2/2 think. The disadvantage is some people get the thinking wrong. The other approach - 'imposition of the well-thought-out-from-above' - has the problem that it doesn't encourage local people to question the correctness what is being imposed. Tricky!
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Replying to @MikeStone2_EoL @KaraChrome
Taking in the consent conversation is a separate, but very valid point. My focus has been on ensuring the record of that conversation remains accurate. Local discretion has its pitfalls. This may help explain a little more. From an email exchange with DoH >pic.twitter.com/rQdhZ3iLr8
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Replying to @C7RKY @KaraChrome
The best way to try and ensure that the record of a conversation is 'accurate' is to get whichever party to the conversation did not write the record, to sign the record to confirm that it appears to be right. BMA/RCN/RC(UK) are resistant to that, however.
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Replying to @MikeStone2_EoL @KaraChrome
Not in this case, it's not. The signature doesn't make a jot of difference in mitigating the risk I'm talking about here I'm afraid - as acknowledged by CQC/NHSE/GMC. If you read the articles I linked to before, it will hopefully explain more.
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Replying to @C7RKY @KaraChrome
Ah - you are interested in 'remains' accurate?
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Replying to @MikeStone2_EoL @KaraChrome
Exactly! As opposed to the form being vulnerable to later amended, in order to try and justify any clinical action - or inaction - that was not in keeping with the consent obtained.
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Replying to @C7RKY @KaraChrome
Well - if you design a better form, you would have the problem of the entire form being substituted for a faked one. I suppose you would need to store copies of completed consent forms in a 'trusted third-party repository' as soon as the form was completed? Unlikely to happen.
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Replying to @MikeStone2_EoL @KaraChrome
3rd party not necessary. Some measures can prevent amendment, but the greatest protection comes from ensuring that the form makes it clear the pt should take their copy immediately after signing it, imho. Can't switch/amend it unnoticed, if the patient has a copy at home.
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Replying to @C7RKY @KaraChrome
Keeping a copy makes sense - but all of this (your issue) is about 'distrust' when you think about why it is necessary: distrust is a very poor foundation for good care/behaviour, especially during end-of-life at home [as I keep pointing out, in BMJ rapid responses].
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Replying to @MikeStone2_EoL @KaraChrome
1/2 You're right, this stems from being given reason to distrust, but it's also about regulation. My mother & I trusted implicitly however, as most do. And it transpires that it's possible to abuse that trust. Potentially systematically & at scale, when you look at the evidence.
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2/2 That risk is acknowledged (see image). In any regulated environment, regulators are obliged to take steps to mitigate confirmed risk. Esp one as universal as this & with such potentially serious implications in the wrong hands. That's my take... for what it's worth.pic.twitter.com/87Bw6RdsUK
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