SCHS Topic 2: Doctor’s Professional Duties

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OUTLINE:
Introduction: Doctor’s relationship and roles
Professionalism and Professional Attributes
Doctor’s duties towards himself/herself
Doctor’s duties towards his/her colleagues
Doctor’s duties towards his/her profession
Doctor’s duties towards his/her community

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  • He should avoid performance of unnecessary medical examinations, prescriptions or dispensing of medications, unnecessary consultations, or the performance of unnecessary medical procedures according to the patient's condition.
  • SCHS Topic 2: Doctor’s Professional Duties

    1. 1. Asst. Prof., Dept. of Medical Ethics King Fahad Medical City – Faculty of Medicine King Saud Bin Abdul-Aziz University for Health Sciences Dr. Ghaiath M. A. Hussein Professionalism and Ethics Education for Residents (PEER) Doctor’s Professional Duties
    2. 2.  Introduction: Doctor’s relationship and roles  Professionalism and Professional Attributes  Doctor’s duties towards himself/herself  Doctor’s duties towards his/her colleagues  Doctor’s duties towards his/her profession  Doctor’s duties towards his/her community Outline
    3. 3. Before we start…where are we? Patient Health Educator Doctor Lab./x- ray Social worker Nurse Manager Doctors Are NOT the focus of the healthcare
    4. 4. Doctor’s Roles YOU Healer Educator/ Scholar Researcher Planner Health Advocate Communicator
    5. 5. Professionalism  “constituting those attitudes and behaviors that serve to maintain patient interest above physician self-interest.” American Board of Internal Medicine  Professional competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served. Epstein and Hundert
    6. 6. What is professionalism about? The ethics of professionalism in medicine is more concerned with the characteristics and behaviors of physicians in the context of medicine as a profession. Specifically, it examines desirable and undesirable attributes of physicians.
    7. 7. What is professionalism about? Undesirable conductDesirable Behaviors Abuse of power, Bias, Sexual harassment, Breach of confidentiality, Arrogance, Greed, Misrepresentation, Impairment, Lack of conscientiousness, and Conflicts of interest Altruism, Accountability, Excellence, Duty, Honor, Integrity, Respect for others, and A commitment to lifelong learning Source:http://www.med.uottawa.ca/students/md/professionalism/eng/what_is_professionalis m.html
    8. 8. Muslim Leading Medical Ethicists! “… The physician should be modest, virtuous and merciful… He should wear clean clothes, be dignified, and have well- groomed hair and beard. He should select his company to be persons of good reputation. He should be careful of what he says and should not hesitate to ask forgiveness if he has made an error... He should be punctual and reliable… He should not wrangle about his fees... He should not give drugs to a pregnant woman for an abortion unless necessary for the mother's health...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. “Al-Tabari, 970 A.D., Fardous Al Hikma
    9. 9. Oath of Muslim Doctor “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 God's mercy, extending my medical care to near and far, virtuous and sinner, friend and enemy;
    10. 10. Oath of Muslim Doctor 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.”
    11. 11. Muslim Doctors’ Duties Towards Patients  Respect for Patient  Respect for Privacy  Comprehensive care  Respect for patient’s autonomy  Inform the patient about his/her condition  Protect patient's interests  Keep the patients’ secrets Source: Islamic Code of Medical & Health Ethics
    12. 12. Doctors’ Duties Towards Patients (KSA)  Listen carefully, treat fairly and show respect (especially during history taking and examination)  Treat them fairly (no discrimination because of religion, sex, race, etc.)  Provide advice and be supportive  Respect privacy (when examining their bodies)  Keeping the patient's medical information strictly confidential  Provide the best of your knowledge and skills needed for the condition, even if they are incurable and terminally ill or dying.  Refer to a specialized (more expert) physician as needed  Refrain from causing any harm to your patients  Take consent from patients before any intervention
    13. 13. Physician's Duties Towards Colleagues  To deal with, and act towards his colleagues in a good manner and in the same way he would prefer to be treated  To avoid direct criticism to his colleague in front of patients  Not to indulge in defaming the honor of his colleagues  To exert every possible effort to educate the colleagues  Respect the differences with colleagues (sex, culture, belief…).  The physician should respect other non-physician medical profession colleagues, and appreciate their roles in healthcare of the patient  She/he must report the incidence in which a colleague could be dangerous to the authority concerned Source: Saudi Council for Health Specialties Manual of Ethics of the Medical Profession
    14. 14. Doctor’s Duties Towards his Profession  Respect the honour of the profession;  Develop him/herself to develop the profession through CME, research, and publications;  Adhere to the standards of practice (GCP, EBM, guidelines, etc.)  Abstain from any behaviour/action that would question his/her credibility, or establish dishonest affairs with patients or their families;  Avoid the request of fame on the account of the professional ethics and standards  To provide role model for his colleagues and patients Source: Islamic Code of Medical & Health Ethics
    15. 15. Doctor’s Duties Towards his Profession  Reflect sincere devotion and dedication to the medical profession.  To avoid any action that could lead to contempt of the medical profession and to maintain the standards of medical profession  To contribute in the development of the profession through research and continuous learning.  The physician should not take advantage of his profession position for obtaining any material or moral gains, which are not in conformity with or violate the laws and tradition.
    16. 16. Doctor’s Duties Towards his Profession  To take the appropriate procedure when he comes to know that one of the members of the health team is sick, ignorant or negligent of his duties; in furtherance of protecting the patient in the first place and the medical profession next.  The physician should refrain, when dealing with the patient, from any act or conduct that would infringe his honesty and integrity.  To avoid seeking fame at the expense of the profession ethics and principles.
    17. 17. Doctor’s Role Towards Community  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: Islamic Code of Medical & Health Ethics
    18. 18. Doctor’s Role Towards Community  To be as an ideal (example) in his attitude and religion  Promotion of health equity among the society members  Maintenance of health resources and the ideal utilization of such resources.  Use his skills, knowledge and expertise to improve the standards and quality of health services rendered to the society.
    19. 19. Doctor’s Rights 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 she/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)
    20. 20. Lack of Professionalism Signs and Symptoms (ABIM, 2001) 1. Abuse of power: – Abuse while interacting with patients and colleagues; – Bias and sexual harassment; and – Breach of confidentiality 2. Arrogance (offensive display of superiority and self-importance); 3. Greed (when money becomes the driving force); 4. Misrepresentation (lying, which is consciously failing to tell the truth; and fraud, which is conscious misrepresentation of material fact with the intent to mislead);
    21. 21. Lack of Professionalism Cont. Signs and Symptoms (ABIM, 2001) 5. Impairment (any disability that may prevent the physician from discharging his/her duties); 6. Lack of conscientiousness (failure to fulfill responsibilities); 7. Conflicts in interests (self-promotion/ advertising or unethical collaboration with industry; acceptance of gifts; and misuse of services – overcharging, inappropriate treatment or prolonging contact with patients).
    22. 22. Types of Unprofessional Acts  Minor lapses,  Major lapses, and  Critical events
    23. 23. Minor Lapses Minor lapses are errors but have minimal consequences. Often there is no awareness of the unprofessional act or it occurs after the fact. There may often be mitigating circumstances. Examples: 1. Resident falls asleep on a stretcher in the hall of the hospital. 2. Resident does not meet deadline for paper due to family illness but does not notify anyone.
    24. 24. Major Lapses Major lapses are errors but have serious consequences. Often there is awareness of the unprofessional act . Usually, there are no mitigating circumstances. Examples: 1. Resident refuses to return phone calls and e-mails from a professor. 2. Resident does not answer his pager from the emergency room 3. Resident rushes in to see a patient with “interesting” findings despite being told to not do so.
    25. 25. Critical Events Critical events are serious events that will require immediate action by the supervisor. It is a clear violation of the code of conduct. Examples: 1. Resident being dishonest either by lying or misrepresenting himself/herself. 2. Resident hitting a patient. 3. Resident being sexually inappropriate with a patient or fellow member of the health care team.
    26. 26. Questions and Discussion

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