You become unwell during clinic

Step 1 · Read the instruction

WHAT TO DO

Check the format and the direction of the scale.

• 1InstructionRank these independent actions
  Judge each action on its own. Option C describes two things in sequence; rank that whole sequence as one action.
• 2Instruction1, most appropriate, to 4, least appropriate
  1 is best. Each rank is used once.

Step 2 · Work out your role and who is affected

WHAT TO DO

When the problem is you, there are usually two groups to protect: the people you might harm by carrying on, and the people who need care you can no longer give.

• 3ScenarioEight patients are still booked to see you.
  These patients are affected whatever you do. Some may be able to wait; others may need to be seen today. Someone has to decide which.
• 4ScenarioYour GP supervisor is in the building.
  There’s a clinician available now who can make that decision and arrange cover. You don’t need to solve this alone.

Other people in the surgery, including patients in the waiting room and staff, are at risk of infection while you keep working.

Step 3 · Separate facts from assumptions, and find the risk

WHAT TO DO

Find the risk and its timescale. Is harm happening now?

• 5Scenariovomiting and diarrhoea, consistent with gastroenteritis
  This is not a minor ailment. It is likely to be infectious, and it affects your ability to work. Every patient you see now is exposed, so the risk is happening already.
• 6ScenarioMidway through morning clinic
  The timing explains the pressure: patients are waiting now, and stopping is disruptive. That pressure is what makes the weaker options tempting.

Don’t assume that you’re safe to carry on because you feel well between episodes. The GMC says you shouldn’t rely on your own assessment of your fitness to work. Also, don’t assume that all eight patients can safely wait.

Step 4 · Name the tension and write your task

WHAT TO DO

Name what you owe the patients, and what you owe yourself and others.

You have a duty to the patients booked to see you, but also a duty not to expose patients and staff to infection and to look after your own health. Leaving and staying both carry a cost, so look for an option that reduces both.

Your task: I need to stop seeing patients while I’m unwell, and make sure a clinician decides what happens to my remaining patients before I leave.

Step 5 · Read each option literally

WHAT TO DO

Break each option into verb + recipient + timing + condition. For each, ask: what happens to the patients?

• 7Option ATell your GP supervisor that you are unwell
  A goes to a clinician who can act. The condition “before you go home” makes it a handover: the plan is agreed before you leave.
• 8Option Aagree how your remaining patients will be seen or rebooked
  A also allows for both possibilities. Patients who need to be seen today can be seen by someone else; others can be rebooked.
• 9Option BAsk the receptionist to rebook all your remaining patients
  B stops exposure straight away. But the receptionist isn’t a clinician, and “all” means no one checks whether a patient needs to be seen today.
• 10Option CFinish seeing the patients already in the waiting room
  C’s condition is the problem. Before it stops exposure, C exposes more patients. It eventually involves your supervisor, so don’t let its similarity to A make it look better than it is.
• 11Option Dwashing your hands carefully between patients
  D reduces risk but doesn’t remove it, and it never stops. It also relies entirely on your own view that you’re fit to work.

Step 6 · Sort into good, acceptable and poor

WHAT TO DO

Group the options before comparing them.

Step 7 · Compare neighbours and settle the order

WHAT TO DO

Explain each comparison with a fact from the scenario.

A versus B. Both take you out of clinic. A ranks above B because eight patients are still booked and a receptionist can’t judge which of them need to be seen today. Your supervisor can. B solves your problem, getting home, but only half of the patients’ problem.

B versus C. B ranks above C because B stops exposure now. C exposes the patients who are waiting before it stops.

C versus D. Both are poor. C at least stops at some point and involves your supervisor. D carries on indefinitely and relies on your own judgement of your fitness.

What could change the answer

WHAT TO DO

Ask which fact would make your preferred action inappropriate.

• A mild cold that doesn’t affect your judgement and poses little risk to patients would not usually require you to stop.
• If your supervisor weren’t available, you would still need to stop. You’d look for another clinician, such as the duty doctor, to decide which patients need to be seen, rather than leaving it to reception.

The exam-speed version

1. Ranking, 1 is best.
2. I’m likely to be infectious, so harm is happening now. Eight patients are still booked. My supervisor is available.
3. Task: stop, and get a clinician to decide what happens to my patients.
4. A does both. B does half. C and D keep exposing patients; D never stops, so D last.

Take this into your next question

Lesson: when you are the problem, ask two questions. Am I safe to keep working, and not just in my own opinion? And who will look after my patients?

When it applies: illness, fatigue and any situation where you need to stop working. See when you may not be fit to work.