Professionalism in medical practice

(Farabi, 09.03.2017)

PROF MOHAMED ALRUKBANDR GHAIATH HUSSEIN,

Levels of Behavioural ‘Control’

Morality

Ethics

Laws & Regulations

Professional standards

Institutional Policies

Personal beliefs

Why can’t/don’t we do what we want to?

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So your expected roles are…CanMEDS (http://www.royalcollege.ca/) SaudiMEDS

Saudi Meds: A competence specification for Saudi medical graduatesRania G. Zaini , Khalid A. Bin Abdulrahman , Abdulaziz A. Al-Khotani , Abdol Monem A. Al-Hayani , Ibrahim A. Al-Alwan , Saddig D. Jastaniah (Medical Teacher , Vol. 33, Iss. 7, 2011)

What is professionalism about?DON’T Undesirable

conductDO-Desirable Behaviors

Abuse of power السلطة استغالل سوءBias االنحياز Harassment (verbal/physical) التحرشBreach of confidentiality سرية انتهاكالمرضىArrogance الغطرسة- الغرورGreed الطمع Misrepresentation -االدعاء الكذبImpairmentاالعاقة Lack of conscientiousness غياب&الضميرConflicts of interest المصالح تضارب

Altruism االيثارAccountability المحاسبيةExcellence - االحسان- االتقان التميزDuty الواجب Respect for others, اآلخرين &احترامcommitment to lifelong learningmaintenance of competence, Honor & integrity, واألمانة الشرفAdherence to ethical codes of conduct,Dedication to self-regulation -ضبط

الذات تنظيم

'Project Professionalism' (ABIM, 2001)Developed by the Physician Charter and identified six key elements of professionalism:

1- Altruismااليثار :• giving priority to patient interests rather than self-

interests2- Accountability المحاسبية:

• being answerable to patients, society and profession

3- Excellence االحسان- : التميز• conscientious effort to perform beyond ordinary

expectation, and • commitment to life-long learning

'Project Professionalism' (ABIM, 2001)4- Duty بالواجب : االلتزام

• free acceptance of commitment to service – i.e. undergoing inconvenience to achieve a high standard of patient care

5- Honor and integrity واألمانة : الشرف• being fair, truthful, straightforward

6- Respect for others اآلخرين : احترام• patients and families, • colleagues, • other healthcare professionals and • students and trainees

Examples of Unprofessional BehaviorsClassroom Setting-Students/Trainee

• Arriving for class late and/or leaving early• Being unprepared for group sessions• Not completing assigned tasks• Disrupting class sessions• Cheating on an exam• Using Mobile Phone during class• Chatting during class• Focusing on the test vs. learning• Prejudging content in advance• Intolerance of the opinions of others

Examples of Unprofessional Behaviors:Clinical Setting-Students

• Dressing inappropriately• Avoiding work and/or responsibilities• Exhibiting little empathy for patients• Demonstrating lack of sensitivity to patients’

cultural backgrounds• Not protecting patient confidentiality

Signs of Lack of professionalism (ABIM, 2001)

Sign Examples1- Abuse of power • Abuse of patients &/or colleagues; bias and harassment

2- Arrogance • Offensive display of superiority and self-importance

3- Greed • when money becomes the driving force for work

4- Misrepresentation • Lying: consciously failing to tell the truth; • Fraud: conscious misrepresentation of material fact with the intent to

mislead

5- Impairment • any disability that may prevent the physician from discharging your duties

6- Lack of conscientiousness

• failure to fulfil responsibilities

7- Conflicts of interests

• Self-promotion/ advertising • Unethical collaboration with industry; acceptance of gifts; • Misuse of services – overcharging, inappropriate treatment or

prolonging contact with patients

So your expected roles are…CanMEDS (http://www.royalcollege.ca/)

SaudiMEDS

Saudi Meds: A competence specification for Saudi medical graduatesRania G. Zaini , Khalid A. Bin Abdulrahman , Abdulaziz A. Al-Khotani , Abdol Monem A. Al-Hayani , Ibrahim A. Al-Alwan , Saddig D. Jastaniah Medical Teacher , Vol. 33, Iss. 7, 2011

Saudi Code ofEthics for healthcare practitioners

HTTP://WWW.SCFHS.ORG.SA/REGLATIONS/CR/DOCUMENTS/%D8%A3%D8%AE%D9%84%D8%A7%D9%82%D9%8A%D8%A7%D8%AA%20%D8%A7%D9%84%D9%85%D9%85%D8%A7%D8%B1%D8%B3%20%D8%A7%D9%84%D8%B5%D8%AD%D9%8A.PDF

Healthcare Practitioner’s Duties Towards Patients Good Treatment of PatientAchieving Patient’s Interest and Guarding your

RightsPatient’s Consent Reassurance of Patient Maintaining Patient’s Secrets - Confidentiality

Duties Towards Professional Colleagues

1. Treat your colleagues the way you would like them to treat you. ( لنفسه يحب ما ألخيه يحب حتى أحدكم يؤمن عليه (ال متفق

2. Do not indulge in their private issues•) يعنيه) ال ما تركة المرء إسالم حسن . من وغيره الترمذي رواه حسن حديث

3. Avoid direct criticism of a colleague in front of patientsتعالى • الله رحمه الشافعي اإلمام قال

الجماعه ** في النصيحة ني وجن انفرادي في بنصحك تعمدنياستماعه ** أرضى ال التوبيخ من نوع اس الن بين صح الن فإن

طاعZه ** تعط لم إذا تجزع فال قولي وعصيت خالفتني وإن4. Doing your best in teaching them

على )• ليصلون الحوت وحتى جحرها في النملة حتى واألرض السماوات وأهل ومالئكته الله إنالخير الناس األلباني ( . معلم وحسنه الترمذي رواه

5. Envisage integrity of those working or trained by himرعيته،) ...( • عن مسئhول وكhلكhم راع، كhلكhم عليه أال متفق

Duties Towards Professional Colleagues6. Follow religious standards (relations with colleagues of

other sex)

7. To accept peer-review of your work8. Respect your non-doctor colleagues, and appreciate

their role in healthcare9. To report to the responsible authority any of his

colleague’s attitudes or conditions that would affect the safety of or inflict harm on the patients

Doctor’s Duties Towards your Profession1.Guard the nobleness -نبل of the professionسمو2.Scientific and practical contributions to the development of

the profession, through research, studies, writing articles, and continuous education.

3.Maintain the medical professional standards and work on improving them in all the professional activities (that you take part in).

4.Do not abuse professional status by achieving privileges, material or moral benefits, apart from those granted through the system and professional customs.

5.Avoid whatever leads (or could lead) to insulting the profession:• maltreatment, or lack of commitment to appointments, وعدم المعاملة سوء

بالمواعيد االلتزام• lying, falsification, arrogance, رورZوالغ والتزوير الكذب• pretending to know what you do not تعرف ال ما معرفة ادعاء

Duties Towards your Profession6. Refrain from any act that would breach your honesty, or integrity while dealing with the patient

7. Avoid hastening to take action with high risk medical procedures unless you are sure of its necessity and that the benefits exceed their risks (of harm).

8. Take the appropriate action if you know that one of the healthcare team is sick, ignorant, or negligent in your responsibilities,

9. Avoid seeking fame on account of the basics and ethics of the profession.

Doctor's Role Towards CommunityPositive interaction with the community’s affairsProtect the community by reporting reportable/epidemic

diseasesImprove health in the community through advocacy and

health education, and involvement in community health activities

Rational use of the healthcare institutions’ resourcesEffective contribution to the development of policies and

health systems that respond to the community needs and facilitates easier access to health care.

Source: Islamic Code of Medical & Health Ethics

The round with Mr. Butcher (Case)

SEE : MODULE 3 IN PROFESSIONALISM AND ETHICS HANDBOOK FORRESIDENTS (PEHR): A PRACTICAL GUIDEHUSSEIN GM, ALKABBA AF, KASULE OH. PROFESSIONALISM AND ETHICS HANDBOOK FOR RESIDENTS (PEHR): A PRACTICAL GUIDE. WARE J, KATTAN T (EDS). 1ST EDITION. RIYADH, SAUDI ARABIA: SAUDI COMMISSION FOR HEALTH SPECIALTIES, 2015.

Summary points • Being a clinician is about being part of a team. You

have rights and duties as part of this team.• Central to your care is your patient (not your ego

and not your bank account).• Many of the positive attitudes and skills can be

developed through training, and self-development.• Developing and adhering to these standards

develops you, improves health care, and enhances public trust in the health system.

• By respecting your patients, colleagues, and the community in general, you build better relations and a better reputation for being a faithful model clinician