good medical practice: a code of conduct for doctors in...
TRANSCRIPT
Good Medical Practice: A Code of Conduct
for Doctors in Australia
This code was endorsed by all Australian State and Territory medical boards and the Australian Medical Council. It has been adopted by the Medical Board of Australia after minor revisions to ensure it is consistent with the Health Practitioner Regulation National Law Act 2009 (the National Law). It is issued under s 39 of the National Law.
Good Medical Practice: A Code of Conduct for Doctors in Australia
1 About this code 1
1.1 Purposeofthecode 1
1.2 Useofthecode 1
1.3 Whatthecodedoesnotdo 1
1.4 Professionalvaluesandqualitiesofdoctors 1
1.5 AustraliaandAustralianmedicine 2
1.6 Substitutedecisionmakers 2
2 Providing good care 3
2.1 Introduction 3
2.2 Goodpatientcare 3
2.3 Shareddecisionmaking 3
2.4 Decisionsaboutaccesstomedicalcare 3
2.5 Treatmentinemergencies 4
3 Working with patients 5
3.1 Introduction 5
3.2 Doctor–patientpartnership 5
3.3 Effectivecommunication 5
3.4 Confidentialityandprivacy 5
3.5 Informedconsent 5
3.6 Childrenandyoungpeople 6
3.7 Culturallysafeandsensitivepractice 6
3.8 Patientswhomayhaveadditionalneeds 6
3.9 Relatives,carersandpartners 6
3.10 Adverseevents 7
3.11 Whenacomplaintismade 7
3.12 End-of-lifecare 7
3.13 Endingaprofessionalrelationship 8
3.14 Personalrelationships 8
3.15 Closingyourpractice 8
4 Working with other health care professionals 9
4.1 Introduction 9
4.2 Respectformedicalcolleaguesand
otherhealthcareprofessionals 9
4.3 Delegation,referralandhandover 9
4.4 Teamwork 9
4.5 Coordinatingcarewithotherdoctors 9
5 Working within the health care system 10
5.1 Introduction 10
5.3 Healthadvocacy 10
5.4 Publichealth 10
6 Minimising risk 11
6.1 Introduction 11
6.2 Riskmanagement 11
6.3 Doctors’performance—
youandyourcolleagues 11
7 Maintaining professional performance 12
7.1 Introduction 12
7.2 Continuingprofessionaldevelopment 12
8 Professional behaviour 13
8.1 Introduction 13
8.2 Professionalboundaries 13
8.3 Reportingobligations 13
8.4 Medicalrecords 13
Contents
Good Medical Practice: A Code of Conduct for Doctors in Australia
Contents
8.5 Insurance 13
8.6 Advertising 13
8.7 Medico-legal,insuranceandother
assessments 14
8.8 Medicalreports,certificatesand
givingevidence 14
8.9 Curriculumvitae 14
8.10 Investigations 14
8.11 Conflictsofinterest 14
8.12 Financialandcommercialdealings 15
9 Ensuring doctors’ health 16
9.1 Introduction 16
9.2 Yourhealth 16
9.3 Otherdoctors’health 16
10 Teaching, supervising and assessing 17
11 Undertaking research 18
11.1 Introduction 18
11.2 Researchethics 18
11.3 Treatingdoctorsandresearch 18
Acknowledgements 19
Good Medical Practice: A Code of Conduct for Doctors in Australia
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1 About this code
1.1 Purpose of the code
Good Medical Practice (thecode)describeswhatisexpectedofalldoctorsregisteredtopractisemedicineinAustralia.Itsetsouttheprinciplesthatcharacterisegoodmedicalpracticeandmakesexplicitthestandardsofethicalandprofessionalconductexpectedofdoctorsbytheirprofessionalpeersandthecommunity.Thecodewasdevelopedfollowingwideconsultationwiththemedicalprofessionandthecommunity.Thecodeisaddressedtodoctorsandisalsointendedtoletthecommunityknowwhattheycanexpectfromdoctors.Theapplicationofthecodewillvaryaccordingtoindividualcircumstances,buttheprinciplesshouldnotbecompromised.
ThiscodecomplementstheAustralianMedicalAssociationCode of Ethics1 andisalignedwithitsvalues,andisalsoconsistentwiththeDeclaration ofGeneva and the International Code of Medical Ethics,2issuedbytheWorldMedicalAssociation.
Thiscodedoesnotsetnewstandards.Itbringstogether,intoasingleAustraliancode,standardsthathavelongbeenatthecoreofmedicalpractice.
Thepracticeofmedicineischallengingandrewarding.Nocodeorguidelinescaneverencompasseverysituationorreplacetheinsightandprofessionaljudgmentofgooddoctors.Goodmedicalpracticemeansusingthisjudgmenttotrytopractiseinawaythatwouldmeetthestandardsexpectedofyoubyyourpeersandthecommunity.
1.2 Use of the code
DoctorshaveaprofessionalresponsibilitytobefamiliarwithGood Medical Practiceandtoapplytheguidanceitcontains.
Thiscodewillbeused:
• Tosupportindividualdoctorsinthechallengingtaskofprovidinggoodmedicalcareandfulfillingtheirprofessionalroles,andtoprovideaframeworktoguideprofessionaljudgment.
• Toassistmedicalboardsintheirroleofprotectingthepublic,bysettingandmaintainingstandardsofmedicalpractice.Ifyourprofessionalconductvariessignificantlyfromthisstandard,youshouldbepreparedtoexplainandjustifyyourdecisionsandactions.Seriousorrepeatedfailuretomeetthesestandardsmayhaveconsequencesforyourmedicalregistration.
• AsanadditionalresourceforarangeofusesthatcontributetoenhancingthecultureofmedicalprofessionalismintheAustralianhealthsystem;forexample,inmedicaleducation;orientation,inductionandsupervisionofjuniordoctorsandinternationalmedicalgraduates;andbyadministratorsandpolicymakersinhospitals,healthservicesandotherinstitutions.
1.3 What the code does not do
Thiscodeisnotasubstitutefortheprovisionsoflegislationandcaselaw.Ifthereisanyconflictbetweenthiscodeandthelaw,thelawtakesprecedence.
Thiscodeisnotanexhaustivestudyofmedicalethicsoranethicstextbook.Itdoesnotaddressindetailthestandardsofpracticewithinparticularmedicaldisciplines;thesearefoundinthepoliciesandguidelinesissuedbymedicalcollegesandotherprofessionalbodies.
Whilegoodmedicalpracticerespectspatients’rights,thiscodeisnotacharterofrights.3
1.4 Professional values and qualities of doctors
Whileindividualdoctorshavetheirownpersonalbeliefsandvalues,therearecertainprofessionalvaluesonwhichalldoctorsareexpectedtobasetheirpractice.
Doctorshaveadutytomakethecareofpatientstheirfirstconcernandtopractisemedicinesafelyandeffectively.Theymustbeethicalandtrustworthy.
Patientstrusttheirdoctorsbecausetheybelievethat,inadditiontobeingcompetent,theirdoctorwillnottakeadvantageofthemandwilldisplayqualitiessuchasintegrity,truthfulness,dependabilityandcompassion.Patientsalsorelyontheirdoctorstoprotecttheirconfidentiality.
Doctorshavearesponsibilitytoprotectandpromotethehealthofindividualsandthecommunity.
Goodmedicalpracticeispatient-centred.Itinvolvesdoctorsunderstandingthateachpatientisunique,andworkinginpartnershipwiththeirpatients,adaptingwhattheydotoaddresstheneedsandreasonableexpectationsofeachpatient.Thisincludesculturalawareness:beingawareoftheirowncultureandbeliefsandrespectfulofthebeliefsandculturesofothers,recognisingthattheseculturaldifferencesmayimpactonthedoctor–patientrelationshipandonthedeliveryofhealthservices.
Goodcommunicationunderpinseveryaspectofgoodmedicalpractice.
1Seehttp://www.ama.com.au/codeofethics2Seehttp://www.wma.net/e/policy/c8.htm3SeetheAustralianCommissiononSafetyandQualityinHealthCare’sAustralianCharterofHealthcareRights(http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/52533CE922D6F58BCA2573AF007BC6F9/$File/17537-charter.pdf)
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Professionalismembodiesallthequalitiesdescribedhere,andincludesself-awarenessandself-reflection.Doctorsareexpectedtoreflectregularlyonwhethertheyarepractisingeffectively,onwhatishappeningintheirrelationshipswithpatientsandcolleagues,andontheirownhealthandwellbeing.Theyhaveadutytokeeptheirskillsandknowledgeuptodate,refineanddeveloptheirclinicaljudgmentastheygainexperience,andcontributetotheirprofession.
1.5 Australia and Australian medicine
Australiaisculturallydiverse.Weinhabitalandthat,formanyages,washeldandcaredforbyIndigenousAustralians,whosehistoryandculturehaveuniquelyshapedournation.OursocietyisfurtherenrichedbythecontributionofpeoplefrommanynationswhohavemadeAustraliatheirhome.
DoctorsinAustraliareflecttheculturaldiversityofoursociety,andthisdiversitystrengthensourprofession.
TherearemanywaystopractisemedicineinAustralia.Thecoretasksofmedicinearecaringforpeoplewhoareunwellandseekingtokeeppeoplewell.Thiscodefocusesprimarilyonthesecoretasks.Forthedoctorswhoundertakerolesthathavelittleornopatientcontact,notallofthiscodemayberelevant,buttheprinciplesunderpinningitwillstillapply.
1.6 Substitute decision makers
Inthiscode,referencetotheterm‘patient’alsoincludessubstitutedecisionmakersforpatientswhodonothavethecapacitytomaketheirowndecisions.Thiscanbetheparents,oralegallyappointeddecisionmaker.Ifindoubt,seekadvicefromtherelevantguardianshipauthority.
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2 Providing good care
2.1 Introduction
Inclinicalpractice,thecareofyourpatientisyourprimaryconcern.Providinggoodpatientcareincludes:
2.1.1 Assessingthepatient,takingintoaccountthehistory,thepatient’sviews,andanappropriatephysicalexamination.Thehistoryincludesrelevantpsychological,socialandculturalaspects.
2.1.2 Formulatingandimplementingasuitablemanagementplan(includingarranginginvestigationsandprovidingtreatmentandadvice).
2.1.3 Facilitatingcoordinationandcontinuityofcare.
2.1.4 Referringapatienttoanotherpractitionerwhenthisisinthepatient’sbestinterests.
2.1.5 Recognisingandrespectingpatients’rightstomaketheirowndecisions.
2.2 Good patient care
Maintainingahighlevelofmedicalcompetenceandprofessionalconductisessentialforgoodpatientcare.Goodmedicalpracticeinvolves:
2.2.1 Recognisingandworkingwithinthelimitsofyourcompetenceandscopeofpractice.
2.2.2 Ensuringthatyouhaveadequateknowledgeandskillstoprovidesafeclinicalcare.
2.2.3 Maintainingadequaterecords(seeSection8.4).
2.2.4 Consideringthebalanceofbenefitandharminallclinical-managementdecisions.
2.2.5 Communicatingeffectivelywithpatients(seeSection3.3).
2.2.6 Providingtreatmentoptionsbasedonthebestavailableinformation.
2.2.7 Takingstepstoalleviatepatientsymptomsanddistress,whetherornotacureispossible.
2.2.8 Supportingthepatient’srighttoseekasecondopinion.
2.2.9 Consultingandtakingadvicefromcolleagues,whenappropriate.
2.2.10 Makingresponsibleandeffectiveuseoftheresourcesavailabletoyou(seeSection5.2).
2.2.11 Encouragingpatientstotakeinterestin,andresponsibilityfor,themanagementoftheirhealth,andsupportingtheminthis.
2.2.12 Ensuringthatyourpersonalviewsdonotadverselyaffectthecareofyourpatient.
2.3 Shared decision making
Makingdecisionsabouthealthcareisthesharedresponsibilityofthedoctorandthepatient.Patientsmaywishtoinvolvetheirfamily,carerorothers.SeeSection1.6onsubstitutedecisionmakers.
2.4 Decisions about access to medical care
Yourdecisionsaboutpatients’accesstomedicalcareneedtobefreefrombiasanddiscrimination.Goodmedicalpracticeinvolves:
2.4.1 Treatingyourpatientswithrespectatalltimes.
2.4.2 Notprejudicingyourpatient’scarebecauseyoubelievethatapatient’sbehaviourhascontributedtotheircondition.
2.4.3 Upholdingyourdutytoyourpatientandnotdiscriminatingonmedicallyirrelevantgrounds,includingrace,religion,sex,disabilityorothergrounds,asdescribedinantidiscriminationlegislation.4
2.4.4 Givingprioritytoinvestigatingandtreatingpatientsonthebasisofclinicalneedandeffectivenessoftheproposedinvestigationsortreatment.
2.4.5 Keepingyourselfandyourstaffsafewhencaringforpatients.Ifapatientposesarisktoyourhealthandsafetyorthatofyourstaff,takeactiontoprotectagainstthatrisk.Suchapatientshouldnotbedeniedcare,ifreasonablestepscanbetakentokeepyouandyourstaffsafe.
2.4.6 Beingawareofyourrighttonotprovideordirectlyparticipateintreatmentstowhichyouconscientiouslyobject,informingyourpatientsand,ifrelevant,colleagues,ofyourobjection,andnotusingyourobjectiontoimpedeaccesstotreatmentsthatarelegal.
4Seehttp://www.hreoc.gov.au/info_for_employers/law/index.html
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2.4.7 Notallowingyourmoralorreligiousviewstodenypatientsaccesstomedicalcare,recognisingthatyouarefreetodeclinetopersonallyprovideorparticipateinthatcare.
2.5 Treatment in emergencies
Treatingpatientsinemergenciesrequiresdoctorstoconsiderarangeofissues,inadditiontothepatient’sbestcare.Goodmedicalpracticeinvolvesofferingassistanceinanemergencythattakesaccountofyourownsafety,yourskills,theavailabilityofotheroptionsandtheimpactonanyotherpatientsunderyourcare;andcontinuingtoprovidethatassistanceuntilyourservicesarenolongerrequired.
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3 Working with patients
3.1 Introduction
Relationshipsbasedonopenness,trustandgoodcommunicationwillenableyoutoworkinpartnershipwithyourpatients.
3.2 Doctor–patient partnership
Agooddoctor–patientpartnershiprequireshighstandardsofprofessionalconduct.Thisinvolves:
3.2.1 Beingcourteous,respectful,compassionateandhonest.
3.2.2 Treatingeachpatientasanindividual.
3.2.3 Protectingpatients’privacyandrighttoconfidentiality,unlessreleaseofinformationisrequiredbylaworbypublic-interestconsiderations.
3.2.4 Encouragingandsupportingpatientsand,whenrelevant,theircarerorfamily,incaringforthemselvesandmanagingtheirhealth.
3.2.5 Encouragingandsupportingpatientstobewellinformedabouttheirhealthandtousethisinformationwiselywhentheyaremakingdecisions.
3.2.6 Recognisingthatthereisapowerimbalanceinthedoctor–patientrelationship,andnotexploitingpatientsphysically,emotionally,sexuallyorfinancially.
3.3 Effective communication
Animportantpartofthedoctor–patientrelationshipiseffectivecommunication.Thisinvolves:
3.3.1 Listeningtopatients,askingforandrespectingtheirviewsabouttheirhealth,andrespondingtotheirconcernsandpreferences.
3.3.2 Encouragingpatientstotellyouabouttheirconditionandhowtheyarecurrentlymanagingit,includinganyalternativeorcomplementarytherapiestheyareusing.
3.3.3 Informingpatientsofthenatureof,andneedfor,allaspectsoftheirclinicalmanagement,includingexamination
andinvestigations,andgivingthemadequateopportunitytoquestionorrefuseinterventionandtreatment.
3.3.4 Discussingwithpatientstheirconditionandtheavailablemanagementoptions,includingtheirpotentialbenefitandharm.
3.3.5 Endeavouringtoconfirmthatyourpatientunderstandswhatyouhavesaid.
3.3.6 Ensuringthatpatientsare informedofthematerialrisksassociatedwithanypartoftheproposedmanagementplan.
3.3.7 Respondingtopatients’questionsandkeepingtheminformedabouttheirclinicalprogress.
3.3.8 Makingsure,whereverpractical,thatarrangementsaremadetomeetpatients’specificlanguage,culturalandcommunicationneeds,andbeingawareofhowtheseneedsaffectunderstanding.
3.3.9 Familiarisingyourselfwith,andusingwhenevernecessary,qualifiedlanguageinterpretersorculturalinterpreterstohelpyoutomeetpatients’communicationneeds.Informationaboutgovernment-fundedinterpreterservicesisavailableontheAustralianGovernmentDepartmentofImmigrationandCitizenshipwebsite.5
3.4 Confidentiality and privacy
Patientshavearighttoexpectthatdoctorsandtheirstaffwillholdinformationabouttheminconfidence,unlessreleaseofinformationisrequiredbylaworpublicinterestconsiderations.Goodmedicalpracticeinvolves:
3.4.1 Treatinginformationaboutpatientsasconfidential.
3.4.2 Appropriatelysharinginformationaboutpatientsfortheirhealthcare,consistentwithprivacylawandprofessionalguidelinesaboutconfidentiality.
3.4.3 Beingawarethattherearecomplexissuesrelatedtogeneticinformationandseekingappropriateadviceaboutdisclosureofsuchinformation.
3.5 Informed consent
Informedconsentisaperson’svoluntarydecisionaboutmedicalcarethatismadewithknowledgeand
5TheAustralianGovernmentDepartmentofImmigrationandCitizenship’sTranslatingandInterpretingService(TIS)Nationalcanbecontactedon131450,orviathewebsite(http://www.immi.gov.au/living-in-australia/help-with-english/help_with_translating/index.htm).
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understandingofthebenefitsandrisksinvolved.TheinformationthatdoctorsneedtogivetopatientsisdetailedinguidelinesissuedbytheNationalHealthandMedicalResearchCouncil.6Goodmedicalpracticeinvolves:
3.5.1 Providinginformationtopatientsinawaythattheycanunderstandbeforeaskingfortheirconsent.
3.5.2 Obtaininginformedconsentorothervalidauthoritybeforeyouundertakeanyexamination,investigationorprovidetreatment(exceptinanemergency),orbeforeinvolvingpatientsinteachingorresearch.
3.5.3 Ensuringthatyourpatientsareinformedaboutyourfeesandcharges.
3.5.4 Whenreferringapatientforinvestigationortreatment,advisingthepatientthattheremaybeadditionalcosts,whichpatientsmaywishtoclarifybeforeproceeding.
3.6 Children and young people
Caringforchildrenandyoungpeoplebringsadditionalresponsibilitiesfordoctors.Goodmedicalpracticeinvolves:
3.6.1 Placingtheinterestsandwellbeingofthechildoryoungpersonfirst.
3.6.2 Ensuringthatyouconsideryoungpeople’scapacityfordecisionmakingandconsent.
3.6.3 Ensuringthat,whencommunicatingwithachildoryoungperson,you:
• treatthemwithrespectandlistentotheirviews
• encouragequestionsandanswertheirquestionstothebestofyourability
• provideinformationinawaythattheycanunderstand
• recognisetheroleofparentsandwhenappropriate,encouragetheyoungpersontoinvolvetheirparentsindecisionsabouttheircare.
3.6.4 Beingalerttochildrenandyoungpeoplewhomaybeatrisk,andnotifyingappropriateauthorities,asrequiredbylaw.
3.7 Culturally safe and sensitive practice
Goodmedicalpracticeinvolvesgenuineeffortstounderstandtheculturalneedsandcontextsofdifferentpatientstoobtaingoodhealthoutcomes.Thisincludes:
3.7.1 Havingknowledgeof,respectfor,andsensitivitytowards,theculturalneedsofthecommunityyouserve,includingthoseofIndigenousAustralians.
3.7.2 Acknowledgingthesocial,economic,culturalandbehaviouralfactorsinfluencinghealth,bothatindividualandpopulationlevels.
3.7.3 Understandingthatyourowncultureandbeliefsinfluenceyourinteractionswithpatients.
3.7.4 Adaptingyourpracticetoimprovepatientengagementandhealthcareoutcomes.
3.8 Patients who may have additional needs
Somepatients(includingthosewithimpaireddecision-makingcapacity)haveadditionalneeds.Goodmedicalpracticeinmanagingthecareofthesepatientsinvolves:
3.8.1 Payingparticularattentiontocommunication.
3.8.2 Beingawarethatincreasedadvocacymaybenecessarytoensurejustaccesstohealthcare.
3.8.3 Recognisingthattheremaybearangeofpeopleinvolvedintheircare,suchascarers,familymembersoraguardian,andinvolvingthemwhenappropriate.
3.8.4 Beingawarethatthesepatientsmaybeatgreaterrisk.
3.9 Relatives, carers and partners
Goodmedicalpracticeinvolves:
3.9.1 Beingconsideratetorelatives,carers,partnersandothersclosetothepatient,andrespectfuloftheirroleinthecareofthepatient.
3.9.2 Withappropriateconsent,beingresponsiveinprovidinginformation.
6SeetheNationalHealthandMedicalResearchCouncil’sdocuments,General Guidelines for Medical Practitioners on Providing Information to Patients(2004;http://www.nhmrc.gov.au/publications/synopses/e57syn.htm)andCommunicating with Patients: Advice for Medical Practitioners(2004;http://www.nhmrc.gov.au/publications/synopses/e58syn.htm)
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3.10 Adverse events
Whenadverseeventsoccur,youhavearesponsibilitytobeopenandhonestinyourcommunicationwithyourpatient,toreviewwhathasoccurredandtoreportappropriately.7Whensomethinggoeswrong,goodmedicalpracticeinvolves:
3.10.1 Recognisingwhathashappened.
3.10.2 Actingimmediatelytorectifytheproblem,ifpossible,includingseekinganynecessaryhelpandadvice.
3.10.3 Explainingtothepatientaspromptlyandfullyaspossiblewhathashappenedandtheanticipatedshort-termandlong-termconsequences.
3.10.4 Acknowledginganypatientdistressandprovidingappropriatesupport.
3.10.5 Complyingwithanyrelevantpolicies,proceduresandreportingrequirements,subjecttoadvicefromyourmedicalindemnityinsurer.
3.10.6 Reviewingadverseeventsandimplementingchangestoreducetheriskofrecurrence(seeSection6).
3.10.7 Reportingadverseeventstotherelevantauthority,asnecessary(seeSection6).
3.10.8 Ensuringpatientshaveaccesstoinformationabouttheprocessesformakingacomplaint(forexample,throughtherelevanthealthcarecomplaintscommissionormedicalboard).
3.11 When a complaint is made
Patientswhoaredissatisfiedhavearighttocomplainabouttheircare.Whenacomplaintismade,goodmedicalpracticeinvolves:
3.11.1 Acknowledgingthepatient’srighttocomplain.
3.11.2 Workingwiththepatienttoresolvetheissue,wherepossible.
3.11.3 Providingaprompt,openandconstructiveresponse,includinganexplanationand,ifappropriate,anapology.
3.11.4 Ensuringthecomplaintdoesnotadverselyaffectthepatient’scare.Insomecases,itmaybeadvisabletoreferthepatienttoanotherdoctor.
3.11.5 Complyingwithrelevantcomplaintslaw,policiesandprocedures.
3.12 End-of-life care
Doctorshaveavitalroleinassistingthecommunitytodealwiththerealityofdeathanditsconsequences.Incaringforpatientstowardstheendoftheirlife,goodmedicalpracticeinvolves:
3.12.1 Takingstepstomanageapatient’ssymptomsandconcernsinamannerconsistentwiththeirvaluesandwishes.
3.12.2 Providingorarrangingappropriatepalliativecare.
3.12.3 Understandingthelimitsofmedicineinprolonginglifeandrecognisingwheneffortstoprolonglifemaynotbenefitthepatient.
3.12.4 Understandingthatyoudonothaveadutytotrytoprolonglifeatallcost.However,youdohaveadutytoknowwhennottoinitiateandwhentoceaseattemptsatprolonginglife,whileensuringthatyourpatientsreceiveappropriaterelieffromdistress.
3.12.5 Acceptingthatpatientshavetherighttorefusemedicaltreatmentortorequestthewithdrawaloftreatmentalreadystarted.
3.12.6 Respectingdifferentculturalpracticesrelatedtodeathanddying.
3.12.7 Strivingtocommunicateeffectivelywithpatientsandtheirfamiliessotheyareabletounderstandtheoutcomesthatcanandcannotbeachieved.
3.12.8 Facilitatingadvancecareplanning.
3.12.9 Takingreasonablestepstoensurethatsupportisprovidedtopatientsandtheirfamilies,evenwhenitisnotpossibletodelivertheoutcometheydesire.
3.12.10Communicatingbadnewstopatientsandtheirfamiliesinthemostappropriatewayandprovidingsupportforthemwhiletheydealwiththisinformation.
3.12.11Whenyourpatientdies,beingwillingtoexplain,tothebestofyourknowledge,thecircumstancesofthedeathtoappropriatemembersofthepatient’sfamilyandcarers,unlessyouknowthepatientwouldhaveobjected.
7Seehttp://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/PriorityProgram-02
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3.13 Ending a professional relationship
Insomecircumstances,therelationshipbetweenadoctorandpatientmaybecomeineffectiveorcompromised,andyoumayneedtoendit.Goodmedicalpracticeinvolvesensuringthatthepatientisadequatelyinformedofyourdecisionandfacilitatingarrangementsforthecontinuingcareofthepatient,includingpassingonrelevantclinicalinformation.
3.14 Personal relationships
Wheneverpossible,avoidprovidingmedicalcaretoanyonewithwhomyouhaveaclosepersonalrelationship.Inmostcases,providingcaretoclosefriends,thoseyouworkwithandfamilymembersisinappropriatebecauseofthelackofobjectivity,possiblediscontinuityofcare,andriskstothedoctorandpatient.Insomecases,providingcaretothoseclosetoyouisunavoidable.Wheneverthisisthecase,goodmedicalpracticerequiresrecognitionandcarefulmanagementoftheseissues.
3.15 Closing your practice
Whenclosingorrelocatingyourpractice,goodmedicalpracticeinvolves:
3.15.1 Givingadvancenoticewherethisispossible.
3.15.2 Facilitatingarrangementsforthecontinuingmedicalcareofallyourcurrentpatients,includingthetransferorappropriatemanagementofallpatientrecords.Youmustfollowthelawgoverninghealthrecordsinyourjurisdiction.
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4 Working with other health care professionals
4.1 Introduction
Goodrelationshipswithmedicalcolleagues,nursesandotherhealthcareprofessionalsstrengthenthedoctor–patientrelationshipandenhancepatientcare.
4.2 Respect for medical colleagues and other health care professionals
Goodpatientcareisenhancedwhenthereismutualrespectandclearcommunicationbetweenallhealthcareprofessionalsinvolvedinthecareofthepatient.Goodmedicalpracticeinvolves:
4.2.1 Communicatingclearly,effectively,respectfullyandpromptlywithotherdoctorsandhealthcareprofessionalscaringforthepatient.
4.2.2 Acknowledgingandrespectingthecontributionofallhealthcareprofessionalsinvolvedinthecareofthepatient.
4.3 Delegation, referral and handover
Delegationinvolvesyouaskinganotherhealthcareprofessionaltoprovidecareonyourbehalfwhileyouretainoverallresponsibilityforthepatient’scare.Referral involvesyousendingapatienttoobtainopinionortreatmentfromanotherdoctororhealthcareprofessional.Referralusuallyinvolvesthetransfer(inpart)ofresponsibilityforthepatient’scare,usuallyforadefinedtimeandforaparticularpurpose,suchascarethatisoutsideyourareaofexpertise.Handoveristheprocessoftransferringallresponsibilitytoanotherhealthcareprofessional.Goodmedicalpracticeinvolves:
4.3.1 Takingreasonablestepstoensurethatthepersontowhomyoudelegate,referorhandoverhasthequalifications,experience,knowledgeandskillstoprovidethecarerequired.
4.3.2 Understandingthatwhenyoudelegate,althoughyouwillnotbeaccountableforthedecisionsandactionsofthosetowhomyoudelegate,youremainresponsiblefortheoverallmanagementofthepatient,andforyourdecisiontodelegate.
4.3.3 Alwayscommunicatingsufficientinformationaboutthepatientandthetreatmenttheyneedtoenablethecontinuingcareofthepatient.
4.4 Teamwork
Mostdoctorsworkcloselywithawiderangeofhealthcareprofessionals.Thecareofpatientsisimprovedwhenthereismutualrespectandclearcommunication,aswellasanunderstandingoftheresponsibilities,capacities,constraintsandethicalcodesofeachother’sprofessions.Workinginateamdoesnotalteradoctor’spersonalaccountabilityforprofessionalconductandthecareprovided.Whenworkinginateam,goodmedicalpracticeinvolves:
4.4.1 Understandingyourparticularroleintheteamandattendingtotheresponsibilitiesassociatedwiththatrole.
4.4.2 Advocatingforacleardelineationofrolesandresponsibilities,includingthatthereisarecognisedteamleaderorcoordinator.
4.4.3 Communicatingeffectivelywithotherteammembers.
4.4.4 Informingpatientsabouttherolesofteammembers.
4.4.5 Actingasapositiverolemodelforteammembers.
4.4.6 Understandingthenatureandconsequencesofbullyingandharassment,andseekingtoeliminatesuchbehaviourintheworkplace.
4.5 Coordinating care with other doctors
Goodpatientcarerequirescoordinationbetweenalltreatingdoctors.Goodmedicalpracticeinvolves:
4.5.1 Communicatingalltherelevantinformationinatimelyway.
4.5.2 Facilitatingthecentralcoordinatingroleofthegeneralpractitioner.
4.5.3 Advocatingthebenefitofageneralpractitionertoapatientwhodoesnotalreadyhaveone.
4.5.4 Ensuringthatitiscleartothepatient,thefamilyandcolleagueswhohasultimateresponsibilityforcoordinatingthecareofthepatient.
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5 Working within the health care system
5.1 Introduction
Doctorshavearesponsibilitytocontributetotheeffectivenessandefficiencyofthehealthcaresystem.
5.2 Wiseuseofhealthcareresources
Itisimportanttousehealthcareresourceswisely.Goodmedicalpracticeinvolves:
5.2.1 Ensuringthattheservicesyouprovidearenecessaryandlikelytobenefitthepatient.
5.2.2 Upholdingthepatient’srighttogainaccesstothenecessarylevelofhealthcareand,wheneverpossible,helpingthemtodoso.
5.2.3 Supportingthetransparentandequitableallocationofhealthcareresources.
5.2.4 Understandingthatyouruseofresourcescanaffecttheaccessotherpatientshavetohealthcareresources.
5.3 Health advocacy
TherearesignificantdisparitiesinthehealthstatusofdifferentgroupsintheAustraliancommunity.Thesedisparitiesresultfromsocial,cultural,geographic,health-relatedandotherfactors.Inparticular,theIndigenouspeopleofAustraliabeartheburdenofgrosssocial,culturalandhealthinequity.Goodmedicalpracticeinvolvesusingyourexpertiseandinfluencetoprotectandadvancethehealthandwellbeingofindividualpatients,communitiesandpopulations.
5.4 Public health
Doctorshavearesponsibilitytopromotethehealthofthecommunitythroughdiseasepreventionandcontrol,educationandscreening.Goodmedicalpracticeinvolves:
5.4.1 Understandingtheprinciplesofpublichealth,includinghealtheducation,healthpromotion,diseasepreventionandcontrolandscreening.
5.4.2 Participatingineffortstopromotethehealthofthecommunityandbeingawareofyourobligationsindiseaseprevention,screeningandreportingnotifiablediseases.
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6 Minimising risk
6.1 Introduction
Riskisinherentinhealthcare.Minimisingrisktopatientsisanimportantcomponentofmedicalpractice.Goodmedicalpracticeinvolvesunderstandingandapplyingthekeyprinciplesofriskminimisationandmanagementinyourpractice.
6.2 Risk management
Goodmedicalpracticeinrelationtoriskmanagementinvolves:
6.2.1 Beingawareoftheimportanceoftheprinciplesofopendisclosureandanonpunitiveapproachtoincidentmanagement.
6.2.2 Participatinginsystemsofqualityassuranceandimprovement.
6.2.3 Participatinginsystemsforsurveillanceandmonitoringofadverseeventsand‘nearmisses’,includingreportingsuchevents.
6.2.4 Ifyouhavemanagementresponsibilities,makingsurethatsystemsareinplaceforraisingconcernsaboutriskstopatients.
6.2.5 Workinginyourpracticeandwithinsystemstoreduceerrorandimprovepatientsafety,andsupportingcolleagueswhoraiseconcernsaboutpatientsafety.
6.2.6 Takingallreasonablestepstoaddresstheissueifyouhavereasontothinkthatpatientsafetymaybecompromised.
6.3 Doctors’ performance — you and your colleagues
Thewelfareofpatientsmaybeputatriskifadoctorisperformingpoorly.Ifyouconsiderthereisarisk,goodmedicalpracticeinvolves:
6.3.1 Complyingwithanystatutoryreportingrequirements,includingthemandatoryreportingrequirementsundertheNationalLaw.8
6.3.2 Recognisingandtakingstepstominimisetherisksoffatigue,includingcomplyingwithrelevantStateandTerritoryoccupationalhealthandsafetylegislation.
6.3.3 Ifyouknoworsuspectthatyouhaveahealthconditionthatcouldadverselyaffectyourjudgmentorperformance,followingtheguidanceinSection9.2.
6.3.4 Takingstepstoprotectpatientsfromriskposedbyacolleague’sconduct,practiceorillhealth.
6.3.5 Takingappropriatestepstoassistyourcolleaguetoreceivehelpifyouhaveconcernsaboutacolleague’sperformanceorfitnesstopractise.
6.3.6 Ifyouarenotsurewhattodo,seekingadvicefromanexperiencedcolleague,youremployer,doctors’healthadvisoryservices,professionalindemnityinsurers,theMedicalBoardofAustraliaoraprofessionalorganisation.
7Part8Division2ss140–143,Health Practitioner Regulation National Law Act 2009(theNationalLaw)
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7 Maintaining professional performance
7.1 Introduction
Maintaininganddevelopingyourknowledge,skillsandprofessionalbehaviourarecoreaspectsofgoodmedicalpractice.Thisrequiresself-reflectionandparticipationinrelevantprofessionaldevelopment,practiceimprovementandperformance-appraisalprocesses,tocontinuallydevelopyourprofessionalcapabilities.Theseactivitiesmustcontinuethroughoutyourworkinglife,asscienceandtechnologydevelopandsocietychanges.
7.2 Continuing professional development
TheMedialBoardofAustraliahasestablishedregistrationstandardsthatsetouttherequirementsforcontinuingprofessionaldevelopmentandforrecencyofpracticeundertheNationalLaw.9
Developmentofyourknowledge,skillsandprofessionalbehaviourmustcontinuethroughoutyourworkinglife.Goodmedicalpracticeinvolves:
7.2.1 Keepingyourknowledgeandskillsuptodate.
7.2.2 Participatingregularlyinactivitiesthatmaintainandfurtherdevelopyourknowledge,skillsandperformance.
7.2.3 Ensuringthatyourpracticemeetsthestandardsthatwouldbereasonablyexpectedbythepublicandyourpeers.
7.2.4 RegularlyreviewingyourcontinuingmedicaleducationandcontinuingprofessionaldevelopmentactivitiestoensurethattheymeettherequirementsoftheMedicalBoardofAustralia.
7.2.5 Ensuringthatyourpersonalcontinuingprofessionaldevelopmentprogramincludesself-directedandpractice-basedlearning.
7Section38(1)(c)and(e)oftheNationalLawandregistrationstandardsissuedbytheMedicalBoardofAustralia.
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8 Professional behaviour
8.1 Introduction
Inprofessionallife,doctorsmustdisplayastandardofbehaviourthatwarrantsthetrustandrespectofthecommunity.Thisincludesobservingandpractisingtheprinciplesofethicalconduct.
TheguidancecontainedinthissectionemphasisesthecorequalitiesandcharacteristicsofgooddoctorsoutlinedinSection1.4.
8.2 Professional boundaries
Professionalboundariesareintegraltoagooddoctor–patientrelationship.Theypromotegoodcareforpatientsandprotectbothparties.Goodmedicalpracticeinvolves:
8.2.1 Maintainingprofessionalboundaries.
8.2.2 Neverusingyourprofessionalpositiontoestablishorpursueasexual,exploitativeorotherinappropriaterelationshipwithanybodyunderyourcare.Thisincludesthoseclosetothepatient,suchastheircarer,guardianorspouseortheparentofachildpatient.
8.2.3 Avoidingexpressingyourpersonalbeliefstoyourpatientsinwaysthatexploittheirvulnerabilityorthatarelikelytocausethemdistress.
8.3 Reporting obligations
DoctorshavestatutoryobligationsundertheNationalLawtoreportvariousproceedingsorfindingstotheMedicalBoardofAustralia.10Theyalsohaveprofessionalobligationstoreporttothemedicalboardandtheiremployeriftheyhavehadanylimitationsplacedontheirpractice.Goodmedicalpracticeinvolves:
8.3.1 Beingawareofthesereportingobligations.
8.3.2 Complyingwithanyreportingobligationsthatapplytoyourpractice.
8.3.3 Seekingadvicefromthemedicalboardoryourprofessionalindemnityinsurerifyouareunsureaboutyourobligations.
8.4 Medical records
Maintainingclearandaccuratemedicalrecordsisessentialforthecontinuinggoodcareofpatients.Goodmedicalpracticeinvolves:
8.4.1 Keepingaccurate,up-to-dateandlegiblerecordsthatreportrelevantdetailsofclinicalhistory,clinicalfindings,investigations,informationgiventopatients,medicationandothermanagement.
8.4.2 Ensuringthatyourmedicalrecordsareheldsecurelyandarenotsubjecttounauthorisedaccess.
8.4.3 Ensuringthatyourmedicalrecordsshowrespectforyourpatientsanddonotincludedemeaningorderogatoryremarks.
8.4.4 Ensuringthattherecordsaresufficienttofacilitatecontinuityofpatientcare.
8.4.5 Makingrecordsatthetimeoftheevents,orassoonaspossibleafterwards.
8.4.6 Recognisingpatients’righttoaccessinformationcontainedintheirmedicalrecordsandfacilitatingthataccess.
8.4.7 Promptlyfacilitatingthetransferofhealthinformationwhenrequestedbythepatient.
8.5 Insurance
Youhaveaprofessionalobligationtoensurethatyourpracticeisappropriatelycoveredbyprofessionalindemnityinsurance.YoumustmeettherequirementssetoutintheRegistrationStandardforProfessionalIndemnityInsuranceestablishedbytheMedicalBoardofAustraliaundertheNationalLaw.11
8.6 Advertising
Advertisementsformedicalservicescanbeusefulinprovidinginformationforpatients.Alladvertisementsmustconformtorelevantconsumerprotectionlegislation,theadvertisingprovisionsintheNationalLawandAdvertising GuidelinesissuedbytheMedicalBoardofAustralia.12Goodmedicalpracticeinvolves:
8.6.1 Makingsurethatanyinformationyoupublishaboutyourmedicalservicesisfactualandverifiable.
8.6.2 Makingonlyjustifiableclaimsaboutthequalityoroutcomesofyourservicesinanyinformationyouprovidetopatients.
8.6.3 Notguaranteeingcures,exploitingpatients’vulnerabilityorfearsabouttheirfuturehealth,orraisingunrealisticexpectations.
10Sections140–143oftheNationalLaw11Section38(1)(a)oftheNationalLawandtheregistrationstandardissuedbytheMedicalBoardofAustralia12Section133ofNationalLawandAdvertising Guidelines issuedbytheMedicalBoardofAustralia
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8.6.4 Notofferinginducementsorusingtestimonials.
8.6.5 Notmakingunfairorinaccuratecomparisonsbetweenyourservicesandthoseofcolleagues.
8.7 Medico-legal, insurance and other assessments
Whenyouarecontractedbyathirdpartytoprovideamedico-legal,insuranceorotherassessment13ofapersonwhoisnotyourpatient,theusualtherapeuticdoctor–patientrelationshipdoesnotexist.Inthissituation,goodmedicalpracticeinvolves:
8.7.1 Applyingthestandardsofprofessionalbehaviourdescribedinthiscodetotheassessment;inparticular,beingcourteous,alerttotheconcernsoftheperson,andensuringthatyouhavetheperson’sconsent.
8.7.2 Explainingtothepersonyourareaofmedicalpractice,yourrole,andthepurpose,natureandextentoftheassessmenttobeconducted.
8.7.3 Anticipatingandseekingtocorrectanymisunderstandingsthatthepersonmayhaveaboutthenatureandpurposeofyourassessmentandreport.
8.7.4 Providinganimpartialreport(seeSection8.8).
8.7.5 Recognisingthat,ifyoudiscoveranunrecognised,seriousmedicalproblemduringyourassessment,youhaveadutyofcaretoinformthepatientortheirtreatingdoctor.
8.8 Medical reports, certificates and giving evidence
Thecommunityplacesagreatdealoftrustindoctors.Consequently,doctorshavebeengiventheauthoritytosignavarietyofdocuments,suchasdeathcertificatesandsicknesscertificates,ontheassumptionthattheywillonlysignstatementsthattheyknow,orreasonablybelieve,tobetrue.Goodmedicalpracticeinvolves:
8.8.1 Beinghonestandnotmisleadingwhenwritingreportsandcertificates,andonlysigningdocumentsyoubelievetobeaccurate.
8.8.2 Takingreasonablestepstoverifythecontentbeforeyousignareportor
certificate,andnotomittingrelevantinformationdeliberately.
8.8.3 Preparingorsigningdocumentsandreportsifyouhaveagreedtodoso,withinareasonableandjustifiabletimeframe.
8.8.4 Makingclearthelimitsofyourknowledgeandnotgivingopinionbeyondthoselimitswhenprovidingevidence.
8.9 Curriculum vitae
Whenprovidingcurriculumvitae,goodmedicalpracticeinvolves:
8.9.1 Providingaccurate,truthfulandverifiableinformationaboutyourexperienceandyourmedicalqualifications.
8.9.2 Notmisrepresenting,bymisstatementoromission,yourexperience,qualificationsorposition.
8.10 Investigations
Doctorshaveresponsibilitiesandrightsrelatingtoanylegitimateinvestigationoftheirpracticeorthatofacolleague.Inmeetingtheseresponsibilities,itisadvisabletoseeklegaladviceoradvicefromyourprofessionalindemnityinsurer.Goodmedicalpracticeinvolves:
8.10.1 Cooperatingwithanylegitimateinquiryintothetreatmentofapatientandwithanycomplaintsprocedurethatappliestoyourwork.
8.10.2 Disclosing,toanyoneentitledtoaskforit,informationrelevanttoaninvestigationintoyourownoracolleague’sconduct,performanceorhealth.
8.10.3 Assistingthecoronerwhenaninquestorinquiryisheldintoapatient’sdeathbyrespondingtotheirenquiriesandbyofferingallrelevantinformation.
8.11 Conflicts of interest
Patientsrelyontheindependenceandtrustworthinessofdoctorsforanyadviceortreatmentoffered.Aconflictofinterestinmedicalpracticeariseswhenadoctor,entrustedwithactingintheinterestsofapatient,alsohasfinancial,professionalorpersonalinterests,orrelationshipswiththirdparties,whichmayaffecttheircareofthepatient.
Multipleinterestsarecommon.Theyrequireidentification,carefulconsideration,appropriatedisclosureandaccountability.Whentheseinterestscompromise,ormight
10SeeIndependent Medical Assessments on Behalf of Parties Other Than the Patient —1998(revised2002)(http://www.ama.com.au/node/510)
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reasonablybeperceivedbyanindependentobservertocompromise,thedoctor’sprimarydutytothepatient,doctorsmustrecogniseandresolvethisconflictinthebestinterestsofthepatient.
Goodmedicalpracticeinvolves:
8.11.1 Recognisingpotentialconflictsofinterestthatmayariseinrelationtoinitiatingorcontinuingaprofessionalrelationshipwithapatient.
8.11.2 Actinginyourpatients’bestinterestswhenmakingreferralsandwhenprovidingorarrangingtreatmentorcare.
8.11.3 Informingpatientswhenyouhaveaninterestthatcouldaffect,orcouldbeperceivedtoaffect,patientcare.
8.11.4 Recognisingthatpharmaceuticalandothermedicalmarketinginfluencesdoctors,andbeingawareofwaysinwhichyourpracticemaybebeinginfluenced.
8.11.5 Recognisingpotentialconflictsofinterestinrelationtomedicaldevicesandappropriatelymanaginganyconflictthatarisesinyourpractice.
8.11.6 Notaskingfororacceptinganyinducement,giftorhospitalityofmorethantrivialvalue,fromcompaniesthatsellormarketdrugsorappliancesthatmayaffect,orbeseentoaffect,thewayyouprescribefor,treatorreferpatients.
8.11.7 Notaskingfororacceptingfeesformeetingsalesrepresentatives.
8.11.8 Notofferinginducementstocolleagues,orenteringintoarrangementsthatcouldbeperceivedtoprovideinducements.
8.11.9 Notallowinganyfinancialorcommercialinterestinahospital,otherhealthcareorganisation,orcompanyprovidinghealthcareservicesorproductstoadverselyaffectthewayinwhichyoutreatpatients.Whenyouoryourimmediatefamilyhavesuchaninterestandthatinterestcouldbeperceivedtoinfluencethecareyouprovide,youmustinformyourpatient.
8.12 Financial and commercial dealings
Doctorsmustbehonestandtransparentinfinancialarrangementswithpatients.Goodmedicalpracticeinvolves:
8.12.1 Notexploitingpatients’vulnerabilityorlackofmedicalknowledgewhenprovidingorrecommendingtreatmentorservices.
8.12.2 Notencouragingpatientstogive,lendorbequeathmoneyorgiftsthatwillbenefityoudirectlyorindirectly.
8.12.3 Avoidingfinancialinvolvement,suchasloansandinvestmentschemes,withpatients.
8.12.4 Notpressuringpatientsortheirfamiliestomakedonationstootherpeopleororganisations.
8.12.5 Beingtransparentinfinancialandcommercialmattersrelatingtoyourwork,includinginyourdealingswithemployers,insurersandotherorganisationsorindividuals.Inparticular:
• declaringanyrelevantandmaterialfinancialorcommercialinterestthatyouoryourfamilymighthaveinanyaspectofthepatient’scare
• declaringtoyourpatientsyourprofessionalandfinancialinterestinanyproductyoumightendorseorsellfromyourpractice,andnotmakinganunjustifiableprofitfromthesaleorendorsement.
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9 Ensuring doctors’ health
9.1 Introduction
Asadoctor,itisimportantforyoutomaintainyourownhealthandwellbeing.Thisincludesseekinganappropriatework–lifebalance.
9.2 Your health
Goodmedicalpracticeinvolves:
9.2.1 Havingageneralpractitioner.
9.2.2 Seekingindependent,objectiveadvicewhenyouneedmedicalcare,andbeingawareoftherisksofself-diagnosisandself-treatment.
9.2.3 Makingsurethatyouareimmunisedagainstrelevantcommunicablediseases.
9.2.4 ConformingtothelegislationinyourStateorTerritoryinrelationtoself-prescribing.
9.2.5 Recognisingtheimpactoffatigueonyourhealthandyourabilitytocareforpatients,andendeavouringtoworksafehourswhereverpossible.
9.2.6 Beingawareofthedoctors’healthprograminyourStateorTerritoryifyouneedadviceonwheretoseekhelp.
9.2.7 Ifyouknoworsuspectthatyouhaveahealthconditionorimpairmentthatcouldadverselyaffectyourjudgment,performanceoryourpatient’shealth:
• notrelyingonyourownassessmentoftheriskyouposetopatients
• consultingyourdoctoraboutwhether,andinwhatways,youmayneedtomodifyyourpractice,andfollowingthedoctor’sadvice.
9.3 Other doctors’ health
Doctorshavearesponsibilitytoassistmedicalcolleaguestomaintaingoodhealth.AllhealthprofessionalshaveresponsibilitiesincertaincircumstancesformandatorynotificationundertheNationalLaw.14Goodmedicalpracticeinvolves:
9.3.1 Providingdoctorswhoareyourpatientswiththesamequalityofcareyouwouldprovidetootherpatients.
9.3.2 NotifyingtheMedicalBoardofAustraliaifyouaretreatingadoctorwhoseabilitytopractisemaybeimpairedandmaytherebybeplacingpatientsatrisk.Thisisalwaysaprofessional,andinsomejurisdictions,astatutory,responsibility.
9.3.3 Encouragingacolleague(whomyouarenottreating)toseekappropriatehelpifyoubelievetheymaybeillandimpaired.Ifyoubelievethisimpairmentisputtingpatientsatrisk,notifytheMedicalBoardofAustralia.Itmayalsobewisetoreportyourconcernstothedoctor’semployerandtoadoctors’healthprogram.
9.3.4 Recognisingtheimpactoffatigueonthehealthofcolleagues,includingthoseunderyoursupervision,andfacilitatingsafeworkinghourswhereverpossible.
14Sections140–143oftheNationalLawandMandatory Reporting GuidelinesissuedbytheMedicalBoardofAustralia.
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10 Teaching, supervising and assessing
10.1 Introduction
Teaching,supervisingandmentoringdoctorsandmedicalstudentsisimportantfortheirdevelopmentandforthecareofpatients.Itispartofgoodmedicalpracticetocontributetotheseactivitiesandprovidesupport,assessment,feedbackandsupervisionforcolleagues,doctorsintrainingandstudents.
10.2 Teaching and supervising
Goodmedicalpracticeinvolves:
10.2.1 Seekingtodeveloptheskills,attitudesandpracticesofaneffectiveteacher,wheneveryouareinvolvedinteaching.
10.2.2 Makingsurethatanydoctorormedicalstudentforwhosesupervisionyouareresponsiblereceivesadequateoversightandfeedback.
10.3 Assessing colleagues
Assessingcolleaguesisanimportantpartofmakingsurethatthehigheststandardsofmedicalpracticeareachieved.Goodmedicalpracticeinvolves:
10.3.1 Beinghonest,objectiveandconstructivewhenassessingtheperformanceofcolleagues,includingstudents.Patientswillbeputatriskifyoudescribeascompetentsomeonewhoisnot.
10.3.2 Providingaccurateandjustifiableinformationwhengivingreferencesorwritingreportsaboutcolleagues.Dosopromptlyandincludeallrelevantinformation.
10.4 Medical students
Medicalstudentsarelearninghowbesttocareforpatients.Creatingopportunitiesforlearningimprovestheirclinicalpracticeandnurturesthefutureworkforce.Goodmedicalpracticeinvolves:
10.4.1 Treatingyourstudentswithrespectandpatience.
10.4.2 Makingthescopeofthestudent’sroleinpatientcarecleartothestudent,topatientsandtoothermembersofthehealthcareteam.
10.4.3 Informingyourpatientsabouttheinvolvementofmedicalstudents,andencouragingtheirconsentforstudentparticipationwhilerespectingtheirrighttochoosenottoconsent.
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11 Undertaking research
11.1 Introduction
Researchinvolvinghumans,theirtissuesamplesortheirhealthinformation,isvitalinimprovingthequalityofhealthcareandreducinguncertaintyforpatientsnowandinthefuture,andinimprovingthehealthofthepopulationasawhole.ResearchinAustraliaisgovernedbyguidelines15issuedinaccordancewiththeNational Health and Medical Research Council Act 1992.Ifyouundertakeresearch,youshouldfamiliariseyourselfwith,andfollow,theseguidelines.
ResearchinvolvinganimalsisgovernedbylegislationinStatesandTerritoriesandbyguidelinesissuedbytheNationalHealthandMedicalResearchCouncil(NHMRC).16
11.2 Research ethics
Beinginvolvedinthedesign,organisation,conductorreportingofhealthresearchinvolvinghumansbringsparticularresponsibilitiesfordoctors.Theseresponsibilities,drawnfromtheNHMRCguidelines,include:
11.2.1 Accordingtoparticipantstherespectandprotectionthatisduetothem.
11.2.2 Actingwithhonestyandintegrity.
11.2.3 Ensuringthatanyprotocolforhumanresearchhasbeenapprovedbyahumanresearchethicscommittee,inaccordancewiththeNational Statement on Ethical Conduct in Human Research.
11.2.4 Disclosingthesourcesandamountsoffundingforresearchtothehumanresearchethicscommittee.
11.2.5 Disclosinganypotentialoractualconflictsofinteresttothehumanresearchethicscommittee.
11.2.6 Ensuringthathumanparticipationisvoluntaryandbasedonanadequateunderstandingofsufficientinformationaboutthepurpose,methods,demands,risksandpotentialbenefitsoftheresearch.
11.2.7 Ensuringthatanydependentrelationshipbetweendoctorsandtheirpatientsistakenintoaccountintherecruitmentofpatientsasresearchparticipants.
11.2.8 Seekingadvicewhenresearchinvolveschildrenoradultswhoarenotabletogiveinformedconsent,toensurethatthereareappropriatesafeguardsinplace.Thisincludesensuringthatapersonempoweredtomakedecisionsonthepatient’sbehalfhasgiveninformedconsent,orthatthereisotherlawfulauthoritytoproceed.
11.2.9 Adheringtotheapprovedresearchprotocol.
11.2.10Monitoringtheprogressoftheresearchandpromptlyreportingadverseeventsorunexpectedoutcomes.
11.2.11Respectingtheentitlementofresearchparticipantstowithdrawfromanyresearchatanytimeandwithoutgivingreasons.
11.2.12Adheringtotheguidelinesregardingpublicationoffindings,authorshipandpeerreview.
11.2.13ReportingpossiblefraudormisconductinresearchasrequiredundertheAustralian Code for the Responsible Conduct of Research.
11.3 Treating doctors and research
Whenyouareinvolvedinresearchthatinvolvesyourpatients,goodmedicalpracticeincludes:
11.3.1 Respectingthepatients’righttowithdrawfromastudywithoutprejudicetotheirtreatment.
11.3.2 Ensuringthatapatient’sdecisionnottoparticipatedoesnotcompromisethedoctor–patientrelationshiportheircare.
15SeetheNational Statement on Ethical Conduct in Human Research(NHMRC2007;http://www.nhmrc.gov.au/publications/synopses/e72syn.htm)andtheAustralian Code for the Responsible Conduct of Research(NHMRC2007;http://www.nhmrc.gov.au/PUBLICATIONS/synopses/r39syn.htm)16SeetheAustralian Code of Practice for the Care and Use of Animals for Scientific Purposes,7thedition(NHMRC2004;http://www.nhmrc.gov.au/publications/synopses/ea16syn.htm)
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AcknowledgementsTheMedicalBoardofAustraliaacknowledgestheworkoftheAustralianMedicalCouncil(AMC)indevelopingthiscode.
Inthefirsteditionofthecode,theAustralianMedicalCouncilacknowledgedtheworkinggroupthatguidedthedevelopmentofthecode;thecontributionoftheorganisationsandindividualswhosethoughtfulfeedbackinformeditsdevelopment;thecontributionoftheAustralianGovernmentDepartmentofHealthandAgeingtotheextensiveconsultationprocessthatsupportedit;andStateandTerritorymedicalboardsthatendorsedit.
Indevelopingthiscode,theAMCconsideredanddrewonbothgeneralandspecificinformationaboutstandardsfromcodesofgoodmedicalpracticeissuedbyAustralianStateandTerritorymedicalboardsandtheAustralianMedicalAssociationCode of Ethics.TheprocesswasalsoinformedbysimilardocumentsissuedbytheGeneralMedicalCounciloftheUnitedKingdom,theMedicalCouncilofNewZealand,theNationalAllianceforPhysicianCompetenceintheUnitedStatesandtheRoyalCollegeofPhysiciansandSurgeonsinCanada.Inaddition,sectionsofthecodewereinformedbyrelevantguidelinesissuedbytheNationalHealthandMedicalResearchCouncilandbyguidelinesdevelopedbyspecialistmedicalcollegesinAustraliaandNewZealand.