5:08 pm @ 19% E> samsonplab.co.uk MEDICO-LEGAL MEDICINE AND ETHICS 2016 Commitment to Professionalism [A doctor should demonstrate ethical practice and commitment to professionalism therefore you must be open and honest With patients if things go wrong. If a patient under your eare has Suffered harm or distress, you must ut matters right (if that is possible) Offer an apology Explain fully and promptly what has happened and the likely short-term and long-term effects. You must respond promptly fully and honestly to complaints and offer an apology when appropriate You should end a professional relationship with 2 patient only when the breakdown of trust between you and the patient means you cannot provide good clinical care to the patient. In providing clinical care you must Prescribe drugs of treatment, including repeat prescriptions, only when you have adequate knowledge of the patient's health, and are satis that the drugs or treatment serve the patient's needs Provide effective treatments based on the best available evidence You must listen to patients, take account oftheir views, and respond honesty to theie questions. You must work in partnership with patients, sharing with them the information they will need to make decisions about their care, including: ‘Their condition, its likely progression and the options for treatment, including associated risks and uncertainties ‘The progress of their care, and your role and responsibilities in the team Wino ie responsible for each aspect of patient care, and how information is shared within teams and among those who will be providing their care You must give patients the information they want of need to knov in 2 way they can understand. You should make sure that arrangements are made, wherever possible, to mest patients” language ang communication needs. Prescription Ensure that your prescribing ie appropriate and responsible and in the patent's best interests Doctors are able to prescribe unlicensed medicine, but before doing so they must be satisfied that an alternative, licensed medicine will not satisfy the patient's naeds. When prescribing offlicence, a doctor would need to take responsiblity for oversecing the patient's care including monitering and any flloy-up treatment. Good Medical Practice requires doctors to take account of the patient's views, support patients in caring for themselves, and listen to patients, take account of their views, and respond honestly to thelr questions. However, GMC does not ‘expect doctors to compromise their clinical judgement in order to suit a patent's preferences. [As long as a doctor genuinely feels that that they treatment they have recommended would be in their patient's best clinical interests, they would not be acting against our guidance by refusing to prescribe an alternative treatment Fequested by the patient. Doctors should only prescribe drugs to meet the identified needs of patients, and never simply because patients demand them. Maintaining trust in the profes It wouldn't usually be appropriate for a doctor to raise the issue of their own personal beliefs in the course of a consultation. If a doctor does find it necessary to explain their personal baliefs to patients (perhaps because - as in this case study - it affects the treatment they provide), the doctor must be careful not to cause the patient distress You must not ask for or accept - from patients colleagues o others - any inducement, gift or hospitality that may affect lor be seen to affect the way You prescribe for, treat of refer patients or commission services for patients. ov II benefit to the patient Whenever @ doctor provides or arranges treatment for a patient, they must do so on the basis of what would be of fverall benefit to the patent. While the vast majonty of treatment dacsions will be medically indicated, the potential benefits stretch beyond striciy medial interests to include, for example, peychological factors. This i= the case with ‘much cosmetic surgery - the doctor decides that the risks of surgery are cutweighed by the potential improvement in a patient's mental health and general wellbeing that a positive outcame could achieve, ‘Autonomy and Privacy Respact patient's autonomy and privacy Doctors must be careful when using information about patients. It is important that the patiant has given consent for the doctor to use their information in this way, whather or not the doctor believes thatthe patient can be identified from the information,8 pm @ 19% E> samsonplab.co.uk ‘Autonomy and Privacy Respect patient's autonomy and privacy’ Doctors must be careful when using information about patients. It is important that the patient has glven consent for the doctor to use their information in this way, whether or not the doctor believes that the patient can be identified from the information. Even if the intended use is teaching, rather than something more easily accessible to the public, the doctor must take care to ensure that the patient is not identifiable from the information. Children and Young people (0-18 Years) Doctors should ahvays actin the best interests of children and young people. This should be the guiding principle in all Gecisions which may affect them, But identifying theic best interests ls not always easy. This is particularly the case in relation to treatment that does not have proven health benefits or when competent young people refuse treatment that 's clearty in their mecical interests, There can also be a conflict between child protection and confidentiality, oth of which are vitally important to the welfare of children and young people [An assessment of best interests will include what is clinically indicated in a particular case. You should also consider: the wiews of the child or young person, so far as they can exprass them, including any previously expressed preferences the wiews of parents the wiews of others close to the child or young person. the cultura, religious or other beliefs and values of the child or parents the wiews of other healthcare professionals involved in providing care to the child er young person, and of any other professionals who have an interest in their welfare lich choice, if there is more than one, wil least restrict the chil or young person's future options You should talk directly and listen to children and young people who are able to take part in discussions about their care. Young people who are able to understand what is being said and who can speak for themselves resent being spoken about when they are present. But younger children might nat be able to understand what their illness or Dropored treatment is likely to involve, even when explained in straightforward terms. Both the GMC and the law permit doctors to undertake procedures that do not offer immediate or abvious therapeutic benefits for children or young people, so long as they are in their best interests and performed with consent To assess their bast Interests you should consider the raligious and cultural beliefs and values of the child or young person and their parents as well as any social, psychological and emotional benefits. This may be relevant in CGroumcision of male chilren for religious or cultural reasonels, of surgical correction of physical charactensics that do rot endanger the chi’ lfe or heath If providing treatment to children, you should be familiar with the detailed advice in 0-18 years: guidance for all doctors, which includes the key points set out in this section of guidance. You should take particular care if you consider providing cosmetic interventions for children or young people - you should make sure the environment for practice is Appropriate to paediatric care, and work with multidistipinary teams that provide expertise in treating children and young people where necessary You must only provide interventions that are in the best interests of the child or young person. If a young person has capacity to decide whether to undergo an intervention, you should stil encourage them to Involve their parents in ‘making their decsion. [A parent can consent to an intervention for a child or young person who does not have the maturity and capacity to ‘make the decision, But you should involve the child in the decision ax much as possible. If you judge that the child does rot want to have the cosmetic intervention, then you must not perform i Assessing Best Interests Doctors should always act in the best interests of children and young people - this should be the guiding principle in all Gecisions that afect them. But in some situations, it can be difficult to Identiy what isin the chlés best interests. This is particularly the case when considering interventions carried out for social, cultural or religious reasons, such as ear-pinning or non therapeutic circumcision. While clnial factors play a significant rele in determining best interests, {octors must also consider other factors, such as the views of the child and their parents 0-18 years: guidance for all doctors and our Cosmetic interventions guidance, states that children and young people should be involved in decisions about their care and that doctors should listan to and respond to their concems. Far cosmetic procedures such as pinnaplasty if a doctor considers that the chil doesn't want the procedure then they must rot perform it Divorce and Parental Responsibility Divorce does not affect parental responsibilty. Parents are usually best placed to judge what is in their chil's best Interests, at least until their children are mature encugh to make those decisions for themselves. However, it can be challenging for dactors when parents da not agree on what's best for ther chil 0-18 years: guidance forall doctors provides advice on who has parental responsibil. Doctors should remember that divorce or separation does not affect parental responsiblity. Everyone with parental responsibilty should be involved in any important discussions about their chile's treatment, and given reasonable access to the medical records, as long as this doesn't confct with the child's best interests. This wil usualy include both natural parents, and might include a local authorty and others if, for example, 2 child isin care, It might be appropriate to involve others close to the chil who regularly care for them, even if they dont legally have parental responsibilty5:08 pm @ 19% m> samsonplab.co.uk Divorce and Parental Responsibility Divorce does nat affect parental responsibility. Parents are usually best placed to judge what is in their chil's best Inerasts, at least until their children are mature enough to make those decisions for themselves. However, it can be challenging for dactors when parents do not agree on what's best for their chil 0-18 years: guidance for all doctors provides advice on who has parental responsibilty. Doctors should remember that divorce or separation does not affect parental responsibilty. Everyone with parental responsiblity should be involved in any important discussions about their child's treatment, and given reasonable access to the medical records, as long as this doesnt conflict with the chil's best interests. This will usually include both natural parents, and might include a local authority and others f, for example, 2 child is in care, It might be appropriate to Involve others close to the chil wo regularly care for them, even if they don't legally have parental responsibilty. der children and young people who understand what it entails should be consulted and asked to agree to their parents being sven access to their madical records. Work with other professionals [A doctor should seek the views of other professionals Wile it f= usually suffcient to have consent from just one parent, doctors should work with both parents where possible, to try to informally resolve disputes that may occasionally arise about the child's treatment. Seeking the views Of others whe are involved in the care of the child may help to achieve this, by giving a clearer picture of where a chila’s best interests li, Other members of a multi-dsciplinary team, or ather professionals who have an interest in the chlé's welfare, such as teachers or socal workers, may be able to provide helpful input. I i is not possible to resolve a dispute about an Important decision informally, it may be appropriate to seek legal advice about applying to the court for a determination fon whether the treatment proposed isin the child's best interests. Coping with Pressure Obstacles of sharing information All doctors know that our medical practice is affected in some way by our limits on time or other resources. Finding 2 way to make best use of those resources can be a challenge, particularly when doctors have to balance the needs of the Individual patient with those of al the patients using a particular service Where time pressures prevent them from spending as much time with patients as they'd tke, doctors should consider what other means they could use to ensure that patients have all the information they want or need about thelr Condition and any proposed investigation or treatment. Clear, up to date written information can be very helpful, as can Getalls of good quality online or other reference sources. Doctors don't practise in isolation, and they ray wish to explore what role other members of the healthcare team might play in providing patients with advice and support Effective Communication Openness, trust and good communication Everyone knows that doctors’ time is limited, but taking time to bulld trust and encourage patients to take an interest in their own healthcare can save time later on. Honesty Is also crudal to a trusting doctor-patient partnership, and it iS Important that doctors are honest about the limits of their knowledge. It's fine for doctors to discuss with patients any policies and procedures that might restrict their practice, as this can help patients to understand their matives, building trust and encouraging patients to comply with treatment. Listen to patients Doctors must listen carefully to what patients have to say, and what they're particularly concerned about, even if it seems obvious straight away what the problem is. Many patients ~ particularly those with long-term conditions - are ‘experts in their condition, and how they experience living with it. I's a doctor's duty to encourage patients to use this knowledge to enable the patient to make informed decisions about their care. You must listen to patients, take account of their views, and respond honestly to their questions You must give patients the information they want or need to know in @ way they can understand. You should make sure that arrangements are made, wherever possible, to mest patient’ language and communeation needs, Responding to patients’ questions is also very important. It doesn’t mean doctors have to take time to answer every single question however irelevant it may be; f just means that they should respond, even i i's to assure them that i's Effective communication between doctors and children and young people Is essential to the provision of good care. You should find out what children, young people and their parents want and need to know, what issues are important to