Importance Questions: Strategy

Importance questions present a different challenge from appropriateness questions. Instead of rating actions, you rate considerations — factors that should (or should not) influence a decision. This lesson provides a strategy for consistently rating considerations correctly.

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How Importance Questions Differ from Appropriateness Questions

Feature	Appropriateness	Importance
You are rating	Actions (things to do)	Considerations (factors to think about)
The scale	Very appropriate → Very inappropriate	Very important → Not important at all
What you are assessing	Whether the action is professionally correct	Whether the factor should influence the decision
Key question	"Should you do this?"	"Should this affect your decision?"

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The Rating Scale for Importance

"Very Important"

This consideration is essential and must be taken into account. Ignoring it would be negligent, dangerous, or unprofessional.

Characteristics of "very important" considerations:

• Directly related to patient safety
• A legal or professional obligation (e.g., confidentiality, consent)
• Involves core ethical principles (autonomy, non-maleficence)
• Would significantly change the decision if ignored

Examples:

• Whether the patient has given informed consent (very important for any procedure)
• Whether the proposed treatment could interact with the patient's current medications
• Whether a patient has capacity to make the decision in question
• Whether the action puts patients at risk

"Important"

This consideration is significant and should be factored in, but it is not the most critical element.

Characteristics of "important" considerations:

• Relates to quality of care but not immediate safety
• Involves practical implications that affect the outcome
• Concerns professional values like teamwork, communication, or patient dignity
• Would improve the decision if considered, but the decision could still be reasonable without it

Examples:

• Whether the patient has family members who should be informed (with consent)
• Whether a colleague has relevant expertise that could be consulted
• Whether the timing of a conversation is appropriate (e.g., not during a busy emergency)
• The impact on team morale of a particular decision

"Of Minor Importance"

This consideration has some relevance but should not heavily influence the decision.

Characteristics of "of minor importance" considerations:

• Relates to convenience or efficiency rather than quality or safety
• Is peripheral to the core issue
• May be context-dependent — relevant in some situations but not this one
• Would not significantly change the decision either way

Examples:

• Whether the action is convenient for you personally
• Whether it is nearly the end of your shift
• Whether you have a personal relationship with the person involved (unless it creates a conflict of interest)
• Whether the action will take a lot of your time (when patient welfare is at stake)

"Not Important at All"

This consideration is irrelevant to the decision and should not factor in.

Characteristics of "not important at all" considerations:

• Has no bearing on patient safety, ethics, or professional standards
• May introduce bias if considered (e.g., the patient's social status, personal appearance)
• Is a distractor — it sounds relevant but is not
• Considering it would be unprofessional or discriminatory

Examples:

• The patient's socioeconomic background when deciding treatment priority
• Whether you personally like or dislike the colleague involved
• The patient's appearance or lifestyle choices (unless clinically relevant)
• Whether the situation will make you popular or unpopular with colleagues
• Your personal career advancement

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The Hierarchy of Considerations

When rating importance, use this hierarchy (most important first):

Tier 1: Patient Safety (Almost Always "Very Important")

• Risk of harm to the patient
• Risk of harm to others
• Medication safety
• Infection control
• Safeguarding concerns

Tier 2: Legal and Professional Obligations (Usually "Very Important")

• Patient consent and capacity
• Confidentiality
• Duty of candour
• Professional guidelines (GMC, NMC)
• Legal requirements

Tier 3: Ethical Principles (Usually "Very Important" or "Important")

• Patient autonomy
• Beneficence (acting in the patient's best interest)
• Justice (fairness, non-discrimination)
• Patient dignity and respect

Tier 4: Quality of Care and Communication (Usually "Important")

• Continuity of care
• Effective communication within the team
• Patient and family preferences
• Quality of the therapeutic relationship
• Impact on learning and professional development

Tier 5: Practical and Logistical Factors (Usually "Of Minor Importance")

• Time constraints
• Resource availability
• Workload implications
• Convenience

Tier 6: Personal and Irrelevant Factors (Usually "Not Important at All")

• Personal feelings about the people involved
• Social status or background of the patient
• Popularity or personal advancement
• Aesthetic or superficial factors

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The "What Would a Responsible FY1 Do?" Test

FY1 (Foundation Year 1) doctors are newly qualified and represent the baseline of professional competence. When rating importance, ask: "Would a responsible FY1 doctor consider this factor when making this decision?"

• If a responsible FY1 would definitely consider it → "Very important" or "Important"
• If a responsible FY1 might consider it → "Important" or "Of minor importance"
• If a responsible FY1 would not consider it → "Not important at all"