Key Public Health Issues

Introduction

Dr. A has been part of a group practicing radiology in a small town in United Kingdom. He reads and image studies from a community hospital, H Medical Center. He has been doing this job for last 15 years. Dr. A has grew up in this town and learned the culture and about this town’s community. He regularly interacts with the community having observed his patient’s changing health over some years. He is also the local medical community’s active member as he met face-to-face with the physicians in the medical center (Chopra et al., 2005).

This case study will discuss the practicing radiography of H Medical Center and how this impacts the role of the radiographers in patient caring. The scope of this case study include ethical and legal issues, promoting professional healthcare practice, meeting needs of the vulnerable groups, and impact of delivery of quality care.

Ethical and Legal issues

The medical center’s administrators informed Dr. A about a cost-cutting initiative. That has been proposed. There was consideration from the medical center whether the imaging studies shall be sent to the specialist of a large hospital in a different county (Brenner and Hall, 2007). The radiologists of the larger hospital have less charge compared to what Dr. A and his group charges. The proposal has been described by Dr. A as having disadvantages to the medical center’s administrations. The administration is response accused Dr. A being motivated by his own financial self interest for his stand. Dr. A also ensures that disclosure of imaging results in disclosure being done with consent of the patient. The consent that Dr. A takes are generally explicit with active agreement, although sometimes agreement is done orally. Commentary

The academic practice in a different county may have the offering of a greater value compared to the local radiologists. If the hospital is a large one, it can deliver diagnostic expertise that is more specialized in the pediatric, musculoskeletal, and neurological imaging compared to small community practice (Berlin, 2003). The larger hospital may also have the ability of offering the after-hours service that is superior in the form of provision of interpretations within minutes of the completion of the exam. This would be difficult for the small medical center to match. The local radiology group, on the other hand, may have some advantages such as better knowing of the patients and to refer physicians and the community at large (Beauchamp and Childress, 2012). Moreover, community radiologists can serve the patients more effectively due to their better understanding of the local health care environment. With regards to confidentiality and informed consent of the patient, if the patient expresses consent for disclosure, there is relief on the part of the doctor from the duty of confidence (Berlin, 2007). The explicit consent is preferred as it is without doubt with respect to the agreement and it has requirement to share more sensitive data. However, there must be necessary capacity of the patient for consenting, which means balancing, retaining, and understanding the information and also communicating their decision. In the setting of the critical care, this can be a challenge when there is sedation of the patients or they have suffering disease processes that affect their conscious level. The patient’s consent given disclosures are not really breaches that provide consent that is freely given and fully informed. Ideally, patients should be voluntarily disclosing information or having beforehand disclosure information and where there is obtainment of practicable consent (Gallagher et al., 2007).

Promoting professional healthcare practice

At H Medical Center, all patients are seen by the radiographers for consultations before an intervention. The compliance is also done with the governmental payor rules and in doing so the consultations are not performed on the tests that have been ordered on the basis of another physician’s decision. In this medical center, it is the post intervention that all patients are seen. These patients become the medical center’s part in practice and all their disease processes are managed by the H Medical Center with the patients’ primary physicians (Chopra et al., 2005). In the follow up regime, all patients are placed. H Medical Center has started to treat with endografts for the superficial femoral artery disease and for the surgeons it has become a very intense competition. Dr. A’s group has been an all interventional radiology group without much of diagnostic radiology.

While there is frequent existence of time pressures and creating barrier, the workforce of radiography at H Medical center can contribute in the areas of health education and health promotion. As Health professionals, radiographers are responsible in recognizing opportunities pertaining to health promotion, arising in the time of their clinical practice, although their view are often taken by the radiographers that their job is primarily concerning treatment of illness or the diagnosis and therefore, the health promotion is the domain of someone else’s (Castle and Reeves 1998). The radiography degree can be benchmarked as identifying requirement in demonstrating the way diagnostic radiographers in H Medical Center can support and influence health education and health promotion among their clients (D’Orsi et al., 2005). In this context, it is important for H Medical Center and Dr. A and his team to educate the general public regarding the benefits and the risks of diagnostic imaging examinations so as making the clients and the patients for giving informed consent and informed judgments about for their examinations.

Meeting needs of the vulnerable groups including safeguarding

Ms D, 57 year old lady having in her breast has a history of suspicious nodes. The nodes had been removed surgically eight years ago at a small hospital in Wales. However, in 2015, there was re-appearance of new nodes having the potential of being cancerous and her doctor recommended a stereotactic biopsy (Department of Health, 1998). However, the problem arose when Ms. D found that the hospital in Wales she visited did not have the equipment in performing the test and there have been a long wait for surgery in the hospital. She then approached some private healthcare centers; but their charges had been unaffordable to Ms. D as she did not have private health insurance. She felt abandoned and have been at the receiving end of a problem that could not left untreated any longer. Then she approached D. A in H Medical Center, who took personal responsibility to give her the opportunity of the free radiology imaging services that H Medical Center offers to the economically backward people.

The philanthropy services that H Medical center practices has been supported by a bank based in London. A new section has been created recently with the help of its sponsors in building, operating, and staffing the new diagnostic imaging center. These sponsorships allow H Medical Center with the provision of quality diagnostic services to the patients with low income levels (Chou et al., 2007). This service of H Medical Center already has a very big positive impact on the town’s public healthcare system. It has turned out to be the game changer for many patients experiencing substantial stress while they endure long waits.

Impact of delivery of quality care including clinical governance

H Medical Center also inculcates the idea ‘learning from experience group’ (LEG) that meets regularly for the discussion of risks and taking appropriate action. This measure of H Medical Center has been running successfully under the stewardship of Dr. A. Then there was a decision that complaints would be fed into the process with the growing realization on the part of the H Medical Center’s management that there could be interlinking of the two (Eisenhardt, 1989). In this context, Dr. A has been calling occasional group meetings on reactive basis, when there has been issues raised or complaints received that failed in taking action from more than one party. However, these meetings are often informal to the extent that the discussions were almost held in a corridor. Because of the Health Bill, the onus has been put for effective and efficient services and the accountability solidly into the hands of the management of the medical centers and the clinical governance. Thus, the meetings called by Dr. A involve everyone’s horizons who realize the

opportunities that lie in the improvement of the H Medical Center’s accountability (Eisenhardt, 1989). There have been occasions when a topic is raised by one person which have already been dealt by the others, and over time those things were been identified having being dismissed previously as unimportant or ‘one offs’ that gained higher precedence as the appearance of the evidence appeared from other departments. Since the calling of the meetings by Dr. A, currently, has been in a reactive way and in the post incident scenario rather than proactively. However, the management of H Medical Center have suggested in advocating the proactive group formation in sharing knowledge that can be reducing the complaints and risks while help is provided for a safer environment to the patients and staff (Lysdahl and Hofmann, 2009). There was realization in H Medical Center in trying effectively learning, the organization needs in pulling together organizational knowledge and various systems. As a consequence to that, the clinical governance manager set up LEG in agreement to the relevant parties. Its aim has been the provision within the teaching PCT of a forum in maximizing the learning and sharing opportunities and reflection on the staff and patients’ experience in forming the issues, trends, and feedback from PALS (Patient Advice and Liaison Services), patient surveys, external events, incidents, and complaints. The people who are most appropriate in finding information about membership have been Commission for Health Improvement that has been the driver to form the group. It was also realized that here is necessity for the involvement of the patient. There has been a view in H Medical Center that it is impossibility for a single patient in having sufficient knowledge of broad depth on a variety of topics that may be arising. Therefore, the decision was taken in asking the public engagement manager in attending on the patient group’s behalf. The public engagement manager attends on the behalf of the patient group and then fed the filtered information back in protecting the identity of the individual staff members to the patient engagement group (Malone, 2008). The patient engagement group sends their feedback to the LEG through the public engagement manager. It was felt by the management of H Medical Center that there is need for the group in having influence and kudos within organization. This led to the non-executive board members agreeing to join. The H Medical Center also has risk manager and clinical governance, PALS coordinator, workforce development manager, assistant complaints manager, complaints manager, and public

engagement manager, service development facilitator and risk administrator (Malone, 2009). The clinical leads and other managers discuss specific items on ad hoc basis. Commentary The purpose of delivery of quality care and clinical governance is receiving staff, public and patient information and ensuring the sharing of the learning points across the medical center. Further, care was taken in reviewing, monitoring, and examining the patients’ issues, claims, adverse incidents, serious untoward incidents, issues from national incidents and issues raised by PALS. The issues are also referred to the relevant managers for necessary actions and further investigations. Improvement has been tried upon by the organization with regards to incidents handling and complaints across the organization that was supported by appropriate training facilities (Clinton and Obama, 2006). There is responsibility on H Medical Center to involve clinical audit group, workforce development group and public engagement group to produce from the experience report with monthly learning. The feedback is given by the organization to the staff, patients, and public regarding the way learning of teaching PCT has taken place from experiences.

Conclusion

H Medical Center follows ethical practice and complies with legal regulations in diagnostic imaging examinations in terms of ensuring informed consent for disclosures and maintaining confidentiality if consent for disclosures is not given by the patient. The philanthropy services are also practiced by H Medical center practices has been supported by a bank based in London. The radiography degree can be benchmarked as identifying requirement in demonstrating the way diagnostic radiographers in H Medical Center can support and influence health education and health promotion among their clients. Finally, the delivery of quality care and clinical governance is also carried out with the receiving of staff, public and patient information and ensuring the sharing of the learning points across the medical center.

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