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Clinical Medicine for the MRCP PACESVolume 2: History-Taking, Communication and Ethics$
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Gautam Mehta, Bilal Iqbal, and Deborah Bowman

Print publication date: 2010

Print ISBN-13: 9780199557493

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199557493.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 08 December 2021

Communication Skills and Ethics

Communication Skills and Ethics

(p.219) Station 4 Communication Skills and Ethics
Clinical Medicine for the MRCP PACES

Gautam Mehta

Bilal Iqbal

Deborah Bowman

Oxford University Press

Capacity is at the heart of ethical decision making. Capacity to make choices about healthcare will rarely, if ever, be assessed without the benefit of input from a clinician. Often it is assumed that a psychiatrist should be involved where there are doubts about capacity, but the criteria for assessing capacity are relatively straightforward and it is a core skill in which all doctors should be competent, calling psychiatrists only in situations of doubt or complexity. Capacity is a legal rather than a medical concept, i.e. its definition is drawn from the law. As such, no doctor should engage in an assessment of a patient’s capacity without understanding the relevant legal processes. As capacity is a legal concept, the standard of proof that is used in assessing capacity is that which is applicable to civil law in general, i.e. on the balance of probabilities rather than beyond reasonable doubt. • The legal test used in assessing capacity to make decisions and choices about healthcare was first established in the case of Re: C (Adult: Refusal of Treatment). Since October 2007, the Mental Capacity Act 2005 and its accompanying Code of Practice is the source for guidance on capacity. The principles in Box 3 underpin the legislation and are particularly important to note: • The task in this scenario is to assess capacity, but clearly to do so effectively a candidate will need to employ appropriate communication skills to explore whether the patient is able to meet the criteria of capacity (see section “Key concepts”), namely: ♦ the patient’s comprehension of information ♦ the patient’s ability to retain that information ♦ whether the patient can weigh information in the balance to reach a considered decision; and ♦ communicate the decision. • Candidates should begin with an appropriate introduction telling the patient their full name and role and checking the patient’s identity and preferred form of address. • The patient should be invited to tell the doctor why he is attending and what he expects to happen at the consultation.

Keywords:   apologies, chaperones, disputes, elderly patients, firearms, gifts, judicial review, knife wounds, living wills, mediation

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