Presentation to 4th year medical students, FOM-KFMC (Feb. 27, 2012)Ghaiath M. A. HusseinAsst. Prof., Dept. of Medical EthicsKing Fahad Medical City – Faculty of MedicineKing Saud Bin Abdul-Aziz University for Health SciencesEmail: email@example.com; firstname.lastname@example.orgOffice: 01-2889999 Ext.7588, Mob.: 0566511653
Doctor Educator GuardsManager Patient Lab./X- ray Social Paramedics worker Nurses
Ishaq ibn „Ali Al-Rahawi (9th century CE) wrote a book entitled Adab al-Tabib or „The Ethics of the Physician‟ . Al-Tabari, the chief physician in 970 A.D., described also the Islamic code of ethics in his book Fardous Al Hikma stated: “… The physician should be modest, virtuous and merciful… He should wear clean clothes, and have well- groomed hair and beard. He should not hesitate to ask forgiveness if he has made an error…. He should be forgiving and never seek revenge…. He ought not loose his temper when his patient keeps asking questions, but should answer gently and compassionately… He should treat alike the rich and the poor, the master and the servant …. He should be punctual and reliable…He should be decent towards women and should not divulge the secrets of his patients… He should speak well of his colleagues….He should not honor himself by shaming others…. “
“I swear by God ...The Great .. To regard God in carrying out my profession; To protect human life in all stages and under all circumstances, doing my utmost to rescue it from death, malady, pain and anxiety; To keep peoples dignity, cover their privacies and lock up their secrets ; To be, all the way, an instrument of Gods mercy, extending my medical care to near and far, virtuous and sinner and friend and enemy; To strive in the pursuit of knowledge and harnessing it for the benefit but not the harm of Mankind; To revere my teacher, teach my junior, and be brother to members of the Medical Profession; To live my Faith in private and in public, avoiding whatever blemishes me in the eyes of God, His apostle and my fellow Faithful… And may God be witness to this Oath.” Any thoughts?
Based on CanMED Framework(http://www.rcpsc.edu/canmeds/CanMEDS2005/index.php)
Definition: As Medical Experts, physicians integrate all of the doctor‟s roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centered care. Key Competencies: Physicians are able to…1. Function effectively as consultants, integrating all of their roles to provide optimal, ethical and patient-centered care;2. Establish and maintain clinical knowledge, skills and attitudes appropriate to their practice;3. Perform a complete and appropriate assessment of a patient;4. Use preventive and therapeutic interventions effectively;5. Demonstrate proficient and appropriate use of procedural skills, both diagnostic and therapeutic;6. Seek appropriate consultation from other health professionals, recognizing the limits of their expertise.
Definition: As Communicators, physicians effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter. Key Competencies: Physicians are able to…1. Develop rapport, trust and ethical therapeutic relationships with patients and families;2. Accurately elicit and synthesize relevant information and perspectives of patients and families, colleagues and other professionals;3. Accurately convey relevant information and explanations to patients and families, colleagues and other professionals;4. Develop a common understanding on issues, problems and plans with patients and families, colleagues and other professionals to develop a shared plan of care;5. Convey effective oral and written information about a medical encounter.
Definition: As Collaborators, physicians effectively work within a healthcare team to achieve optimal patient care. Key Competencies: Physicians are able to… 1. Participate effectively and appropriately in an interprofessional healthcare team; 2. Effectively work with other health professionals to prevent, negotiate, and resolve interprofessional conflict 4. Manager Definition: As Managers, physicians are integral participants in healthcare organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the healthcare system. Key Competencies: Physicians are able to…1. Participate in activities that contribute to the effectiveness of their healthcare organizations and systems;2. Manage their practice and career effectively;3. Allocate finite healthcare resources appropriately;4. Serve in administration and leadership roles, as appropriate.
Definition: As Health Advocates, physicians responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations.Key Competencies: Physicians are able to…1. Respond to individual patient health needs and issues as part of patient care;2. Respond to the health needs of the communities that they serve;3. Identify the determinants of health of the populations that they serve;4. Promote the health of individual patients, communities and populations.
Definition: As Scholars, physicians demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge.Key Competencies: Physicians are able to…1. Maintain and enhance professional activities through ongoing learning;2. Critically evaluate information and its sources, and apply this appropriately to practice decisions;3. Facilitate the learning of patients, families, students, residents, other health professionals, the public, and others, as appropriate;4. Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices.
A PHYSICIAN SHALL Always exercise his/her independent professional judgment and maintain the highest standards of professional conduct. Respect a competent patients right to accept or refuse treatment. Not allow his/her judgment to be influenced by personal profit or unfair discrimination. Be dedicated to providing competent medical service in full professional and moral independence, with compassion and respect for human dignity.
A PHYSICIAN SHALL Deal honestly with patients and colleagues, and report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception. Not receive any financial benefits or other incentives solely for referring patients or prescribing specific products. Respect the rights and preferences of patients, colleagues, and other health professionals.
A PHYSICIAN SHALL Recognize his/her important role in educating the public but should use due caution in divulging discoveries or new techniques or treatment through non-professional channels. Certify only that which he/she has personally verified. Strive to use health care resources in the best way to benefit patients and their community. Seek appropriate care and attention if he/she suffers from mental or physical illness. Respect the local and national codes of ethics
Respect for Patient Respect for Privacy Comprehensive care Respect for patient‟s autonomy Inform the patient about his/her condition Protect patients interests Keep the patients‟ secrets Source: Islamic Code of Medical & Health Ethics
A physician should: Listen carefully to the patient’s complaint, sympathizing with him in his suffering, treat him well, and be gentle while examining him. Respect his patient’s opinion, but that should not keep the physician from giving the appropriate instructions. Treat all his patients equally, without any discrimination based on their prestige, their social or moral status, the physician‟s own feelings towards them, their religious or racial background, their political orientation, or their gender, nationality, or color. Fear God when dealing with his patients; show respect for their beliefs, religions, and traditions Avoid any violations of Islamic law, such as being alone with a member of the opposite sex or looking at the private parts (awra) of a patient except in as much as the process of examination, diagnosis, and treatment requires; in the presence of in the presence of a third party; and after obtaining permission from the patient. Source: The Islamic Charter of Medical and Health Ethics
A physician should Ask only for the tests needed for the patient, without adding any tests not justified by the patient‟s case. He should base his whole diagnosis and treatment on the best available evidence and data. Honestly explain to the patient or anyone representing him the type, causes, and complications of the illness, and of the usefulness of diagnostic and therapeutic procedures. NOT hesitate to refer the patient to a more experienced doctor or to a doctor who has more effective equipment whenever the patient‟s case calls for such a referral, nor to refer him to a doctor whom the patient wishes to consult. Continue to give an emergency patient the proper treatment until it is no longer needed or until care for the patient is taken over by another doctor. Continue to extend proper care to patients with incurable, terminal, or fatal diseases, and to console them and give them hope to the last minutes of their lives. Relieve the patient’s pain and give him the feeling that the physician is eager to give him proper care and attention. Source: The Islamic Charter of Medical and Health Ethics
Positive interaction with the community‟s affairs Protect the community by reporting reportable/epidemic diseases Improve health in the community through advocacy and health education, and involvement in community health activities Rational use of the healthcare institutions‟ resources Effective contribution to the development of policies and health systems that respond to the community needs and facilitates easier access to health care. Source: The Islamic Charter of Medical and Health
The Doctor has the right to: Receive his/her complete right to respectful treatment and civil rights, equal to other community members Chances to continuous education and training (through libraries, conferences, workshops, symposia, etc.) A setup within which s/he can provide healthcare in compliance with the international guidelines and standards Not to be coerced by any means to do or abstain from doing a work related to his/her profession, except within the limits of law Not to be suspended or halted from practice, expect within the limits of law & professional regulations Defend him/herself in any trial and professional discipline, or/and to have the right to delegate lawyers (or experts)
The Islamic Charter of Medical and Health Ethics. (www.emro.who.int/PDF/IslamicCharter_MedicalHealthEthics.pdf) The CanMEDS 2005 Physician Competency Framework (http://www.ub.edu/medicina_unitateducaciomedica/documentos/CanMeds.pdf) WMA International Code of Medical Ethics (http://www.wma.net/en/30publications/10policies/c8/)