Medical career Flashcards
What does professionalism encompass?
There are different domains in medical professionalism and these are delivered as commitments which correlate with the attributes described in the GMC’s Good Medical Practice:
Honesty
Confidentiality
Maintaining appropriate relationships and trust
Improving quality of care and access to care
Fair distribution of finite resources
Scientific knowledge
Competence and professional duties
Is professionalism a fixed concept?
The underlying principles of professionalism are dynamic, reflecting the changing role and responsibilities of doctors today and the shifts in public expectations and attitudes towards them.
In a society where doctors are increasingly mistrusted for a variety of reasons, professionalism is threatened and the stakes are ever higher for poor practice.
A remarkable difficulty in assessing and determining medical professionalism, is the lack of a comprehensive description or definition.
What is honesty and does it mean that doctors should tell their patients everything?
It is the transparency that doctors display to patients; this plays a role in informed consent. This does not mean patients should be informed about every possible side effect of a treatment. For example, a side effect with a 0.001% chance might be deemed negligible but above 5% is significant.
What about when a medical error occurs?
Should we be honest when a medical error occurs?
When approaching errors, you should be open, honest and timely. Doctors are human and medical errors do occur. When errors do occur, patients should be told immediately, with an apology and information about how to report the error if they wish to do so.
The patient should be given support and compensation and the doctors involved should reflect upon the error to ensure it doesn’t happen again in the future.
However, there are many views on how medical errors should be handled; some believe that trivial and non-harmful errors do not need to be disclosed to patients.
Needless to say this is a sensitive topic in medical ethics. However, the policy on disclosing harmful errors is non-negotiable. All hospitals have set procedures in dealing with such errors.
What is confidentiality and why is it important?
Confidentiality is the right of a patient to have personal, identifiable medical information kept private unless approval is given for it to be shared. Patient data should not leave the hospital environment except with the said patient and confidentiality should be observed even while dealing with persons acting on a patient’s behalf.
Confidentiality is key to delivering the best possible care as patients will more likely provide accurate and substantial information if there is no risk of public exposure. The commitment to confidentiality extends to all healthcare professionals involved in the care of a patient, including medical students.
When are doctors allowed to break confidentiality?
The only situation where it is ethical and legal for a doctor to breach confidentiality is when the patient poses a threat to others or society or when required to do so by law. In the former case, the bar must be set very high and the doctor should explore the reasons why confidentiality has to be broken and inform the patient of their intention to breach confidentiality.
How do doctors make patients aware of their right to confidentiality?
Discussions about confidentiality should occur at the start of any conversation in which the patient could potentially disclose information.
This involves telling the patient about the manner in which the information given will be handled, for example, “whatever you tell me today will not be shared with anyone except the people currently in charge of your care, you are able to withdraw your consent at any point during this conversation”.
How do doctors Maintain appropriate relationships and trust
The doctor-patient relationship of mutual respect is represented by the recognition of the patient’s vulnerability and dependency in the partnership that has been embarked on.
It is imperative that one does not exploit this relationship for sexual advantage, financial gain or any other personal goals.
Do doctors have to declare conflicts of interests?
There are various opportunities that may arise for a doctor which can interfere with their professional duty to the patient and potentially break trust while leading to personal gain for the doctor. These most commonly manifest in dealing with industries, big pharma and insurance companies.
Just as scientists are obliged to, doctors have a responsibility to disclose any potential conflicts of interest that might arise during dealings with patients.
How is the quality of care assessed?
The quality of medical care is assessed against patient-oriented outcomes; a satisfactory standard of care can be attained by sustaining clinical competence and making efforts to increase patient safety. The WHO Surgical Safety Checklist has been a success, setting a precedent for measures to ensure patient safety, and improving health outcomes
What is a clinical audit and what does it involve?
A clinical audit is a quality improvement cycle that involves measurement of the effectiveness of health care against agreed and proven standards for high quality, subsequently reflecting on the results and taking action to bring practice in line with these standards to improve the quality of care and health outcomes.
Audits go through a cycle that consists of: initiation; setting the standards to be measured against and measuring current performance; comparing with previously set standards; putting improvement strategies in place to implement change; and re-auditing after a set time to see if there has been an improvement.
how do doctors distribute finite resocurces?
Because the NHS has limited funds and resources, doctors play an interesting role of being managers and clinicians as employees one the one hand, and advocates of patients on the other. It falls upon the doctor to manage these resources and distribute them to the patient population in a just manner.
The medical profession is required to promote justice in health care and this includes fair distribution of health care resources while keeping in mind the available resources and making cost-effective decisions.
How does doctors distributing finite resocurces responsibility translate into everyday practice?
This translates into everyday practice as the avoidance of unnecessary procedures and tests; this is a skill that relies on clinical acumen and emphasises the importance of clinical competence.
It protects the patients from exposure to avoidable harm, such as unnecessary radiation from X-rays and ensures that the resources are preserved for cases that are justifiable and more urgent.
Do doctors need to be scierntific researchers?
Commitment to scientific knowledge does not necessarily mean involvement with research, but it does involve the ability to apply knowledge gained from discoveries for the benefit of the patient. This is known as translational medicine in which scientific parameters are translated into clinical tools.
Surely doctors are not expected to remember every single thing about medicine?
Although it is essential to keep up to date with the body of knowledge, the interpretation of engagement with and awareness of uncertainty of knowledge is more valuable than the holding of knowledge.
Another facet to knowledge is ensuring one follows guidelines as set out by NICE or other relevant bodies. This ensures that the care given to patients is evidence-based and the best proven practice.
