In order for a doctor to practice in the UK doctors must be registered with the GMC and hold a licence. Under the Medical Act (1983)6, the GMC has 4 main roles:
- Keeping a register of qualified doctors
- Developing and encouraging good medical practice
- Ensuring medical education is of a high standard
- Providing a disciplinary service
A good doctor makes the care of his/her patient their first concern; they are competent; keep their knowledge and skills up to date; establish and maintain good relationships with patients and colleagues; are honest and trustworthy and act with integrity 1.
- As doctors are entrusted with the lives and health of patients and are accountable for the decisions and actions they take, they must:
- Make the care of a patient their first concern
- Protect and promote the health of patients and the public
- Provide a good standard of practice and care
- Treat patients as individuals and respect their dignity
- Work in partnership with patients
- Be honest and open and act with integrity
- In order to be an effective clinician, a doctor must be able to develop and maintain a professional relationship with both their patients and their colleagues.
- By being polite, considerate, honest, trustworthy as well as treating each patient with dignity and as an individual, a doctor will be able to effectively communicate with the patient, obtain their trust and subsequently address the individual patient needs.
- Good communication requires listening to the views and questions of the patient, providing information in an accessible way and collaborating to come up with a shared plan.
- Within the clinical environment, it is also important to work in teams. A doctor should act as a positive role model and be a supportive and encouraging influence to others involved in patient care.
- In order to do the above, a doctor should; respect the skills and contributions of others, encourage and support each member, communicate effectively and review each situation regularly.
Clinical examples of when this could happen are 9:
- Imbalance of power
- This could arise if a doctor has access to expertise and healthcare resources which the patient needs, or the if the doctor takes advantage of possible vulnerability - emotional or physical - of a patient seeking healthcare
- Sexual/Improper relationships11
- An example could be the use of a home visit to pursue a relationship
- A doctor must not pursue a sexual relationship with a former patient, where at the time of the professional relationship the patient was vulnerable, for example because of mental health problems, or because of their lack of maturity
- Intimate examinations
- Intimate examinations can be embarrassing or distressing for patients
- Whenever examining a patient, doctors are required to be sensitive to what the patient may perceive as intimate (examinations of breasts, genitalia and rectum)
- A chaperone MUST be offered
- Sexualised behaviour
- Sexualised behaviour has been defined as 'acts, words or behaviour designed or intended to arouse or gratify sexual impulses and desires'
- A doctor must never make an advance on a patient
- If a patient displays sexualised behaviour, wherever possible, a doctor should treat them politely and considerately and try to re-establish a professional boundary
- Central to the above, and medical professionalism in general, is an important human characteristic: probity
- Probity means being honest and trustworthy, and acting with integrity
- A doctor must ensure that their actions justify the trust a patient and society has put in them
- If at any stage, a doctor commits a criminal offence they must report it to the GMC, and if action is being taken against them within a medical organisation, they must inform any other medical organisations with which they are associated with and undertake work for.
A doctor must declare any interest, financial or commercial, in an organisation to the patient and healthcare purchaser (the GP) if they intend to utilise said outside agency 5.
As doctors we should not allow our personal beliefs to affect our professional relationship with patients. These personal beliefs include views on a patient's age, colour, culture, disability, ethnic/national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation or social or economic status.2
There are a number of examples where a doctor's personal beliefs may interfere with appropriate patient care:
- Patient care pre- and post-termination
- If a woman requires medical care before or after a termination of pregnancy, a doctor is required (both legally and ethically) to provide it, regardless of his/her beliefs 4.
- The completion of cremation forms
- A doctor must sign a cremation form if required to do so.
- Failing to sign the form may result in a post-mortem examination of the deceased and subsequent delay and unnecessary distress to the family.
- Wearing clothing or other insignia of religious affiliation.
- Although no formal guidelines exist on the above, it should be noted that doing so may result in difficulty establishing rapport and gaining the trust of the patient - thus creating a potential barrier to effective communication.3
Patient's personal beliefs may also affect care, the most obvious manifestation of this is seen with religious beliefs.
Essential treatment can be refused (conscientious objection); Jehovahs' Witnesses and the use of blood and blood products or non-essential intervention requested; Jewish and Islamic faiths seeking male circumcisions.
Doctors should be familiar with:
- Clinical governance structures
- Risk management structures
- Processes within the organisations for which they work
- Fear of potential working tension
- Not wanting to implicate colleagues
- It may have a negative career impact
However, the following points should be recognised 10:
- A doctor's primary duty is to their patients
- Legal protection against victimisation or dismissal is given via the Public Interest Disclosure Act 1988 7
- Even if the concern is groundless, as long as it is done in best interests then it will be justified
- If you believe a patient is at risk report it via the appropriate channels immediately
- The first port of call is the Consultant, then the Medical Director/Practice Partner
- If your concern is about one of these, an appropriate alternative may be the Medical Director or Clinical Governance Lead at your Trust or Health Board
- Medical students may raise concern with their Dean
- Each workplace should have a structure in place 8
- If you are not satisfied with the outcome you may make your concerns public as long as patient confidentiality is not compromised (Note: it is a good idea to contact your defence association when considering this)
- Be clear, honest and objective
- Focus on patient safety
- Keep a record of concerns and any steps taken
- GMC: Duties of a Doctor
- GMC: Valuing Diversity - Guidance for Doctors
- GMC: Personal Beliefs and Medical Practice (March 2008)
- Janaway v Salford Health Authority All England Law Rep 1988 Dec 1; 3:1079-84
- GMC: Conflicts of Interest (September 2008)
- Medical Act (1983)
- Public Interest Disclosure Act (1998)
- Health Service Circular (1999/198)
- GMC: Maintaining Boundaries - Guidance for Doctors (November 2006)
- GMC: Raising Concerns about Patient Safety - Guidance for Doctors (November 2006)
- Kerr/Haslam Inquiry (2005)