Session 3: Inter-collegial relations and principles of professional ethics Flashcards
What are ethical guidelines?
Standards of conduct establishing the essence of honourable behaviour.
What are the 4 HCPSA ethical guidelines?
- The Hippocratic Oath
- International code of medical ethics
- Declaration of Geneva
- Credo
What are the 2 broad categories of medical ethics?
- Interests of the patient
2. Mutual relations between colleagues
What 6 things does the HPCSA expect from doctors?
- Sufficient evaluation of the patient
- Applicable and special examinations
- Sufficient and correct acts, e.g notes, correct use of resources
- Refer when indicated
- Knowing limitations
- Being up to date
How is the present milieu structured?
- THE SYSTEM
* Little in service networking, thus little comprehension of conditions
* Little in-service training because of compartmentalization (lack of support by senior colleagues) - PARADIGM SHIFT
* Team approach vs. paternalism
* Pressure on all compartments- everyone protects their own wickets
* Effect of top management
- poor leadership in Dept. of Health,
- centralized decision-making
- racial basis for appointments and actions
- financial policies and budgetary focus
- restrictions
- rationalizations
* Services
- limited capability to manage numbers
- numbers overload
- down referrals to lower levels demand
- aggression of patients
- burnout and demotivation
- limitation of beds
- transport system
- limitations on special investigations
* Academic
- less than optimal relations - PERSONAL
* Highly selected, younger and inexperienced doctors
* Personality and cultural differences
* Communication styles differ, resulting in gaps
- ineffective call systems
- unfair/unrealistic expectations
- disrespect at all levels
- professional immaturity
- lack of integrity
- role confusion
* HIV impact
* Incapable, unwilling & absent support personnel
* Limiting rules and regulations, e.g rules sonar, scans, repeat prescriptions, cholesterol, etc.
Name and describe the 2 professional roles.
- THE GENERAL PRACTITIONER/ FAMILY DOCTOR
* Coordinates the patient’s total medical care system and the
access to all the other compartments of the system - THE CONSULTANT/ SPECIALIST
* Focuses on a specific aspect of health care
* Starting point of specialized care
* Specialised care is mostly a once-ff & for specific reasons
Name and describe the 3 types of inter-collegial relationships in health care.
- Between colleagues of the same discipline
* partners, associates, assistants, locums, and opposition - Between a GP and specialist
* can be positive, neutral, or negative - Between members of allied professions and the above
* may include non-medical, alternative professions e.g nurses,
physios, OT, clinical psychology, dietitians, social work,
pastoral care, dentist, etc.
Name 5 factors that positively affect relationships between colleagues.
- Professional maturity
- Attitude, friendship, non-selfishness
- Common approach to problem-solving
- Willingness to learn
- Respect fosters respect
Name 5 factors that negatively affect relationships between colleagues.
- Perceived difference in status
- Cultural and language differences
- Perceptions
- Misconception of roles
- Communication problems
- poor referrals
- poor feedback
- referrals too late
- competition
- bad mouthing
Discuss inter-professional communication.
- Good referrals and the correctness of the entire process rely
on effective communication between colleagues. - Healthy communication is direct, immediate, healthily
assertive, and clear.
What does referring mean?
Transferring part of, or all of the responsibilities for a patient’s care, usually temporarily and for a specific indication.
*effective communication
What is peer review?
Method> improve the quality of care> evaluation of medical care> practitioners from comparable practicing environments and comparably trained.
What is external peer review?
- Evaluation of medical practice by external evaluators on grounds of complaints received.
- Starts w/ preliminary investigation
- Formal investigation follows if necessary.
What is whistle-blowing?
The necessary reporting of doctors whose practice is below acceptable standards.
- Disclosures Act provides protection
- Impairment (when the problem is noted)
What are the 2 aspects of supersession?
- Unacceptable taking over of a patient who’s still under the care of another practitioner
- Unacceptable hindering of a patient to obtain a 2nd opinion
What are the two aspects of bad-mouthing?
- Verbal
2. Suggestion or reflection
What is consent?
A requirement for administering any form of treatment, whether diagnostic or therapeutic
- Patient has a right to self-determination
- It is up to the Dr to decide whether a minor can now give consent
What are the 5 key requirements for consent?
- Willing
- Explicit
- Specific reasons
- Not against good morals
- Accountable patient
Discuss the guidelines to follow for consent.
- 10+ years= consent to treatment
- 12+ years= consent to operations
- If underage, the father’s decision is decisive if parents are split.
- Mentally disabled: curator, spouse, adult child, brother or sister
- Spouses can consent independently
When is consent valid?
When based on necessary knowledge in respect of the nature+ effect of the proposed treament.
Name and discuss the 4 key elements of informed consent.
- Disclosure of information- info generally required by a patient
- Comprehension of the information- intellect and effective communication
- Willing consent- selecting own objectives from a variety of options
- Juristic capacity- ability to come to a conclusion based on rational grounds
What does confidentiality entail?
- In secret, may not be repeated
- Divulging any information about a patient w/o consent
- All identifiable information regarding a patient, their condition,
diagnosis, prognosis, treatment, etc, must be kept
confidential EVEN AFTER THE DEATH OF THE PATIENT-
Otherwise it’s a violation of their right to privacy. - Confidentiality may only be disclosed w/ permission
- Exceptions: court; public interest
Examples of confidentiality breaching situations.
- Ward rounds
- Lay-out of the practice waiting area
- Certificates
- Typists
- Visibility of computers
- Telephonically - identity and issues must be established
- Tea room
- W/ consent: court, 2nd opinion, colleague, the interest of the patient, duty towards the community
List the 4 acceptable forms of business practices.
- Solus practice
- Partnerships
- Associations
- Incorporated practices
Unacceptable forms of business practices.
- A non-medical person may not own a medical practice
- Franchises
- Managed health care(dr must not be pressurized into doing/ not doing certain things)
Name the 4 solutions to apply when ethical rules are transgressed.
- Re-establish the basic ethical principles
- Peer review + whistle-blowing
- Principles of good communication
- Policies and guidelines must be clear
