Asst. Prof., Dept. of Medical EthicsKing Fahad Medical City – Faculty of MedicineKing Saud Bin Abdul-Aziz University for Health Sciences

Dr. Ghaiath M. A. Hussein

Saudi Commission for Health SpecialtiesProfessionalism and Ethics Education for Residents (PEER)

Doctor’s Professional Duties

Introduction: Doctor’s relationship and roles Professionalism and Professional Attributes Doctor’s duties towards himself/herself Doctor’s duties towards his/her colleagues Doctor’s duties towards his/her profession Doctor’s duties towards his/her community

Outline

Before we start…where are we?

Patient

Health Educator

Doctor

Social worker

Nurse

Manager

Doctors Are NOT the focus of the healthcare

Doctor’s Roles

YOU

Healer

Educator/ Scholar

Researcher

Planner

Health Advocate

Communicator

Professionalism

“constituting those attitudes and behaviors that serve to maintain patient interest above physician self-interest.”

American Board of Internal Medicine

Professional competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit

of the individual and community being served. Epstein and Hundert

What is professionalism about?

The ethics of professionalism in medicine is more concerned withthe characteristics and behaviors of physicians in the context ofmedicine as a profession. Specifically, it examines desirable andundesirable attributes of physicians.

What is professionalism about?Undesirable conduct Desirable Behaviors

Abuse of power, Bias, Sexual harassment, Breach of confidentiality, Arrogance, Greed, Misrepresentation, Impairment, Lack of conscientiousness, and Conflicts of interest

Altruism,Accountability, Excellence, Duty, Honor, Integrity, Respect for others, and A commitment to lifelong learning

Source:http://www.med.uottawa.ca/students/md/professionalism/eng/what_is_professionalism.html

Muslim Leading Medical Ethicists!“… The physician should be modest, virtuous and merciful… He

should wear clean clothes, be dignified, and have well- groomed hair and beard. He should select his company to be persons of good reputation. He should be careful of what he says and should not hesitate to ask forgiveness if he has made an error...

He should be punctual and reliable… He should not wrangle about his fees... He should not give drugs to a pregnant woman for an abortion unless necessary for the mother's health...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.

“Al-Tabari, 970 A.D., Fardous Al Hikma

Oath of Muslim Doctor

“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, friend and enemy;

Oath of Muslim Doctor

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.”

Muslim Doctors’ Duties Towards Patients

Respect for Patient المريض احترام Respect for Privacy المريض خصوصية ضمان Comprehensive care للمريض الشاملة الرعاية Respect for patient’s autonomy المريض استقاللية احترام Inform the patient about his/her condition بطبيعة المريض تبصير مرضه

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

Source: Islamic Code of Medical & Health Ethics

Doctors’ Duties Towards Patients (KSA) Listen carefully, treat fairly and show respect (especially during

history taking and examination) Treat them fairly (no discrimination because of religion, sex, race,

etc.) Provide advice and be supportive Respect privacy (when examining their bodies) Keeping the patient's medical information strictly confidential Provide the best of your knowledge and skills needed for the

condition, even if they are incurable and terminally ill or dying. Refer to a specialized (more expert) physician as needed Refrain from causing any harm to your patients Take consent from patients before any intervention

Physician's Duties Towards Colleagues To deal with, and act towards his colleagues in a good manner

and in the same way he would prefer to be treated To avoid direct criticism to his colleague in front of patients Not to indulge in defaming the honor of his colleagues To exert every possible effort to educate the colleagues Respect the differences with colleagues (sex, culture, belief…). The physician should respect other non-physician medical

profession colleagues, and appreciate their roles in healthcare of the patient

She/he must report the incidence in which a colleague could be dangerous to the authority concerned

Source: Saudi Council for Health Specialties Manual of Ethics of the Medical Profession

Doctor’s Duties Towards his Profession

Respect the honour of the profession; Develop him/herself to develop the profession through CME,

research, and publications; Adhere to the standards of practice (GCP, EBM, guidelines, etc.) Abstain from any behaviour/action that would question his/her

credibility, or establish dishonest affairs with patients or their families;

Avoid the request of fame on the account of the professional ethics and standards

To provide role model for his colleagues and patients

Source: Islamic Code of Medical & Health Ethics

Doctor’s Duties Towards his Profession

Reflect sincere devotion and dedication to the medical profession.

To avoid any action that could lead to contempt of the medical profession and to maintain the standards of medical profession

To contribute in the development of the profession through research and continuous learning.

The physician should not take advantage of his profession position for obtaining any material or moral gains, which are not in conformity with or violate the laws and tradition.

Doctor’s Duties Towards his Profession

To take the appropriate procedure when he comes to know that one of the members of the health team is sick, ignorant or negligent of his duties; in furtherance of protecting the patient in the first place and the medical profession next.

The physician should refrain, when dealing with the patient, from any act or conduct that would infringe his honesty and integrity.

To avoid seeking fame at the expense of the profession ethics and principles.

Doctor’s Role Towards Community

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.

Source: Islamic Code of Medical & Health Ethics

Doctor’s Role Towards Community

To be as an ideal (example) in his attitude and religion

Promotion of health equity among the society members

Maintenance of health resources and the ideal utilization of such resources.

Use his skills, knowledge and expertise to improve the standards and quality of health services rendered to the society.

Doctor’s RightsThe 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 she/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)

Lack of ProfessionalismSigns and Symptoms (ABIM, 2001)1. Abuse of power:

– Abuse while interacting with patients and colleagues; – Bias and sexual harassment; and – Breach of confidentiality

2. Arrogance (offensive display of superiority and self-importance);

3. Greed (when money becomes the driving force);

4. Misrepresentation (lying, which is consciously failing to tell the truth; and fraud, which is conscious misrepresentation of material fact with the intent to mislead);

Lack of Professionalism Cont.Signs and Symptoms (ABIM, 2001)

5. Impairment (any disability that may prevent the physician from discharging his/her duties);

6. Lack of conscientiousness (failure to fulfill responsibilities);

7. Conflicts in interests (self-promotion/ advertising or unethical collaboration with industry; acceptance of gifts; and misuse of services – overcharging, inappropriate treatment or prolonging contact with patients).

Types of Unprofessional Acts

Minor lapses,

Major lapses, and

Critical events

Minor LapsesMinor lapses are errors but have minimal consequences. Often there is no awareness of the unprofessional act or it occurs afterthe fact. There may often be mitigating circumstances.

Examples: 1. Resident falls asleep on a stretcher in the hall of the

hospital. 2. Resident does not meet deadline for paper due to family

illness but does not notify anyone.

Major LapsesMajor lapses are errors but have serious consequences. Often there is awareness of the unprofessional act . Usually, there are nomitigating circumstances.

Examples: 1. Resident refuses to return phone calls and e-mails from

a professor. 2. Resident does not answer his pager from the emergency

room3. Resident rushes in to see a patient with “interesting”

findings despite being told to not do so.

Critical Events

Critical events are serious events that will require immediate actionby the supervisor. It is a clear violation of the code of conduct.

Examples: 1. Resident being dishonest either by lying or

misrepresenting himself/herself.2. Resident hitting a patient. 3. Resident being sexually inappropriate with a patient or

fellow member of the health care team.

Questions and Discussion