Over the last few decades patients have rightly become better informed, leading to more questions about their care and what remedies are available to them. With patient expectations of doctors growing, it is imperative that you maintain your professionalism at all times, says Dr Graham Howarth, MPS’s Head of Medical Services – Africa
As a doctor, your fitness to practise can be called into question for matters related to your conduct – this might involve the way you interact with social media or your awareness of doctor–patient boundaries. Or your attitude may be challenged. These are all aspects of life as a doctor that are not easily defined but could potentially attract complaints and HPCSA investigations if not properly observed.
Clinical negligence claims in South Africa have also been increasing, and MPS believes this stems from heightened patient awareness and increased claimant lawyer activity, not deterioration in the quality of patient care provided by doctors.
Nobody could disagree with the need for patients to be better educated about their rights and responsibilities, but I would challenge the premise that there has necessarily been a decline in professionalism among doctors.
There is a continuing need for doctors to define and embed appropriate values throughout their professional lives. The concept of professionalism is the basis of medicine’s contract with society. It’s what society and patients expect of their healthcare professionals. Professionalism is the way that healthcare professionals fulfil their part of this contract and in return they are rewarded by patient trust.
But how do you personify professionalism? Some people would see professionalism as being predominantly about observable behaviours. Others believe it is a much broader concept encompassing competencies in terms of knowledge, clinical and non-clinical skills, which together with appropriate attitudes and values result in expected professional behaviours and relationships.
At MPS, we broadly recognise a set of characteristics that, together, form the foundation of trust within the doctor–patient relationship. These characteristics include expertise, standards, respectability, responsibility and reliability, probity and conduct.
Standards
When it comes to day-to-day practice, professionalism is about adherence to a defined set of standards. You should try and incorporate these standards and codes of practice into every day behaviour and performance by following the HPCSA’s Guidance for Good Practice in the Health Care Professions.
A patient’s trust in a doctor is no longer assumed; it is reached and earned through a display of appropriate professional qualities and behaviours, for example, expertise, probity and concern, and these act as markers of professionalism.
Probity
All medical professionals should be competent, behave ethically and conduct themselves with honesty. Your professional integrity is a measure of the degree to which your own professional reputation and credibility remain intact, and is a precious attribute that needs to be cultivated and protected from the very start of a professional career, including entry to medical school. A medical professional is expected, by their colleagues and society, to be a person who can be trusted to be honest and respectable.
Offering a chaperone is an example of showing respect for the patient and for your own protection. Chaperones are used to reassure patients, as well as to protect doctors from sexual impropriety. If a patient rejects an offer of a chaperone make sure you record this in the patient’s notes. If you feel it is personally risky for you to proceed without a chaperone present, you should trust your instincts and simply tell the patient that because of the nature of the examination, you would prefer a chaperone to be present. If the patient still declines, then you must decide whether to proceed without a chaperone or to suggest that the patient see another doctor.
Responsibility and reliability
As a doctor you are responsible for looking after patients and ensuring that the care you provide them with is safe and to a high level. You are expected to have the relevant knowledge and skills to do your job and to keep them up to date.
Keeping good medical records is an integral part of good medical practice – not only do they provide good continuity of care but clear, comprehensive notes can help protect you should you be faced with a complaint or claim.
Unprofessional conduct
The HPCSA publishes guilty verdicts for unprofessional behaviour on its website. Recent examples have included:
- A doctor found guilty of unprofessional conduct for canvassing or touting for patients – this contravened the ethical rules of conduct.
- A doctor found guilty of two counts of unprofessional conduct for fraudulently trying to claim medical aid for services rendered to patients that were different and/or more expensive than those actually dispensed.
- A doctor found guilty of unprofessional conduct for breaching patient confidentiality – the doctor disclosed confidential information without the patient’s consent.
- A doctor found guilty of unprofessional conduct for physically assaulting a colleague.
Being open
True professionalism comes into play when mistakes are made. Knowing what to do when things go wrong and how to react appropriately can make all the difference in ensuring high standards of patient care are maintained and a timely resolution is reached. You should be prepared to acknowledge mistakes, learn from them and take appropriate steps to prevent a recurrence. You should act in a way that is deemed appropriate by the public and your colleagues, set good examples and act reasonably at all times.
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