Overview of Doctor’s Roles and

DutiesPresentation to 4th year medical students, FOM-KFMC (Feb. 27, 2012)

Ghaiath M. A. HusseinAsst. Prof., Dept. of Medical Ethics

King Fahad Medical City – Faculty of Medicine

King Saud Bin Abdul-Aziz University for Health Sciences

Email: ghaiathme@gmail.com; ghussein@kfmc.med.sa

Office: 01-2889999 Ext.7588, Mob.: 0566511653

Patient

Doctor

Guards

Lab./X-ray

Social worker

Nurses

Paramedics

Manager

Educator

Who is the FOCUS of healthcare?

Doctors Are NOT the focus of the healthcare

Ishaq ibn ‘Ali Al-Rahawi (9th century CE) wrote a book entitled Adab al-Tabib or ‘The Ethics of the Physician’ .

Al-Tabari, the chief physician in 970 A.D., described also the Islamic code of ethics in his book Fardous Al Hikma stated: “… The physician should be modest, virtuous and merciful…

He should wear clean clothes, and have well- groomed hair and beard. He should not hesitate to ask forgiveness if he has made an error….

He should be forgiving and never seek revenge…. He ought not loose his temper when his patient keeps asking questions, but should answer gently and compassionately… He should treat alike the rich and the poor, the master and the servant ….

He should be punctual and reliable…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…. “

What Muslim medical ethicists said?

“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 and friend and enemy; 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.”

Any thoughts?

Oath of Muslim doctor

What are your roles as a doctor?

Based on CanMED Framework (http://www.rcpsc.edu/canmeds/CanMEDS2005/index.php)

Definition: As Medical Experts, physicians integrate all of the doctor’s roles, applying medical knowledge, clinical skills, and professional attitudes in their provision of patient-centered care.

Key Competencies: Physicians are able to…1. Function effectively as consultants, integrating all of their roles

to provide optimal, ethical and patient-centered care;2. Establish and maintain clinical knowledge, skills and attitudes

appropriate to their practice;3. Perform a complete and appropriate assessment of a patient;4. Use preventive and therapeutic interventions effectively;5. Demonstrate proficient and appropriate use of procedural

skills, both diagnostic and therapeutic;6. Seek appropriate consultation from other health professionals,

recognizing the limits of their expertise.

1. Medical Expert

Definition: As Communicators, physicians effectively facilitate the doctor-patient relationship and the dynamic exchanges that occur before, during, and after the medical encounter.

Key Competencies: Physicians are able to…1. Develop rapport, trust and ethical therapeutic relationships

with patients and families;2. Accurately elicit and synthesize relevant information and

perspectives of patients and families, colleagues and other professionals;

3. Accurately convey relevant information and explanations to patients and families, colleagues and other professionals;

4. Develop a common understanding on issues, problems and plans with patients and families, colleagues and other professionals to develop a shared plan of care;

5. Convey effective oral and written information about a medical encounter.

2. Communicator

Definition: As Collaborators, physicians effectively work within a healthcare team to achieve optimal patient care.

Key Competencies: Physicians are able to…1. Participate effectively and appropriately in an interprofessional healthcare team;2. Effectively work with other health professionals to prevent, negotiate, and

resolve interprofessional conflict

4. ManagerDefinition: As Managers, physicians are integral participants in healthcare

organizations, organizing sustainable practices, making decisions about allocating resources, and contributing to the effectiveness of the healthcare system.

Key Competencies: Physicians are able to…1. Participate in activities that contribute to the effectiveness of their healthcare

organizations and systems;2. Manage their practice and career effectively;3. Allocate finite healthcare resources appropriately;4. Serve in administration and leadership roles, as appropriate.

3. Collaborator

Definition: As Health Advocates, physicians responsibly use their expertise and influence to advance the health and well-being of individual patients, communities, and populations.

Key Competencies: Physicians are able to…1. Respond to individual patient health needs and issues as

part of patient care;2. Respond to the health needs of the communities that

they serve;3. Identify the determinants of health of the populations that

they serve;4. Promote the health of individual patients, communities

and populations.

5. Health Advocate

Definition: As Scholars, physicians demonstrate a lifelong commitment to reflective learning, as well as the creation, dissemination, application and translation of medical knowledge.

Key Competencies: Physicians are able to…1. Maintain and enhance professional activities through ongoing

learning;2. Critically evaluate information and its sources, and apply this

appropriately to practice decisions;3. Facilitate the learning of patients, families, students, residents,

other health professionals, the public, and others, as appropriate;

4. Contribute to the creation, dissemination, application, and translation of new medical knowledge and practices.

6. Scholar

Doctors’ Duties(Part 1: Towards patients& community)

A PHYSICIAN SHALL

Always exercise his/her independent professional judgment and maintain the highest standards of professional conduct.

Respect a competent patient's right to accept or refuse treatment.

Not allow his/her judgment to be influenced by personal profit or unfair discrimination.

Be dedicated to providing competent medical service in full professional and moral independence, with compassion and respect for human dignity.

GENERAL DUTIES OF PHYSICIANS (WMA)

A PHYSICIAN SHALL Deal honestly with patients and colleagues, and

report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception.

Not receive any financial benefits or other incentives solely for referring patients or prescribing specific products.

Respect the rights and preferences of patients, colleagues, and other health professionals.

GENERAL DUTIES OF PHYSICIANS (WMA)

A PHYSICIAN SHALL Recognize his/her important role in educating the

public but should use due caution in divulging discoveries or new techniques or treatment through non-professional channels.

Certify only that which he/she has personally verified.

Strive to use health care resources in the best way to benefit patients and their community.

Seek appropriate care and attention if he/she suffers from mental or physical illness.

Respect the local and national codes of ethics

GENERAL DUTIES OF PHYSICIANS (WMA)

Respect for Patient المريض احترام Respect for Privacy المريض خصوصية ضمان Comprehensive care للمريض الشاملة الرعاية Respect for patient’s autonomy استقاللية احترام المريض

Inform the patient about his/her condition تبصيرمرضه بطبيعة المريض

Protect patient's interests المريض مصلحة حماية Keep the patients’ secrets المريض سر كتمان

Muslim Doctors’ Duties Towards Patients

Source: Islamic Code of Medical & Health Ethics

A physician should: Listen carefully to the patient’s complaint, sympathizing with him

in his suffering, treat him well, and be gentle while examining him. Respect his patient’s opinion, but that should not keep the

physician from giving the appropriate instructions. Treat all his patients equally, without any discrimination based on

their prestige, their social or moral status, the physician’s own feelings towards them, their religious or racial background, their political orientation, or their gender, nationality, or color.

Fear God when dealing with his patients; show respect for their beliefs, religions, and traditions

Avoid any violations of Islamic law, such as being alone with a member of the opposite sex or looking at the private parts ('awra) of a patient except in as much as the process of examination, diagnosis, and treatment requires; in the presence of in the presence of a third party; and after obtaining permission from the patient.

DUTIES OF PHYSICIANS TO PATIENTS

Source: The Islamic Charter of Medical and Health Ethics

A physician should Ask only for the tests needed for the patient, without adding any tests

not justified by the patient’s case. He should base his whole diagnosis and treatment on the best available evidence and data.

Honestly explain to the patient or anyone representing him the type, causes, and complications of the illness, and of the usefulness of diagnostic and therapeutic procedures.

NOT hesitate to refer the patient to a more experienced doctor or to a doctor who has more effective equipment whenever the patient’s case calls for such a referral, nor to refer him to a doctor whom the patient wishes to consult.

Continue to give an emergency patient the proper treatment until it is no longer needed or until care for the patient is taken over by another doctor.

Continue to extend proper care to patients with incurable, terminal, or fatal diseases, and to console them and give them hope to the last minutes of their lives.

Relieve the patient’s pain and give him the feeling that the physician is eager to give him proper care and attention.

DUTIES OF PHYSICIANS TO PATIENTS

Source: The Islamic Charter of Medical and Health Ethics

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.

Doctor’s role towards soceity

Source: The Islamic Charter of Medical and Health Ethics

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 s/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)

Doctor’s Rights...

The Islamic Charter of Medical and Health Ethics. (www.emro.who.int/PDF/IslamicCharter_MedicalHealthEthics.pdf)

The CanMEDS 2005 Physician Competency Framework (http://www.ub.edu/medicina_unitateducaciomedica/documentos/CanMeds.pdf)

WMA International Code of Medical Ethics (http://www.wma.net/en/30publications/10policies/c8/)

References and required readings

QUESTIONS & DISCUSSIONS