WEEK3: Professional Boundaries

Question 1

What are professional boundaries as a healthcare professional?

Answer 1

• effective and appropriate interaction between professionals and the public they serve.
• Boundaries exist to protect both the professional and the client.
• Boundary violations harm the patient and the professional.
• The ramifications are widespread.
• Damage usually extends to marriages, families, other patients, communities, clinics, institutions, and the profession in general.

Question 2

What is duty of care?

Answer 2

• all patients entitled to good standard of practice and care from doctors
  NEED:
• professional competence
• good relationships with patients and colleagues
• observance of professional ethical obligations

Question 3

What should doctors NOT do?

Answer 3

• treat themselves, or family or friends

Question 4

What are the statistics of how doctors self medicate?

Answer 4

• only 50% doctors have a GP
• 90% doctors happy to manage their own acute conditions
• 25% are happy to manage chronic conditions
• 25% self medicate
• 50% order diagnostic investigations on themselves
• 70% are embarrassed to attend another doctor
• 87% were reluctant to consult for psychiatric problems

Question 5

Why shouldn’t doctors treat themselves, colleagues, family members etc?

Answer 5

• inappropriate consulting style – e.g. corridor consulting.
• Doctors present with higher rates of depression, suicide and substance abuse = leading to poor patient care
• The family relationship and context= deter information disclosure or people act inappropriate
• Family should be registered with different GP to allow for objectivity and reduced conflict of interests.
• 70% are embarrassed to attend another doctor
• 87% were reluctant to consult for psychiatric problems

Question 6

What is whistle blowing?

Answer 6

• You must protect patients from risk of harm posed by another colleague’s conduct, performance or health. o

Question 7

What do you do if another doctor is underperforming?

Answer 7

• speak to them to see if they are unwell and should consult a doctor
• get management involved bc this is hard to do alone
• Be supportive
• be mindful of how health issues of this person are impacting performance
• an illness related underperformance- can manage with sickleave until recovery

Question 8

What does the GMC do about someone underperforming?

Answer 8

• GMC ‘act quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practice‘
• first notify bodies at work
• then notify GMC or professional bodies

Question 9

When should the GMC act?

Answer 9

• Dr has made serious mistakes in diagnosis or treatment
• not examined patients properly
• misused information about patients
• treated patients without properly obtaining their consent
• behaved dishonestly in financial matters, or in dealing with patients, or research
• made sexual advances towards patients
• misused alcohol or drugs.

Question 10

Should you accept gifts from patients?

Answer 10

• Dealing with amorous patients ineffectively can damage the doctor patient relationship
• can lead to unprofessional practice
• Get support from colleagues, suggest patient consults a different doctor, involve the defence organisation and the police if necessary.

Question 11

Can doctors have sex with their patients?

Answer 11

• no emotional relationship with patient

- Sexual relationships are considered an abuse of power and serious malpractice

Question 12

How should personal health be addressed by doctors?

Answer 12

• must be registered with a GP outside of your family
• have appropriate vaccinations
• must consult a qualified colleague if you suspect you have a serious illness.

Question 13

What is the practioner health programme?

Answer 13

• For doctors and dentists in London with mental, physical health, or addiction problems which may be affecting their work.
• Confidential.
• GMC not involved if there is considered to be no risk to patients

Question 14

What is probity?

Answer 14

• strong moral principles, honesty etc.
• must act with beneficence
• must not allow any of your personal interests alter a course of treatment (e.g. if you are receiving gifts from a drug company it does not mean that you will advertise that drug)
  = but if you do then you must make the patient aware of this involvement x

Question 15

How should a patient break bad news?

Answer 15

• answer patient’s agenda
• empathy
• no jargon
• dont exclude patient

Question 16

What do drug companies do to doctors?

Answer 16

• Companies act to have their drugs added to the prescription activity of the doctor through meeting representatives of that company
• free meals
• funding for travelling to conferences or research.

Question 17

What influence can the gifts given by drug companies have on doctors?

Answer 17

• gifts cost money (like other advertising)
• influence behaviour
• create obligation
• create sense of entitlement
• erode professional values
• demean profession
• companies use sophisticated manipulation and set diff agendas to doctors