3. 10 Important Ethical Issues in
Private Health Care Services
Acceptance of patients to their services ?
Health insurance ?
Financial Ethical issues between providers ?
Patients and Family rights ?
Health care providers professionalism ?
Maintaining confidentiality ?
Why patients need private Sectors ?
Ethical Issues During Medical Consultation ?
Ethical Issues Related to other Medical Services ?
Emergency Cases ?
6. Professionalism
Professionalism
It is a collection of behaviours that include
multiple dimensions of the clinical context. It
involves relation of the physician with hir/her
oneself, relation with colleagues in the
workplace, relation with the patients, and
relation with the community.
7. How Are You Judged As A
Professional?
– Your Communication and Relations
– Your Image and Appearance
– Your Competence
– Your characters
– Your Appearance
– Your Behavior
– Your Attitude
– Your commitment
7
8. (
للعالمين رحمة إال أرسلناك وما
)
We have sent you not but as a Mercy for the Worlds
1-Religion;
2-Mind;
3-Soul (self);
4- Wealth; &
5- Progeny.
10. وأنظمتها المهنة أخالقيات
أخالقيات
المهنة
(code of Ethics )
:
هي
توجيهات
مستمدة
من
القيم
والمبادئ
تعنى
بكيفية
التصر
ف
الالئق
أثناء
ممارسة
األنشطة
المهنية
المختلفة
.
Are guidelines derived from values and principles
intended for the appropriate behavior while practicing
various professional activates
أما
أنظمة
المهنة
(code of conduct )
:
فهي
مجموعة
من
القواعد
والتشريعات
التي
تنظم
عمل
الممارسين
للمهنة
ويترتب
على
انتهاكها
عقوبات
،
فهي
نوع
من
القوانين
.
Are set of rules and legislations that regulate the work
of practitioners ,the violation of which imposes
consequent penalties they are kind of law.
13. Before we start …. Is our
patients our priorities ?
Patient
Doctor
Lab./X-
ray
Social
worker
Nurse
Manager
Educator
Doctors Are NOT the focus of the healthcare
14. Our Duties Towards Patients
Respect for Patient المريض احترام
Respect for Privacy المريض خصوصية ضمان
Comprehensive care للمريض الشاملة الرعاية
Respect for patient’s autonomy المريض استقاللية احترام
Inform the patient about his/her condition
لزم اذا وذويه وتثقيفه مرضه بطبيعة المريض تبصير
Protect patient's interests المريض مصلحة حماية
Keep the patients’ secrets المريض سر كتمان
Source: Islamic Code of Medical & Health Ethics
15.
16.
17. Privacy vs. Confidentiality
Privacy
About people
Sense of being in
control of access
that others have to
ourselves
A Right to be
Protected
Respect patient Body
Confidentiality
Extension of privacy
About identifiable data
Agreement about
maintenance and who
has access to
identifiable data
protects patients from
inappropriate disclosures
of ( Health Information)
18. -when األسرار تفشى متى
؟
Patients care المريض رعاية غرض
Teaching purpose التعليم لغرض
Medical Research العلمي البحث لغرض
Medical Fitness الطبية اللياقة
For patients Family العائلة ألفراد
21. ETHICS DURING CONSULTATION
as Example of Patient Rights
-
تجنب
التعالي
على
المريض
مهما
كان
مستواه
العلمي
أو
االجت
ماعي
.
حسن
االستقبال
والتبسم
واحترام
الكبير
ورحمة
الصغير
- To avoid sense of arrogance
and superiority, or down look
upon, mock or ridicule the
patient irrespective of his
educational or social status .
24. المرض تاريخ أخذ أثناء المريض معاملة حسن
:
(HISTORY(
-
احترام
وجهة
نظر
المريض
,
خاصة
في
األمور
التي
تتعلق
ب
ه
شخصيا
وال
يمنع
ذلك
من
توجيه
المريض
التوجيه
المن
اسب
.
- to respect patient’s point of view especially in
respect of personal matters, but that does not
mean to properly direct or advice him.
25. عليه الطبي الفحص أثناء المريض معاملة حسن
:
(physical examination)
-
الرفق
بالمريض
عند
الفحص
وأخذ
أذن
ه
،
وعدم
الفحص
على
مناطق
في
جسمه
لي
س
لها
حاجة
للفحص
عليها
.
- to gently conduct medical
examination on the patient,
take his permission and
explain what you will do .
28. والتشخيصية الطبية الفحوصات طلب
(Investigation)
-
إجراء
الفحوصات
الطبية
الالزمة
فقط
للمريض
.
-
وعدم
إضافة
فحوصات
ال
تطلبها
حالته
الصحية
.
To perform or request only the
necessary medical or laboratory tests
which the patient’s condition requires,
without requesting any additional
unnecessary tests.
30. التشخيص أثناء المريض معاملة حسن
(Diagnosis)
-
و عمليا تشخيصا مريضه يشخص أن الطبيب على يجب
وأن دقيقا
ومرض تشخيصه المريض يتفهم لكي ذلك للمريض يشرح
وال ه
نادره حاالت في اال التشخيص المريض على يخفي
.
Physician should tell the patients about his
case and diagnosis and there Disease
31. التشخيص أثناء المريض معاملة حسن
(Diagnosis)
-
تحري
الصدق
في
إخبار
المريض
أو
من
ينوب
عن
ه
بالحالة
المرضية
وأسبابها
ومضاعفاتها
,
وفائد
ة
االجراءات
التشخيصية
والعالجية
,
وتعريفهم
ب
البدائل
المناسبة
للتشخيص
أو
للعالج
بأسلوب
واضح
.
2-To be honest by informing the patient or his
guardian about the actual condition of his disease,
the causes of such disease, complications, and the
benefits of diagnostic or therapeutic procedures.
32.
33. العالج أثناء المريض معاملة حسن
(Treatment)
-
االقتصار
في
وصف
الدواء
أوالعالج
أو
إجراء
العمليات
الجراحية
على
ما
تتط
لبه
حالة
المريض
فقط
.
- To prescribe only the medicine, or perform the
surgical operation which the patient’s
condition requires only.
34. العالج أثناء المريض معاملة حسن
(Treatment, Education)
-
تثقيف
المريض
عن
مرضه
خصوصا
وصحته
عموما
,
ووقاي
ته
من
األمراض
بالطرق
المناسبة
والفعالة
,
ومن
أهمها
التثقيف
المب
اشر
وجها
لوجه
أو
استخدام
الوسائل
الفعالة
األخرى
متى
توفرت
له
.
- To educate the patient about his disease, and
about his health condition in general,
explaining the appropriate and effective
ways by which he could preserve his health
and protect himself against diseases.
35. العالج أثناء المريض معاملة حسن
:
(Treatment)
تخفيف
آالم
المريض
بكل
ما
يستطيعه
وما
يتاح
له
من
وسائ
ل
عالجية
نفسية
ومادية
,
وإشعار
المريض
بحرصه
على
العناية
به
ور
عايته
.
- Try to do the best to relieve the patient’s sufferings
using all possible psychological, social and medical
thereby causing the patient to be in good concern.
36. العالج أثناء المريض معاملة حسن
:
(Treatment)
-
بم المتعلقة الشرعية المخالفات بعض منه لوحظ إذا المريض نصح
من رضه
يك أن قبل مسلمة هي الطبيبة أو مسلم هو الطبيب ألن الطبيب قبل
طبيب ون
طبيبة تكون أو
(.
والكحول االدمان
)
Educate your patient about his disease and any other
issues related to his life related to his disease
37.
38. حالته متابعة أثناء المريض معاملة حسن
:
(Follow up)
-
االستمرار
في
تقديم
الرعاية
الطبية
المناسبة
للمر
ضى
المصابين
بأمراض
غير
قابلة
للعالج
أو
مستعصي
ة
أو
مميتة
حتى
في
اللحظات
األخيرة
من
حياتهم
.
- to continue providing the appropriate medical
care for those patients suffering from chronic
untreatable, or incurable, or even fatal
(terminal) diseases, until the last moments of
their lives.
39. حالته متابعة أثناء المريض معاملة حسن
:
(Follow up)
-
التأكد
من
أن
المريض
يتلقى
العناية
الطبي
ة
الالزمة
أثناء
غياب
الطبيب
.
2 - to make sure that the patient receives the
necessary medical care during the absence of
the physician.
40. إحالته أثناء المريض معاملة حسن
:
(Patient Referral)
-
إحالة
المريض
إلى
طبيب
مختص
بنوع
مرضه
أو
إلى
طبيب
لديه
وس
ائل
أكثر
فعالية
إذا
استدعت
حالة
المريض
ذلك
,
وال
يجوز
للطبيب
أن
ي
تباطأ
في
اإلحالة
متى
ما
كان
ذلك
في
مصلحة
المريض
.
- to refer the patient to the physician
specialized in the type of his disease, or to
the physician who has more advanced and
effective means if the condition of the
patient so requires.
41. إحالته أثناء المريض معاملة حسن
(Patient Referral)
-
عند
رغبة
المريض
في
استشارة
طبيب
آخر
(
فيما
يخص
مرضه
)
,
فعلى
الطبيب
أال
يمتنع
عن
تحقيق
رغبة
المري
ض
,
وأن
يسهل
على
المريض
الحصول
على
التقارير
والمعلومات
ال
الزمة
لذلك
.
- when a patient wishes to consult another
physician (in respect of the condition of
his disease), the physician should not
refuse Patient Right.
42. الطبية للتقارير طلبه عند المريض معاملة حسن
(Medical Report)
-
إدراك
أن
للمريض
الحق
في
أن
يغير
طبيبه
,
وأن
ل
ه
الحق
في
الحصول
على
المعلومات
المدونة
بسجل
ه
الطبي
أو
الحصول
على
التقرير
الطبي
الالزم
ا
لذي
يشرح
حالته
المرضية
.
- to realize the fact that the patient is entitled for the
right of consulting another physician, and also for
the right of obtaining the recorded information in
his medical record or the necessary medical
report describing the condition of his disease.
43. حالته متابعة أثناء المريض معاملة حسن
:
(Follow up)
-
االستمرار
في
تقديم
العالج
الالزم
للمريض
في
الح
االت
اإلسعافية
حتى
تزول
الحاجة
إليه
أو
حتى
تنتقل
ر
عايته
إلى
طبيب
كفء
.
- (in emergency unit) to continuously
provide the necessary treatment for
emergency cases until necessary
emergency medical aid from his part
until the patient is referred to the care
of another specialized physician.
45. Outline and Introduction
Examples of financial issues in
clinical practice in private sectors:
A- Healthcare Practitioner’s Fee
B- Practicing in Private Sector
C- Advertisements and Publicity
D- Participation in the Media
E- Gifts and Benefits
F- Relationships with Pharmaceutical and
Medical Equipment Companies
G- Other issues
46. Brainstorming…
Is it okay for doctor s
to:
– Think about money?
– Talk about money?
– Work for money?
47. We deal with money in
Health practice
We get paid (fees/salary and other payments)
More than one practice
Participation in advertisements
Paid media appearances
We may receive gifts
48. Legal guidance on doctor ’s
Financial fees
Article 10 of the Law of Practicing Healthcare
Professions states that,
“A healthcare professional is prohibited from
advertising or promoting himself, directly or
indirectly, except in cases provided for in the
Implementing Regulations.”
The concept of the ‘fee of the similar’
(المثل )أجرة represents the fees that would have
been paid to a similar doctor with similar
qualifications in the same conditions.
49. (A) Healthcare Practitioner’s Fee
1- The doctor is allowed to take fair fees (determined
by the responsible authority or by following ongoing
customs .
2- It is not permissible to exaggerate in the set fees, or
abuse the patient’s condition to achieve material or
moral benefit.
3- It is not permissible to coerce the patient to obtain
additional money on top of the fees for him or for
someone else.
50. (A) Healthcare Practitioner’s Fee
4- It is not permissible to expose the patient to investigations or medical
procedures without a clear medical indication.
فقط التكسب اجل من يحتاجها ال فحوصات عمل المريض على التعرض
5- Doctors are prohibited to take or give financial when referring a
patient to somewhere else, or for prescribing medications or medical
equipment or others.
المرضى تحويل على عمولة اخذ الطبيب على يمنع
6- The doctor should disclose to the institution any financial or
commercial relations that the doctor or his family members have with the
institution(s) .
تجاريه عالقة أي عن االفصاح الطبيب على
المعدات أو االدوية بشركات اسرته الفراد أو له
51. (B) Practicing in Private Sector
the doctor should not under any circumstance
give priority to his personal interests,
financially or socially, above the interests of
the patient.
The patient or the (walk-in) visitors should be
informed about the estimated fees for the
healthcare before initiating the provision of
service.
52. (C) Participation in the Media
When talking to the media the doctor should:
1- Refrain ( عن اإلمتناع ) from advertising himself or his
working place.
2- Tell his professional status or scientific degree along
with his area of medical specialization.
3- Refrain عن اإلمتناع
) ) from praising his expertise and
achievements
4- Be considerate of the responsibility to provide medical
information that is professionally authentic and
acceptable.
54. Gifts and Benefits
A Health care providers GIFT is :
anything that could be given to the doctor from individuals or
( companies )enterprises or others on top of his pre-
determined fees (salary) at his work place, with the intention
of achieving unjustified benefits.
These benefits include but are not limited to:
– financial payments .
– Free Travel and trip for conferences .
– Any-kind of benefits .
– morale like obtaining services, facilities, hospitality, food,
training services, loans, or compensation, etc.
55. Gifts and Benefits
Individuals’ gifts
1- Any form of bribe should not be taken or given in any form, regardless
whether they were cheap or expensive.
2- Any form of expensive in-kind gifts should not be accepted.
Inexpensive gifts ( if it is not personally ) that people usually exchange
among themselves as an expression of passion and cordiality can be
accepted, ( if it will be not affect his or her decisions like:
– Pens
– Scientific books
– Medical journals
– Simple food
56. Gifts and Benefits
Corporate gifts ( Should be officially only
through your Institution ).
1- It is not permissible personally for Health care
providers to accept or give bribes
2- It is not permissible for the doctor to accept gifts,
loans, equipment, instruments, or cash from the
commercial companies for whatever justification.
3- Medical Institutions can accept educational grants
and financial support to attend training courses,
conferences, or other activities of public interests.
58. Conditions for Practicing in
Private Sector
If the system permits the doctor to work in the
private sector, in addition to his work in the public
sector, the following should be observed:
1- his work in the private sector does not affect his
governmental work.
2- This work should be officially through his original
work .
3- his work in the public sector should NOT be used
as means/bridge to his private work
59. Conditions for Practicing in
Private Sector
If the system permits the doctor to work in the
private sector, in addition to his work in the public
sector, the following should be observed:
4- When referring a patient from the private sector to
the governmental (public) health facility for which the
doctor works; the doctor should not discriminate this
patient from other patients in terms of appointments, or
provision of care.
5- patients Rights should be always priorities .