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;[1988] 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)

• Show All
• GMC & Good Medical Practice
• Professional Relationships
• Probity, Honesty, & Trust
• Conflicts of Interest
• Religious Beliefs
• Reporting Incidences

• A Commerical Proposal
• The Whistleblower

• Assessment Questions
• Study Resources