Session 3: Inter-collegial relations and principles of professional ethics

Question 1

What are ethical guidelines?

Answer 1

Standards of conduct establishing the essence of honourable behaviour.

Question 2

What are the 4 HCPSA ethical guidelines?

Answer 2

1. The Hippocratic Oath
2. International code of medical ethics
3. Declaration of Geneva
4. Credo

Question 3

What are the 2 broad categories of medical ethics?

Answer 3

1. Interests of the patient

2. Mutual relations between colleagues

Question 4

What 6 things does the HPCSA expect from doctors?

Answer 4

1. Sufficient evaluation of the patient
2. Applicable and special examinations
3. Sufficient and correct acts, e.g notes, correct use of resources
4. Refer when indicated
5. Knowing limitations
6. Being up to date

Question 5

How is the present milieu structured?

Answer 5

1. THE SYSTEM
   * Little in service networking, thus little comprehension of conditions
   * Little in-service training because of compartmentalization (lack of support by senior colleagues)
2. PARADIGM SHIFT
   * Team approach vs. paternalism
   * Pressure on all compartments- everyone protects their own wickets
   * Effect of top management
   - poor leadership in Dept. of Health,
   - centralized decision-making
   - racial basis for appointments and actions
   - financial policies and budgetary focus
   - restrictions
   - rationalizations
   * Services
   - limited capability to manage numbers
   - numbers overload
   - down referrals to lower levels demand
   - aggression of patients
   - burnout and demotivation
   - limitation of beds
   - transport system
   - limitations on special investigations
   * Academic
   - less than optimal relations
3. PERSONAL
   * Highly selected, younger and inexperienced doctors
   * Personality and cultural differences
   * Communication styles differ, resulting in gaps
   - ineffective call systems
   - unfair/unrealistic expectations
   - disrespect at all levels
   - professional immaturity
   - lack of integrity
   - role confusion
   * HIV impact
   * Incapable, unwilling & absent support personnel
   * Limiting rules and regulations, e.g rules sonar, scans, repeat prescriptions, cholesterol, etc.

Question 6

Name and describe the 2 professional roles.

Answer 6

1. THE GENERAL PRACTITIONER/ FAMILY DOCTOR
   * Coordinates the patient’s total medical care system and the
   access to all the other compartments of the system
2. THE CONSULTANT/ SPECIALIST
   * Focuses on a specific aspect of health care
   * Starting point of specialized care
   * Specialised care is mostly a once-ff & for specific reasons

Question 7

Name and describe the 3 types of inter-collegial relationships in health care.

Answer 7

1. Between colleagues of the same discipline
   * partners, associates, assistants, locums, and opposition
2. Between a GP and specialist
   * can be positive, neutral, or negative
3. Between members of allied professions and the above
   * may include non-medical, alternative professions e.g nurses,
   physios, OT, clinical psychology, dietitians, social work,
   pastoral care, dentist, etc.

Question 8

Name 5 factors that positively affect relationships between colleagues.

Answer 8

1. Professional maturity
2. Attitude, friendship, non-selfishness
3. Common approach to problem-solving
4. Willingness to learn
5. Respect fosters respect

Question 9

Name 5 factors that negatively affect relationships between colleagues.

Answer 9

1. Perceived difference in status
2. Cultural and language differences
3. Perceptions
4. Misconception of roles
5. Communication problems
   - poor referrals
   - poor feedback
   - referrals too late
   - competition
   - bad mouthing

Question 10

Discuss inter-professional communication.

Answer 10

• Good referrals and the correctness of the entire process rely
  on effective communication between colleagues.
• Healthy communication is direct, immediate, healthily
  assertive, and clear.

Question 11

What does referring mean?

Answer 11

Transferring part of, or all of the responsibilities for a patient’s care, usually temporarily and for a specific indication.
*effective communication

Question 12

What is peer review?

Answer 12

Method> improve the quality of care> evaluation of medical care> practitioners from comparable practicing environments and comparably trained.

Question 13

What is external peer review?

Answer 13

• Evaluation of medical practice by external evaluators on grounds of complaints received.
• Starts w/ preliminary investigation
• Formal investigation follows if necessary.

Question 14

What is whistle-blowing?

Answer 14

The necessary reporting of doctors whose practice is below acceptable standards.

• Disclosures Act provides protection
• Impairment (when the problem is noted)

Question 15

What are the 2 aspects of supersession?

Answer 15

1. Unacceptable taking over of a patient who’s still under the care of another practitioner
2. Unacceptable hindering of a patient to obtain a 2nd opinion

Question 16

What are the two aspects of bad-mouthing?

Answer 16

1. Verbal

2. Suggestion or reflection

Question 17

What is consent?

Answer 17

A requirement for administering any form of treatment, whether diagnostic or therapeutic

• Patient has a right to self-determination
• It is up to the Dr to decide whether a minor can now give consent

Question 18

What are the 5 key requirements for consent?

Answer 18

1. Willing
2. Explicit
3. Specific reasons
4. Not against good morals
5. Accountable patient

Question 19

Discuss the guidelines to follow for consent.

Answer 19

• 10+ years= consent to treatment
• 12+ years= consent to operations
• If underage, the father’s decision is decisive if parents are split.
• Mentally disabled: curator, spouse, adult child, brother or sister
• Spouses can consent independently

Question 20

When is consent valid?

Answer 20

When based on necessary knowledge in respect of the nature+ effect of the proposed treament.

Question 21

Name and discuss the 4 key elements of informed consent.

Answer 21

1. Disclosure of information- info generally required by a patient
2. Comprehension of the information- intellect and effective communication
3. Willing consent- selecting own objectives from a variety of options
4. Juristic capacity- ability to come to a conclusion based on rational grounds

Question 22

What does confidentiality entail?

Answer 22

1. In secret, may not be repeated
2. Divulging any information about a patient w/o consent
3. All identifiable information regarding a patient, their condition,
   diagnosis, prognosis, treatment, etc, must be kept
   confidential EVEN AFTER THE DEATH OF THE PATIENT-
   Otherwise it’s a violation of their right to privacy.
4. Confidentiality may only be disclosed w/ permission
5. Exceptions: court; public interest

Question 23

Examples of confidentiality breaching situations.

Answer 23

1. Ward rounds
2. Lay-out of the practice waiting area
3. Certificates
4. Typists
5. Visibility of computers
6. Telephonically - identity and issues must be established
7. Tea room
8. W/ consent: court, 2nd opinion, colleague, the interest of the patient, duty towards the community

Question 24

List the 4 acceptable forms of business practices.

Answer 24

1. Solus practice
2. Partnerships
3. Associations
4. Incorporated practices

Question 25

Unacceptable forms of business practices.

Answer 25

• A non-medical person may not own a medical practice
• Franchises
• Managed health care(dr must not be pressurized into doing/ not doing certain things)

Question 26

Name the 4 solutions to apply when ethical rules are transgressed.

Answer 26

1. Re-establish the basic ethical principles
2. Peer review + whistle-blowing
3. Principles of good communication
4. Policies and guidelines must be clear