To Station 4 With Love And Sweats!

Being one of the most fearsome stations of all, the scenario outlined could well be quite tricky and taunting, nonetheless on the other hand, could be quite straight-forward at times. It is for this very reason it's been said to be the most unpredictable station.

Allow me to share some of the points that I've learnt throughout the journey in becoming an mrcpian;)

Remember these 5 core principles in medical ethics:

1. Non-maleficence - ie to do no-harm first!
   Remember this principle first. You will find that it's applicable in any scenarios, and it's indeed very true in our daily clinical practice.
2. Beneficence - ie to do good for patients
3. Patient's autonomy and right to confidentiality
4. Truth-telling
5. Justice and sharing - ie fairness in provision of care in face of limited resources

Hence, after spending 14 mins with the surrogate and 1 min of reflection, time for heads-up and face the music! Place your discussion with the examiners based on all these core principles. You won't go wrong. But to get a 4 would require much of your soft skills in tackling the surrogate's emotion and responses.

Here are some illustrations:

• A patient with advance statement for no-CPR came in with an umcomplicated MI. Your task is to explain with regards to his advance statement and its application to his current diagnosis.
  Principles: Autonomy vs beneficence
  
  
• Relatives of a patient with poor outlook came to you requesting ICU admission. Your ICU has 1 bed left. A young man with polytrauma is on his way to the hospital. Your task is to address this issue with the relatives.
  Principles: Autonomy (any advance statement?) vs justice and sharing of care
  
  
• You accidentally prescribed bactrim to a patient with a previous history of sulfur allergy. The patient developed Steven-Johnson syndrome. The father is keen to meet you for an explanation.
  Principles: Non-maleficence & truth-telling (apology)
  
  
• A young man is tested positive for HIV. He refused to tell his wife despite adequate explanation. Your task is to meet him and explain with regards to the risk of transmission of HIV to his sexual partner(s).
  Principles: Autonomy (confidentiality) vs non-maleficence (public interests) and justice