivation
• Effects judgment and behaviour

Z Zealand

• Please stay
• Or come back (we did)
• It actually is the best