All at sea over diving course
Business Dilemmas
Dr Kathryn Leask
Dr Kathryn Leask discusses what to do if asked to complete a medical form for an introductory SCUBA course.
Dilemma 1
Must I complete patient’s form?
Q I am a private respiratory consultant and one of my patients, who suffers from asthma, has asked me to complete and sign a form for him to take part in a SCUBA diving introductory course.
He has specifically been asked to fill in a medical form due to his asthma. There are also other questions on the form about his health that I don’t have information for, such as neurological conditions like migraine.
The patient has ticked these boxes saying he does not suffer from any other medical condition than asthma.
Should I complete the form?
A Patients often ask doctors to complete forms for sporting or other activities to confirm they are fit to take part. The difficulty lies in the fact that the doctor may not have any expertise in the activity and may not be aware of the stresses or issues that might arise during the event.
The GMC says that when you complete or sign forms, reports and other documents, you must make sure that you take reasonable steps to check the information is correct and you must not deliberately leave out relevant information. And you must also make sure that any documents you write or sign are not false or misleading
As SCUBA diving is a specialist sport, you may not know what the implications of the patient’s asthma are for his safety while diving and the patient would be best placed to be examined by a doctor who specialises in diving medicine.
You are also having to rely on the patient’s account of their health with regards to other body systems without any direct knowledge of this.
If you were to complete the form you should take appropriate steps to verify the information; for example, by contacting the patient’s GP, with the patient’s consent.
What you could offer the patient, in this situation and any other where a patient requests information for such events, is to provide a factual medical report detailing the medical conditions you are aware of and what treatment the patient is receiving.
However, in this case, the patient will need to complete specific forms for their diving club and confirm that they are fit to dive.
A factual report is unlikely to satisfy this requirement. Drawing the GMC’s guidance to the patient’s attention may be helpful in explaining to them the difficulties signing such a form may present for a doctor without specialist knowledge.
Can she do a smear?
Dr Kathryn Leask
Is a new healthcare assistant able to carry out cervical screenings? Dr Kathryn Leask gives her advice.
Dilemma 2
Can my assistant do screenings?
Q I am a private gynaecologist who has just employed a new healthcare assistant (HCA). She is a former practice nurse with extensive experience but wanted a change of pace before retirement.
The nurse who used to carry out cervical screening for me is not currently available. My new HCA has completed all her training, including a recent update, to carry out cervical screening and was carrying out the procedure up to the point she left her previous role.
While my nurse is unavailable, can the HCA carry out screenings in the interim?
A When you delegate a task, such as the consultation and clinical examination associated with cervical screening, you must be satisfied that the person to whom you delegate has the knowledge, skills and experience to provide the care. As such, you are still responsible for the overall management of the patient.
According to the Government’s guidance, a person who takes a cervical sample must have the required level of knowledge and understanding of the cervical screening programme.
While your new HCA may have the competency to carry out cervical screening in view of her previous role and employment, only certain groups of healthcare professionals are eligible.
This includes registered nurses and registered nursing associates. If your new employee is in a HCA role and not registered, they would not, therefore, be able to carry out cervical screening.
It is also important to ensure that the staff who assist you also have the appropriate indemnity in place for the work they do.
Dr Kathryn Leask is a medico-legal adviser at the Medical Defence Union (MDU)