What is a professional?
Members who profess a commitment to: - competence - integrity (someone you can trust to do the right thing when no-one is looking) - morality - altruism (putting individual patients interests first, above your self-interest (putting patients needs before your own) - promotion of the public good (responding to and addressing concerns of society, responsible use of resources, and maintaining health of the public)
What is a profession?
An occupation whose core element of work is based on a mastery of complex knowledge and skills used in the service of others.
What is professionalism?
A set of values, behaviours and relationships that underpins the trust the public has in doctors. Three main features: 1. Placing interests of patients above those of the physician 2. Setting and maintaining standards of competence and integrity; and 3. Providing expert advice to society on matters of health
What is a social contract?
The profession forms a social contract with society. The profession provides specialised skills and guarantees commitment to these attributes (integrity, altruism, etc) in return for: autonomy in practice and the privilege of self-regulation. The profession is then trusted to provide specific services to society. In other words, the medical profession is given prestige, autonomy, self-regulation and rewards in the expectation of professionalism. Failure of professionalism, leads to erosion of social contract.
What is trust?
Trust is the firm belief in reliability, truth or ability of someone. Trust is the outcome of professionalism Binds the social contract Expert professions are trusted by the public Patients who are ill must trust those caring for them, must believe their best interests are at hear; you will use your knowledge wisely; you will do no harm especially at their most vulnerable time. Trust is dependent on professionalism, and thus it is fragile
What does professional autonomy mean?
Thre freedom to make independent decisions in the best interests of patients and for the good of society.
What is self-regulation?
Is when a profession is allowed to set itself rules and regulations to protect the public. These rules ensure services are competent and ethical. Self regulation gives the profession the right to: - set standards for the profession - enforce those standards and regulate practice (e.g. standards for entering the profession (student selection), standards of practice (registration), rules as to when and how members may be removed from the profession.)
Why is self-regulation so desirable to the profession?
- Individual members of the profession can practise without supervision - Professionals are accountable for their own actions, the conduct of their practice, and of their colleagues - It means other groups and/or government cannot impose requirements on the profession - Prestige and public trust (if successful) - Ensures a good relationship with government that allows the profession to express its own view - Minimises governments role (but does not completely eliminate it)
Why is self-regulation so desirable to the public?
- More efficient than government and less costly - Specialised skills means specialised standards - Insulates the government from the actions of profession - There are still mechanisms for government to ensure public accountability -Self-regulation is incomplete (e.g. external regulation is imposed for some activity (e.g. prescribing and dispensing medicines
What does failure of professionalism lead to?
Failure of professionalism leads to erosion of social contract and the loss of the privilege of self-regulation
How do we (medicine practioners self-regulate?
The Medical Board of Australia regulates Australia’s medical practitioners. These roles include: - registers medical practitioners and medical students - develops standards, codes and guidelines for the medical profession - investigates notifications and complaints - approves accreditation standards and accredited courses of study
Why are uni’s interested in the professionalism of students?
Unprofessional student behaviour predicts disciplinary action as a registered physician. Students who adopt professionalism are likely to make better doctors. Universities are no longer turning a ‘blind eye’ to poor practise of medical students.
Can you post clinical images on Facebook?
No. Clinical images are confidential ‘health information’ and must be treated like all other medical records. You cannot use clinical images for any purpose other than that for which consent was obtained.
What is patient confidentiality?
Means to not divulge patient information without just cause. Information means everything, including that a person has been a patient at all.
What are some of the things expected from a 1st year medical student?
- Patient Confidentiality - Time management - Politeness and respect - Personal appearance - Awareness of your scope
What are the four philosophical arguments for confidentiality?
- Principle-based: to respect patients autonomy, for beneficence, and non-maleficence 2. Virtue-based: It shows we can keep a promise. It builds ‘trust’ which underpins the doctor-patient relationship. 3. Moral-based: Protecting secrets is morally right 4. Consequentialist-based: confidentiality is necessary to encourage patients to disclose their symptoms/concerns. Without confidentiality, harm could arise
What are some exemptions to the rule of confidentiality?
Exemptions mandated by law: - Notifiable diseases (e.g. sexually transmitted infections, epidemics, bioterrorism, etc) - Reporting of child abuse - Police warrants/summons Exemptions in the public interest: - Patient is at risk to themselves or harming others (eg HIV infected person engaging in unprotected sex without disclosure) - Patients discloses they have committed a serious crime
What is informed consent?
- Is a persons voluntary decision about medical care which is made with knowledge and understanding of the benefits and risks involved. - Health professionals therefore have a duty of disclosure (of information)
When is informed consent required?
- Informed consent is required before examining, investigating and providing treatment (except in an emergency). - Informed consent is required before involving any patient in teaching and research
What are the 3 elements that is the best practice in obtaining informed consent?
- Threshold element - Competence (are they capable of giving consent? are they well enough? are they are child? are they mentally competent?) 2. Information elementions - disclosure of information (risk/benefits information, even if the patient did not ask - Understanding of information (you may disclose the information, but did the patient understand it?) 3. Consent elements - Voluntariness (was consent freely given? Or undue influence/manipulation?) - Authorisation (are you the person authorised to seek consent? is the consent documented/written?)
How do you ensure the patient understands what they are consenting to? (informed consent)``
- Use plain language - Repeat information - Reinforce key issues - Use an interpreter (if needed) - Draw diagrams - Allow adequate time - Check for understanding - Offer second opinions
Reporting to the Medical Board is mandatory. This is to prevent the public being placed at risk of harm. What are some of the challenges of reporting impaired doctors?
- Reporting the poor performance of colleagues is hard to do. 2. Impaired doctors seeking help are to scared to seek treatment if they know they will be reported. Proposed solution: The AMA has advocated for treating practitioners to be exempted from mandatory reporting requirements.
What is a conflict of interest?
Is when a doctor, entrusted with acting in the best interests of patients, also has financial, professional or personal interests, or relationships, which may affect their care of the patient.
Why is pharmaceutical prescribing and dispensing a conflict of interest?
- Might have commercial gain from dispensing, which may influence the doctors decision to prescribe a medicine and the choice of medicine.
- The patients interests may not come first.
- Doctors may excercise undue influence over patients
