CSA troubleshooting: 10 - Ethical issues in the CSA

The last of our 10-part series discusses how to handle difficult ethical dilemmas.

A request for an inappropriate fitness certificate or prescription may be part of the exam (Photo: JH Lancy)
A request for an inappropriate fitness certificate or prescription may be part of the exam (Photo: JH Lancy)

Ethical issues and dilemmas occur on an everyday basis in general practice. They range from the common and insignificant to the less frequent situations requiring further advice from outside organisations.

How it is covered in the CSA exam

The CSA aims to reflect the varied ethical issues and dilemmas that GPs face, and tests ethics in real life situations.

A candidate may have to deal with a request for an inappropriate sickness/fitness certificate or prescription, or they may be asked to bring about a patient's death prematurely, omit important information from the medical records, or take some form of action against the likely underperformance of a medical colleague.

What to do in the exam

It is useful to have an appreciation of ethical principles, and there are a number of models that can help form a basis for your decision-making.

But knowing an ethical framework does not necessarily help you find the solution to a difficult problem; it may simply get you into the habit of looking at the problem from a number of different perspectives.

In the CSA exam there is not always one single right answer to a difficult issue.

Usually, you are expected to weigh up the positives and negatives of different approaches, and use your negotiating skills with the patient in front of you. However, there can be situations where there is a clear cut right and wrong answer, and these cases are usually based on regulations, such as those from the DVLA or the GMC.

Demonstrate that you can take responsibility for decision making, rather than seeking to pass the problem on to another agency, such as your defence organisation.

How to prepare

You can revise for the exam by applying an ethical framework to the every day situations you encounter in the surgery.

It would be a good idea to familiarise yourself with the regulations surrounding fitness to work, drive or fly. End-of-life situations are also common in the CSA, so read up on death and assisted suicide.

Ethical dilemmas often involve use of resources and conflicts between patients' and doctors' agendas, so thinking through any rationing situations that a GP may have to deal with would be useful. These could include prescribing or  referral for expensive investigations or treatments, or ones without a clear evidence base showing benefit.

  • Dr Denny is an MRCGP examiner and a GP in Edinburgh

Read more from this series and find further advice for GP registrars

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