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Professionalism and regulation


Doctors and other regulated healthcare providers are expected to behave in a “professional way” in their working lives and their personal lives, too, but it can be difficult to understand what this means and why it is important.

When it comes to day-to-day practice, professionalism is about adherence to a defined set of standards, incorporating these standards and codes of practice into everyday behaviour and performance. They are constantly evolving, and it is the role of a professional regulator to define and uphold professional standards.

What is medical professionalism?

Professionalism in healthcare and medicine spans a range of behaviours, which a practitioner must adhere to both in the workplace and at home. This article includes guidance for maintaining professional boundaries with colleagues, patients, and on social media. For doctors, maintaining professionalism should be a priority throughout their career.

The GMC defines Professionalism as "the standards of care and behavior expected of medical professionals."

This includes many factors, such as treating others well, being honest and trustworthy, and making patient care a priority. 

 

There are currently 32 regulated healthcare occupations ranging from doctors, dentists, and nurses to pharmacists, opticians, and osteopaths. The government is responsible for deciding which occupations are regulated and by which of the 10 health and care regulators. To work in any of the regulated healthcare professions, professionals must be registered with the appropriate health and care regulator.

In 2005, following a series of high-profile medical scandals, including the criminal actions of Dr. Harold Shipman, the Royal College of Physicians (RCP) produced a report called Doctors in Society: Medical Professionalism in a Changing World to seek to redefine the Nature and role of medical professionalism in modern society. The Royal College of Physicians defined professionalism in this report as “a set of values, behaviours, and relationships that underpins the trust the public has in doctors”.

In other words, professionalism is the way that doctors and other healthcare professionals fulfil their part of a social contract and, in return, are rewarded by the trust of patients and the respect of the public.

 

Good Medical Practice

Doctors in the UK are regulated by the General Medical Council (GMC).

The GMC is a public body whose primary role is to protect, promote, and maintain the health and safety of the public. It does this by controlling entry to the medical register, setting out the standards of care and behaviour expected of all doctors, investigating any complaints or concerns about doctors on the register, and, in very rare cases, suspending or removing doctors from the register. 

Good Medical Practice is a set of GMC guidelines that set out the standards of care and behaviour expected of all doctors, and it covers areas that include:

  • making the care of patients the first concern
  • providing a good standard of practice and care, and working within competence
  • working in partnership with patients and supporting them to make informed decisions about their care
  • treating colleagues with respect and helping to create an environment that is compassionate, supportive and fair
  • acting with honesty and integrity, and being open if things go wrong
  • protecting and promoting the health of patients and the public
Fitness to practice investigations by a regulator can arise from a range of things that could call professionalism into question - and this can relate to matters at work and outside of work

Other regulators such as the General Dental Council (GDC) and the Nursing and Midwifery Council (NMC) set similar standards of care and behaviour for dental professionals and nursing and midwifery professionals respectively.

Fitness to practice investigations by a regulator can arise from a range of things that could call professionalism into question - and this can relate to matters at work and outside of work.

 

Read more on: Professional regulation

10/04/2024

Raising concerns and whistleblowing

Raising concerns and whistleblowing

Time to read article: 4 mins
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One of the most difficult situations faced by any clinician is when you are concerned that a colleague’s behaviour, health or professional performance may be placing patients at risk. This factsheet outlines your duty to raise concerns when patients may be at risk of harm.

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Professionalism in action


What follows is an outline of some of the most important aspects of professionalism, exploring the expectations that come around each one and how they relate to the concept of being a "good professional".

It covers aspects of professionalism that can also be referred to as probity - which directly concerns honesty, integrity, and trustworthiness of a healthcare practitioner. While probity is only a part of professionalism as a whole, the two terms are often used interchangeably.

Competency and a good standard of care

The GMC state that “Good medical professionals are competent, keep their knowledge and skills up to date, and provide a good standard of practice and care”.

This means that a doctor must be competent in all aspects of their work, recognising and working within the limits of their competency. They must keep up-to-date with developments and follow the laws, guidance, and regulations that affect their work. It also means participating in quality assurance and quality improvement activity such as accreditation, revalidation and continuous professional development.

The GMC also advise that a good standard of care requires doctors to treat patients with kindness, compassion and respect and to recognise that patients are individuals with diverse needs.

...a doctor must be competent in all aspects of their work, recognising and working within the limits of their competency.

Good professionals listen to their patients and work in partnership with them, supporting patients in making informed decisions about their care and treatment. A good professional will also acknowledge a patient’s right to dignity and privacy.

For more information, please see our guidance on Consent and on Confidentiality.

Professional boundaries in healthcare

Managing the relationship with patients also means maintaining professional boundaries. While healthcare providers are expected to show compassion and kindness when treating patients, it can be challenging to show this human side without blurring the boundary between professional and personal relationships.

The GMC is clear that doctors should not pursue sexual or improper emotional relations with patients. There are instances where doctors have developed strong emotional responses to a patient, and patients have developed strong emotional responses to a doctor - and although many doctors would not describe themselves as predatory or exploitative, the fact is that power in the doctor–patient relationship is inherently unequal and to pursue those feelings would be unethical. The GMC has published detailed guidance for doctors on maintaining personal and professional boundaries.

Social media for doctors

Being aware of professional boundaries extends to the use of social media. The media has reported examples of healthcare professionals revealing confidential patient information on blogs, Facebook, Twitter, and other forums. Healthcare professionals who fail to restrict access to their private lives risk damaging their professional image and that of the profession in general.

Medical Protection's advice is that everything posted to social networks should be treated as if it is something that has been written down; it is never truly anonymous and exists in perpetuity, meaning that the chances of such comments being traced to the author should never be disregarded. Comments made innocently about patients, treatments, or particular procedures can potentially breach confidentiality, especially if they mention unusual symptoms or conditions.

Healthcare professionals who fail to restrict access to their private lives risk damaging their professional image and that of the profession in general

 

Social media is an arena within which healthcare professionals must tread carefully, mindful of their responsibility to maintain public trust and the standing of the profession. For this reason, MPS strongly advises against adding patients as “friends” on sites such as Facebook.

Additional information can be found in the following article Pitfalls of social media

Working with colleagues

Teamwork is integral to the safe delivery of healthcare, and the professional approach to good teamwork centres on good communication, mutual respect, kindness and courtesy. This means listening to colleagues, communicating clearly, politely and considerately, and being respectful of colleagues’ skills and contributions. To provide a good standard of care, professionals must work collaboratively with colleagues and be willing to offer advice and support to colleagues where required.

It is important to help to create a culture in healthcare that is respectful, fair, supportive, and compassionate - showing respect for, and sensitivity towards, one another’s cultures and beliefs. A good professional will not discriminate against, bully, or harass anyone based on their personal characteristics or for any other reason. In addition, healthcare professionals should not behave in a sexual way towards colleagues with the effect or purpose of causing offence, embarrassment, humiliation or distress by maintaining appropriate personal and professional boundaries.

Unresolved personal or professional disagreements between healthcare professionals who share responsibility for patients are potentially prejudicial to patient care, and it is the responsibility of all who work in the clinical team, including those who manage them, to make sure that patients are protected from any adverse outcome that results from colleagues not working properly together. Independent, external professional assistance with conflict resolution may sometimes be necessary and can be extremely effective.

A good professional will not discriminate against, bully, or harass anyone based on their personal characteristics or for any other reason

Safe delegation and referral is an area of practice where professionalism can be called into question. When delegating a task or when a task has been delegated, all parties must be sure that the individual to whom the task has been assigned has the competency to carry it out. When delegating a task, the GMC says of doctors: “You must be satisfied that the person providing care has the appropriate qualifications, skills, and experience to provide safe care for the patient.”

Continuity of care is essential and any transition of care, including referrals, must be properly handled. This relies on clear lines of communication with colleagues and an equally clear line of responsibility.

Read more on: Working with colleagues

Professional integrity

Honesty and integrity are central to probity and define how any professional person should act. This is vital in healthcare because trust is an essential part of the relationship between a healthcare professional and a patient. Patients and others often confide a great deal of personal and private information to healthcare professionals, so complete faith in their professionalism is required.

A duty to be honest and open covers all aspects of professional practice, including when:

  • Writing a CV
  • Preparing medical reports
  • Record-keeping
  • Signing or completing documents
  • Giving evidence or acting as a witness
  • Co-operating with any complaint or investigation
  • Assisting the coroner or procurator fiscal with inquests or inquiries into a patient’s death

This means taking reasonable steps to verify information in the documents and not deliberately leaving out relevant information.

For more advice on acting honestly and with integrity please see our article on Probity

Health and care regulators are interested in how a healthcare professional acts both in a clinical setting and in their personal lives

Acting with integrity also requires healthcare professionals to be open and honest with patients if things go wrong. The GMC advise doctors that “If a patient under your care has suffered harm or distress, you should:

(a) put matters right (if that is possible)

(b) offer an apology

(c) explain fully and promptly what has happened and the likely short-term and long-term effects.”

For more information and advice on what to do when things go wrong, please read our article: Chapter 4: Professionalism - What to do when things go wrong

Health and care regulators are not only interested in how healthcare professionals practice in a clinical setting. They also take an interest in matters that can arise in a professional’s personal life. An example of this is the requirement of doctors to inform the GMC of any criminal charges, convictions or if a “caution” has been accepted, even if the incident leading to the caution, charge or conviction is not related to medical practice. A similar duty of disclosure is expected of other healthcare professions including dentists and nurses.

The types of things that are likely to concern the GMC include, misuse of drugs, drunk driving and physical violence. All these scenarios could bring public confidence in the profession into question and raise concerns about an individual doctor’s professionalism and fitness to practice.

For more information about how the GMC would investigate such a concern, please go to How do FTP hearings work?

Practitioner health

Physical and mental ill health can have an impact on the care that doctors and others provide to patients, so it is important for healthcare professionals to look after their health and to seek help from their GP or an appropriate specialist when unwell.

In particular, the GMC advise that wherever possible, doctors should avoid providing medical care to themselves or anyone that they have a close personal relationship with. Providing self-care or care to someone that you have a close personal relationship with gives rise to issues such as a lack of objectivity, difficulty in doing an appropriate assessment, and follow up.

Healthcare professionals should be sufficiently immunised against common serious communicable diseases, and to report any fears they have about a potentially contagious illness.

If conditions at work or interactions with colleagues are having an impact on health then it is advisable to raise concerns through an employer, to see if any reasonable alterations at work could significantly improve wellbeing.

Focusing on effective recovery when away from work, such as hobbies, being outside, and exercising are important as well as having a low threshold to seek emotional support from close ones

Medical students and trainees

Professionalism does not begin on the first day of graduation as a healthcare professional. When training in a trusted and respected profession, there is an expectation that students will demonstrate a high standard of behaviour at all times. The GMC, GDC, and NMC all publish clear guidance for students on expected standards of care and behaviour.

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