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S3 L5 Doctor-Doctor and Doctor- Other Health Professionals V2

S3 L5 Doctor-Doctor and Doctor- Other Health Professionals V2

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Published by: 2013SecB on Apr 21, 2011
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09/05/2011

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S3 L3: Peer Relationship
INTRODUCTION The team's ability to care effectively for the patient depends onthe ability of individual persons to treat each other with integrity,honesty, and respect in daily professional interactions regardless of race, religion, ethnicity, nationality, sex, sexual orientation, age, or disability.PEER RELATIONSHIP 
‡
 
Types of Relationship In Health Care
‡
 
Doctor-Colleague Relationship
‡
 
alpractice and Remedies
‡
 
Peer Review 
‡
 
 Arranging Reliever 
‡
 
orking in Teams
‡
 
Leading Teams
‡
 
Referral Relationships
‡
 
Delegation and Arranging Relievers
‡
 
Doctor treating another doctor 
‡
 
Doctors and physicians in training
‡
 
The Impaired Physician
‡
 
Conflict Resolution Accepted types of relationships in health care:1.
 
Patient-doctor relationship2.
 
Doctor-colleague relationship3.
 
Doctor-allied health professionals relationship All the above are related to one another in a bond of relationshipbased on trust.SIR± Smooth inter-personal relationship can easily be detected in health care when:
‡
 
compliance with one¶s duties is easily done & perfected;
‡
 
 people behave they know each other well;
‡
 
openness of heart and communication linesRelationships maybe:
‡
 
formal 
‡
 
informal Everyone is recognized for his distinct role, skill and knowledge. All health professionals are important because they have their distinct characteristic and no one among them canmonopolize the immense art of healing.Doctor-colleague Relationship:Professionalism-they are allies and friends.
‡
 
Cooperation
‡
 
Coordination
‡
 
Competition must be in how to combat the diseaseThe Health Care Profession is:
‡
 
Collaborative
‡
 
collegial 
‡
 
ally-based  Anathema in the world of cure:
‡
 
Personal and professional bickering;
‡
 
ealousy and envy 
hen doctors and colleagues become competitors or enemies rather than allies, they become a disgrace to the profession.
‡
 
Professional Relationship
‡
 
Need for good personal relationship:
‡
 
Leadership and accountability 
‡
 
Common decision making
‡
 
Cooperation in carrying decisions
‡
 
 Adequate communications
‡
 
utual support 
isdom on Professional Relationship:Sir 
illiam Osler ³ 
any a physician whose daily work is a daily round of beneficence will say hard things and think hard thought of a colleague.No sin will so easily beset you as uncharitableness towards your brother practitioner. So strong is the personal element in the practiceof medicine, and so many are the wagging tongues in every parish, that evil-speaking, lying, and slandering find a shining mark in the lapsesand mistakes which are inevitable in our work. From the day you begin practice never under any circumstances listen to a tale to thedetriment of a brother practitioner. And when any dispute or troublearise, go frankly, ere sunset, and talk the matter over, in which way youmay gain a brother and a friend.´ Dr. Aimee A. Silva,
D, (2002):³It takes more than going through years of studying, training,and passing exams to become a good doctor. Years of practice cannever guarantee perfection of craft. Values and virtues will serve asbeacon to guide the healers through the perils they encounter.´ Declaration of Geneva & International Code of 
edical Ethics, 35 
th
 assembly, Venice, 1983
y colleagues will be my brothers.DUTIES OF PHYSICIAN TO EACH OTHER:
‡
 
 A physician shall behave towards his colleagues ashe would have them behave towards him.
‡
 
 A physician shall not entice patients from his colleagues.
‡
 
 A physician shall observe the principles of the ³Declarationof Geneva´ approved by the world 
edical Association
alpractice suits frequently result from:
‡
 
Lack of training in communication skills of doctors;
‡
 
 poor communication between physicians and patients;
‡
 
inadequate informed consent on the patient¶s part;
‡
 
Doctors¶ unresponsive to patients¶ complaints
‡
 
Patients¶ misinformed, unrealistic expectations
 ALPRACTICE DOCTOR-COLLEAGUE RELATIONSHIP PEER RELATIONSHIP 
   B   i   e   n
   A   g
   N   i   n   a
   I   a   n
   J   o    h   n
       G    
   R   a   c    h   e    l
   M   a   r    k
   J   o   c   e    l    l   e
   E    d   o
   G   i   e   n   a    h
   J    h   o
   K   a   t    h
   A   y   n   z
   J   e
   G    l   a    d
   N   i   c    k   i   e
   R   i   c   o    b   e   a   r
   T   e   a   c    h   e   r
   D   a    d   a   n   g
   N   i       a
   A   r    l   e   n   e
   V   i   v   s
   P   a   u    l    f   i   e
   R   i   c   o   F .
   R   e   n
   M   a   i
   R   e   v   s
   M   a   v   i   s
   J   e   p   a   y
   Y   a   n   a
   M   a   y   i
   S   e   r   g   e
   H   u   n   g
   T   o   p   e
 
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‡
 
Defensive attitude of consumers towards arrogant& self-serving professionals
‡
 
 patient¶s frustration because physicians seem unresponsiveto their complaints;
‡
 
 patient¶s mis-informed, unrealistic expectations about thebenefits of treatment;
O OPPOSITE RE 
EDIES FOR THE 
 ALPRACTICE PROBLE 
S:1.
 
Peer review± in a field so highly technical asmedicine, noone is competent to evaluateprofessional performanceexcept peers in theprofession or even in the same medical specialty.Fraternal correction- members do not simply ignore or hide the defects of colleagues out of indifference or self-interest,but are seriously concerned to help them overcome these defectsand repair the consequences.Some observers argue that peer discipline has never beensuccessful in protecting the patient or even in maintaining highstandards of medical competence. A profession is too concerned with its own autonomy to be very diligent in disciplining its members. Consequently, they believe that disciplining a profession must first of all concern thosewho suffer from malpractice or neglect.Health care consumers must know and defend their own rights by all available economic, legal, and political means. Since the primary responsibility for health must remain with each person to whom the professional is only a servant, the ultimate right to call the medical  profession to account must be in the hands of those the professionexists to servethe users of health services have the fundamental right to the final word in regulating the profession through public law.2.
 
Public evaluation- The medical professional stands for truth,but provides a service to human physical or mental health, aservice which must ultimately be judged in terms of its practical enhancement of human well-being. Consequently,the medical profession must accept a public, practical evaluation of its service. In this regard, medical  professionals have no complete autonomy in the realm of medical practice.RESPONSIBILITIES OF COLLEAGUES  All physicians have a duty to participate in peer review. Fearsof retaliation, ostracism by colleagues, loss of referrals, or inconvenience are not adequate reasons for refusing to participate in peer review.It is unethical for a physician to disparage the professional competence, knowledge, qualifications, or services of another  physician to a patient or a third party or to state or imply that a patient has been poorly managed or mistreated by a colleague without substantial evidence.In the absence of substantial evidence of professional misconduct, negligence, or incompetence, it is unethical to use the peer review process to exclude another physician from practice, torestrict clinical privileges, or to otherwise harm the physician's practicePoints to Ponder 
‡
 
Unless we know how to be true, just and kind 
‡
 
Unless we practice virtue always
‡
 
Unless we consider our colleagues equally 
‡
 
Unless we reward meritorious acts
‡
 
Unless we deal fairly with misbehaviors
‡
 
Unless we unite to act for the common good The
edical Profession will suffer attacks within and without and no one is to blame but those in the profession who do nothing tocorrect its own wrong doings.Points to Ponder 
‡
 
Can we blame the lack of trust among our colleaguestowards each other? 
 ± 
 
Politics in electing officers in medical societies
 ± 
 
Employ a padrino to enter into residency training
 ± 
 
Use influence or money to practice in a hospital 
 ± 
 
Expose questionable practice in media
 ± 
 
Few resolved cases of malpractice
 ± 
 
Continue to allow unfair and unethical practice inthe operating room or in the wards
 ± 
 
Gossip of other¶s misdemeanor in public 
‡
 
The best patient care is often a team effort, and mutual respect, cooperation, and communication should govern thiseffort.
‡
 
Each member of the patient care team has equal moral status.
‡
 
hen a health professional has significant ethical objectionsto an attending physician's order, both should discuss thematter thoroughly.
‡
 
echanisms should be available in hospitals and outpatient settings to resolve differences of opinion among members of the patient care team.
‡
 
orking in a team does not change your personal accountability for your professional conduct and the careyou provide.
‡
 
hen working in a team, you must:
 ± 
 
respect the skills and contributions of your colleagues;
 ± 
 
maintain professional relationships with patients;
 ± 
 
communicate effectively with colleagues withinand outside the team;
‡
 
hen working in a team, you must:
 ± 
 
make sure that your patients and colleaguesunderstand your professional status and specialty,your role and responsibilities in the team and whois responsible for each aspect of patients' care;
 ± 
 
 participate in regular reviews and audit of thestandards and performance of the team, takingsteps to remedy any deficiencies;
 ± 
 
be willing to deal openly and supportively with problems in the performance, conduct or health of team membersIf you lead a team, you must ensure that:
‡
 
medical team members meet the standards of conduct and care;
‡
 
any problems that might prevent colleagues from other  professions following guidance from their own regulatory bodies are brought to your attention and addressed;
LEADING A TEA
 
ORKING IN TEA
 
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‡
 
all team members understand their personal and collectiveresponsibility for the safety of patients, and for openly and honestly recording and discussing problems;
‡
 
each patient's care is properly co-ordinated and managed and that patients know who to contact if they have questionsor concerns;
‡
 
arrangements are in place to provide cover at all times;
‡
 
regular reviews and audit of the standards and performanceof the team are undertaken and any deficiencies areaddressed;
‡
 
systems are in place for dealing supportively with problemsin the performance, conduct or health of team members.THE ETHICAL REFERRAL SYSTE 
A
ONG HEALTH PROFESSONIALS:Life is too vast for a single doctor to be an expert in all thedimensions of medical care, the reason why specializations must be pursued.
‡
 
there is no single therapy for a single disease;
‡
 
there is plurality of diagnosis as every condition can be
‡
 
seen differently since a diagnosis is just an opinion;
‡
 
recognition of one¶s limitations even as one has to work 
‡
 
above all for the best interest of the patient.
‡
 
referring a patient to another doctor is never a sign of one¶s incompetence but a sign of professionalism,and a matter of principled nobility and honor.ETHICAL REFERRAL SYSTE 
 
arnings to Health professionals:referral system can only work best when doctors honor SIR ³smooth Interpersonal relationship´ that must be pursued and  promoted at alltimes;solicitation of patients is very unprofessionaland is awfully distasteful.
‡
 
Referral involves transferring some or all of theresponsibility for the patient's care, usually temporarily and for a particular purpose, such as additional investigation,care or treatment, which falls outside your competence.
‡
 
In order to utilize fully the expertise of specially trained consultants, it is recommended that referrals be made by generalists as well as by specialties whenever appropriately  provided.
 ± 
 
The referral is the attending physician¶s soledecision.
 ± 
 
The reason for the referral and expected outcomesare adequately explained to and accepted by the patient or his qualified guardian.
 ± 
 
Good judgment, communication, honesty and goodwill underlie the process.
‡
 
The consultant must be informed of the referral directly by the attending physician or through his or her delegated authority (resident physician or staff nurse) after the request is duly recorded in the patient¶s chart.
‡
 
The purpose of the referral must be specified: evaluation,diagnostic procedure, co-management, etc 
‡
 
 A consultant can refuse to accept a referral.
‡
 
Once he or she accepts, he/she cannot delegate theresponsibility to another 
‡
 
His or her responsibility will depend upon the specified  purpose of the referral.
 ± 
 
If a consultant accepts the referral it is his or her duty to answer the same as soon as possible and to write his evaluation/ recommendations on theconsultation sheet provided by the hospital.
 ± 
 
If the referral is for evaluation, the consultant¶s primary responsibility is to the attending physician. It is to him that the consultant must give his or her opinions and suggestions, not tothe patient.
‡
 
His or her responsibility will depend upon the specified  purpose of the referral. (continued)
 ± 
 
If the referral is for co-management, his or her  primary responsibility is as co-attending physician. The consultant must, however,continue to communicate with the referring physician under whose service the patient wasadmitted.
 ± 
 
 A consultant cannot delegate responsibility to anassistant, fellow, or resident. It is precisely toutilize his or her expertise that the consultation ismade.
 ± 
 
If during the course of treatment the consultant cannot continue attending to then patient, theattending physician must be notified for appropriate action.
‡
 
To assure a coordinated effort that is in the best interest of the patient, the attending physician should remain in chargeof overall care, communicating with the patient and coordinating care on the basis of information derived fromthe consultations.
‡
 
Consultants should not make cross referrals but may suggest it to the attending physician.
‡
 
The attending physician who does not agree with theconsultant's recommendations is free to call in another consultant.
‡
 
 After the condition for which the patient was originally referred has been resolved, the consultant should submit aseparate professional fee and end his/her services.
‡
 
Follow-up, future consultation, etc. should be by the original attending physician, unless these are delegated to theconsultant through a subsequent referral.
‡
 
In case of life threatening conditions, when the attending physician is not available, any physician involved in the casemust do what he deems as necessary for the best interest of the patient.
‡
 
In case of readmission or consultation for a new complaint, patient¶s autonomy should be respected. The consultant should however encourage the patient to return to his or her original physician
‡
 
Delegation involves asking a nurse, doctor, medical student or other health care worker to provide treatment or care onyour behalf.
‡
 
It is unethical to delegate authority for patient care toanyone, including another physician, who is not appropriately qualified and experienced.
 ARRANGING RELIEVER DELEGATION REFERRAL RELATIONSHIPS 

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