medical council of new zealand, good medical practice, a guide for doctors

8/12/2019 Medical Council of New Zealand, Good Medical Practice, A Guide for Doctors

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GOOD

MEDICALPRACTICEMedical Council of New Zealand, April 2013

TE KAUNIHERA RATA O AOTEAROA

MEDICAL COUNCIL OF NEW ZEALAND

Protecng the public, promong good medical pracceTe aki i te iwi whnui me te whakatairanga pai i te mahi e p ana ki te taha rongo


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Patients are entitled to good

doctors. Good doctors make

the care of patients their rst

concern; they are competent,

keep their knowledge and skills

up to date, establish and maintaingood relationships with patients

and colleagues, are honest and

trustworthy and act ethically.


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The principal purpose of the

Medical Council of New Zealand

is to protect the health and

safety of the public by providing

mechanisms to ensure doctors are

competent and t to practise.

The Council has the following key funcons:

registering doctors

determining qualicaons

prescribing scopes of pracce

seng standards and supporng doctors to uphold these standards

recerfying and promong lifelong learning for doctors

reviewing the pracce of doctors if there is a concern about performance,

professional conduct or health

accreding training instuons including medical schools, colleges of medicine and

hospitals.


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About Good Medical

PracticeUnder secon 118(i) of the Health Praconers Competence

Assurance Act 2003, a funcon of the Medical Council is to set

standards of clinical competence, cultural competence and

ethical conduct for doctors. Under Right 4 of the Code of Health

and Disability Service Consumers Rightspaents also have

the right to have services provided that comply with legal,

professional, ethical and other relevant standards. The Council

has developed Good Medical Pracceto be the foundaon

document for these standards.

The standards detailed in Good Medical Pracce, and in

other Council statements, are those which the public and

the profession expect a competent doctor to meet and have

been developed through discussion with the public and

the profession. Where relevant, Good Medical Praccealso

provides guidance to assist doctors understand, and comply

with, the requirements of legislaon.

Good Medical Pracceis not intended to be exhausve. There

may be obligaons or situaons that are not expressly provided

for. In such circumstances, a doctor s rst priority should always

be the care of his or her paent.

Good Medical Practiceis not a Code of Ethics it does not

seek to describe all the ethical values of the profession or to

provide specific advice on ethical issues, ethical frameworks

and ethical decision-making. This type of advice is provided by

the New Zealand Medical Association.Good Medical Pracceis addressed to doctors, but is also intended

to let the public know what they can expect from doctors.


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How Good Medical

Practiceapplies toyou

For medical students, Good Medical Pracceidenes the

basic dues of a good doctor and serves as a source of

educaon and reecon.

For doctors, Good Medical Pracceserves as a basis foryou to monitor, and reect on, your own conduct and that

of your colleagues. The Health Praconers Disciplinary

Tribunal, the Councils Professional Conduct Commiees

and the Health and Disability Commissioner may use Good

Medical Pracceas a standard by which to measure your

professional conduct.

For paents, Good Medical Pracceprovides guidance for

assessing the minimum ethical and clinical conduct expected

of doctors.

The direcves outlined in Good Medical Pracceare usually

dues and must be followed. However, we recognise that not

all dues will apply in all situaons. Somemes there are factors

outside a doctors control that aect whether or not, or how,

he or she can comply with some standards. Throughout this

resource we have used the term you should (rather than a

more direcve term such as you must) to indicate where this is

the case.

If you believe that a doctor is not meeng standards outlinedin Good Medical Pracce, you should raise your concerns with

the doctor, draw that maer to the aenon of the doctors

employer, or report your concerns to the Registrar of the Medical

Council1or the Oce of the Health and Disability Commissioner2,

or in the event of maers related to health informaon privacy

and security - the Oce of the Privacy Commissioner 3.

1 Telephone 0800 286 801 or email

[email protected] . For moreinformaon, refer to the Fitness

to Pracce page of the Councils

website, www.mcnz.org.nz

2 Telephone 0800 11 22 33 or email

[email protected].

For more informaon, refer to

www.hdc.org.nz

3 Telephone 04 474 7590, or email

[email protected].

For more informaon, refer to

www.privacy.org.nz


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Professionalism

Paents trust their doctors with their health and wellbeing, andsomemes their lives. To jusfy your paents trust, follow the

principles outlined below and the dues outlined in the rest of

this document.

Caring for paents

Make the care of paents your rst concern.

Protect and promote the health of paents and the public.

Respecng paents

Aim to establish a relaonship of trust with each of your paents.

Be aware of cultural diversity, and funcon eecvely and

respecully when working with and treang people of dierent

cultural backgrounds.

Treat paents as individuals and respect their dignity by:

treang them with respect

respecng their right to condenality and privacy.

Working in partnership with paents and colleagues

Work in partnership with paents by:

listening to them and responding to their concerns and

preferences

giving them the informaon they want or need in a way they

can understand and ensuring they understand it

respecng their right to reach decisions with you about their

treatment and care

supporng them in caring for themselves to improve and

maintain their health.

Maintain the trust of colleagues, and treat them respecully.

Work with colleagues in ways that best serve paents interests


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Acng honestly and ethically

Be honest and open when working with paents; act ethically

and with integrity by:

acng without delay to prevent risk to paents

acng without delay if you have good reason to believe that

a colleague may be pung paents at risk

never discriminang unfairly against paents or colleagues

never abusing your paents trust in you or the publics trust

of the profession.

Work cooperavely with, and be honest, open and construcve

in your dealings with managers, employers, the Medical Council,

and other authories.

Accepng the obligaon to maintain and improve standards

Act in accordance with relevant standards.

Keep your professional knowledge and skills up to date

Recognise, and work within, the limits of your competence.

Be commied to autonomous maintenance and improvement in

your clinical standards in line with best evidence-based pracce.

Demonstrate reecveness, personal awareness, the ability toseek and respond construcvely to feedback and the willingness

to share your knowledge and to learn from others.

Accept a responsibility for maintaining the standards of the

profession.

Remember that you are personally accountable for your

professional pracce you must always be prepared to explain

your decisions and acons.


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Areas of

professionalism

1. The Council expects doctors to be competent in:

caring for paents

respecng paents

working in partnership with paents and colleagues

acng honestly and ethically

accepng the obligaon to maintain and improve

standards

In the secons that follow, we outline the requirements of

each of these areas of professionalism.


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Caring for patients

Principles

Make the care of paents your rst concern.

Protect and promote the health of paents and the public.

Providing good clinical care

2. When you assess, diagnose or treat paents you must

provide a good standard of clinical care. This includes:

adequately assessing the paents condion, taking

account of the paents history and his or her views,

reading the paents notes and examining the paent

as appropriate4

providing or arranging invesgaons or treatment

when needed

taking suitable and prompt acon when needed, and

referring the paent to another praconer or service

when this is in the paents best interests.

3. In providing care you are expected to5:

provide eecve treatments based on the best available

evidence

consult and take advice from colleagues when

appropriate

take steps to alleviate pain and distress whether or not

a cure is possible.

Safe pracce in an environment of resource

limitaon

4. Strive to use resources eciently, consistent with good

evidence based paent care, and balance your duty of care

to each paent with your duty of care to the community and

wider populaon

6

.

4 See the Councils statement on

Non-treang doctors performing

medical assessments of paents

for third pares,which outlinesthe specic requirements for non-

treang doctors performing medical

assessments for other pares.


Telehealthfor informaon about

providing services electronically or

from a distance.

6 For more informaon, see the

Councils statement on Safe

pracce in an environment of

resource limitaon.


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Keeping records7

5. You must keep clear and accurate paent records that report:

relevant clinical informaon

opons discussed

decisions made and the reasons for them

informaon given to paents

the proposed management plan

any drugs or other treatment prescribed.

6. Make these records at the same me as the events you are

recording or as soon as possible aerwards.

7. Take all reasonable steps to ensure that records containing

personal data about paents, colleagues or others are kept

securely.

Administrave systems

8. Your administrave systems must support the principles and

standards contained within Good Medical Pracce.

Prescribing drugs or treatment8

9. You may prescribe drugs or treatment, including repeat

prescripons, only when you:

have adequate knowledge of the paents health

are sased that the drugs or treatment are in the

paents best interests.

10. Before prescribing any medicine you should have a face-to-face consultaon with the paent or, in the absence of

a face-to-face consultaon, discuss the paents treatment

with another New Zealand registered health praconer

who can verify the paents physical data and identy. When

neither of these opons is possible or praccal, it may be

reasonable pracce to:7 See the Councils statement on

The maintenance and retenon of

paent records


Good prescribing pracce.


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Complete a prescripon for a paent if you are

providing cover for an absent colleague or are

discharging a paent from hospital and review the

paents notes.

Renew a prescripon of a paent you, or a colleaguein the same pracce, have seen previously, following

a review of its appropriateness for the paent. When

the prescripon has potenally serious side eects, you

should regularly assess the paent.

Complete a prescripon when you have a relevant

history and there is an urgent clinical need to prescribe,

provided that you inform the paents regular doctor as

soon as possible 9.

Providing care to yourself or those close to you10

11. Other than in exceponal circumstances you should not

provide medical care to yourself or anyone with whom you

have a close personal relaonship.

Treang people in emergencies11

12. In an emergency, oer to help, taking account of your

own safety, your competence, and the availability of other

opons for care.

Treang paents who present a risk of harm

13. If a paent poses a risk to your own health and safety or

that of other paents or sta, you should take all reasonable

steps to minimise the risk before providing treatment ormaking suitable arrangements for treatment.

9 For example, when a public health

physician prescribes prophylacc

medicines for family members of

a paent, aer that paent has

been diagnosed with a serious

communicable disease.


Providing care to yourself and

those close to you.

11 See the Councils statement on The

doctors dues in an emergency.


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Respecting

patients

Principles

Aim to establish a relaonship of trust with each of your paents.

Be aware of cultural diversity, and funcon eecvely and

respecully when working with and treang people of dierent

cultural backgrounds.

Treat paents as individuals and respect their dignity by:

treang them respecully

respecng their right to condenality and privacy.

Establishing and maintaining trust

14. You should aim to establish and maintain trust with yourpaents. Relaonships based on openness, trust and good

communicaon will enable you to work in partnership with

them to address their individual needs.

15. Make sure you treat paents as individuals and respect their

dignity and privacy.

16. Be courteous, respecul and reasonable.

Cultural competence12

17. New Zealand has as its founding document the Treaty of

Waitangi. You should acknowledge the place of the Treaty,

and apply the principles of partnership, parcipaon and

protecon in the delivery of medical care. You must also

be aware of cultural diversity and funcon eecvely and

respecully when working with and treang people of all

cultural backgrounds. You should acknowledge:

12 See the Councils Statement on

cultural competence.For specic

guidance on providing care toMori paents, see the Councils

Statement on best pracces

when providing care to Mori

paents and their whnauand

Best health outcomes for Mori:

Pracce implicaons.For advice on

providing care to Pacic paents,

see Best health outcomes for Pacic

peoples: Pracce implicaons.

See also Coles Medical pracce

in New Zealandfor advice on

providing care toAsian people in

New Zealand.


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that New Zealand has a culturally diverse populaon

that each paent has cultural needs specic to him/her

that a doctors culture and belief systems inuence his

or her interacons with paents

that ones culture may may impact on the doctor-

paent relaonship

that a posive outcome for paent and doctor

is achieved when they have mutual respect and

understanding

18. You must consider and respond to the needs of all paents.

You should make reasonable adjustments to your pracce to

enable them to receive care that meets their needs13.

Personal beliefs and the paent

19. You must not refuse or delay treatment because you believe

that a paents acons have contributed to their condion. Nor

should you unfairly discriminate against paents by allowing

your personal views to aect your relaonship with them.

20. Your personal beliefs, including polical, religious and moral

beliefs, should not aect your advice or treatment. If youfeel your beliefs might aect the advice or treatment you

provide, you must explain this to paents and tell them

about their right to see another doctor. You must be sased

that the paent has sucient informaon to enable them to

exercise that right.

21. Do not express your personal beliefs to your paents in ways

that exploit their vulnerability or that are likely to cause

them distress.

Treang informaon as condenal14

22. Treat all informaon about paents as condenal and

sensive15.

13 New Zealand is a signatory to

the United Naons Convenon

on Persons with Disabilies. This

convenon is intended to protect

the rights and dignity of persons

with disabilies. The convenon

includes provisions to ensure that

persons with disabilies receive

care appropriate to their needs,

and at the same standard as others.

14 See the Health Informaon Privacy

Code.

15 Rule 10 (1)(d) of the Health

Informaon Privacy Code, allows

you to disclose informaon about

a paent in a limited range of

circumstances, including when

disclosure [is] necessary to prevent

or lessen a serious and imminent

threat to public health or public

safety or the life and health of an

individual.


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Supplementary guidance

Sharing informaon in public

When sharing informaon in any public forum (including,

for example, chang in a hospital cafeteria or posng to a

social networking site), do not disclose informaon about

yourself that might undermine your relaonship with paents.

Similarly, do not disclose informaon that might idenfy and

cause distress to colleagues, paents or their families.

Supplementary guidance

Sharing informaon with parents, caregivers

or next of kin

When working with paents under 16 years, you should

determine their competence to understand their condion

and make decisions about their treatment. If they are

competent, they are entled to condenality. In the absence

of a concern that the young person is at risk of harm, you

should only share informaon with parents and caregivers

with the paents consent.

When working with adult paents who have an intellectualdisability or communicaon dicules you should make a

judgement as to whether you are acng in the paents best

interests by sharing informaon with family or caregivers.

Whenever possible you should seek the permission of the

vulnerable adult to share informaon about their condion

and treatment with others.

When an adult paent has died, advise the paents partner

or next of kin, unless you know that the paent would have

objected. When a paent under 16 has died, explain to theparents or caregivers to the best of your knowledge why and

how the paent died.

Involving relaves, carers and partners

23. Acvely involving relaves, carers and partners in a paents

care is inherent to cultural competence and a posive

doctor-paent relaonship, and is oen part of good clinical

care. When appropriate you should seek the paents


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permission to involve relaves, carers and / or partners in

their care. You must always be courteous, respecul and

reasonable to relaves, carers, partners and others close

to the paent. Make sure you are sensive and responsive

in providing informaon and support, for example, aer apaent has died.

Supplementary guidance End of life care

As a doctor you play an important role in assisng paents,

families/whnau and the community in dealing with the

reality of dying and death. In caring for paents at the end

of life, you share with others the responsibility to take care

that the paent dies with dignity, in comfort and with as lilesuering as possible. You should take care to communicate

eecvely and sensively with paents, their families and

support people so that they have a clear understanding of

what can and cannot be achieved. You should oer advice

on other treatment or palliave care opons that may be

available. You should ensure that support is provided to

paents and their families, parcularly when the outcome is

likely to be distressing to them.

Supplementary guidance Euthanasia

You must not parcipate in the deliberate killing of a paent

by acve means. Euthanasia is an oence under the Crimes

Act 1961 and illegal in New Zealand.

Dealing with adverse outcomes16

24. If a paent under your care has suered serious harm or

distress you should act immediately to put maers right. You

should express regret at the outcome, apologise if appropriate,

and explain fully and without delay to the paent:

what has happened

the likely short-term and long-term eects

what you and your health service can do to alleviate the

problem 16 Refer to the Councils statement onDisclosure of harm.


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what steps have been or will be taken to invesgate

what happened and (if possible) prevent it from

happening again.

how to make a complaint.

25. Paents who have a complaint about the care or treatment

they have received have a right to a prompt, construcve

and honest response, including an explanaon and, if

appropriate, an apology.

26. Do not allow a paents complaint to prejudice the care or

treatment you provide or arrange for that paent.

Reporng of alleged abuse

27. If you have any concerns about alleged or suspected sexual,

physical or emoonal abuse or neglect of vulnerable

paents, you should report this to the appropriate

authories without delay. You should inform the paent, and

if the paent is under the care of another person, his or her

caregivers of your intenon to report your concerns, taking

into account that such acon might endanger you or the

paent. Giving informaon to others for the protecon of a

paent may be a jusable breach of condenality17and,

where a vulnerable adult is at risk of injury, is a legal duty18.

Ending a professional relaonship19

28. In some rare cases, because of a lack of trust and

condence, you may need to end a professional relaonship

with a paent. If you do so, you must be prepared to jusfy

your decision. You should tell the paent in wring if

possible why you have made this decision. You should alsoarrange for the paents connuing care and forward the

paents records without delay.

17 As outlined in the Privacy Act and

the Health Informaon Privacy Code.

18 As outlined in s.151 of the Crimes

Act 1961.


Ending a doctor-paent relaonship.


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Working in

partnership withpatients and

colleagues

Principles

Work in partnership with paents by:

listening to them and responding to their concerns and

preferences

giving them the informaon they want or need

in a way they can understand and ensuring they

understand it

respecng their right to reach decisions with you

about their treatment and care

supporng them in caring for themselves to improve

and maintain their health.

Maintain the trust of colleagues, and treat them politely and

considerately.

Work with colleagues in ways that best serve paents interests.

Assessing paents needs and priories

29. The care or treatment you provide or arrange must be made

on the assessment you and the paent make of his or her

needs and priories, and on your clinical judgement about

the likely eecveness of the treatment opons.


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Supporng self care

30. Encourage your paents and the public to take an interest in

their health and to take acon to improve and maintain their

health. Depending on the circumstances, this may include:

advising paents on the eects their life choices may

have on their health and wellbeing and the outcome of

treatments

oering paents appropriate preventave measures,

such as screening tests and immunisaons, that are

appropriate to their parcular health status and

consistent with guidelines and best pracce

encouraging paents to stay in, or return to, work or

engage in other purposeful acvies20

Informaon, choice of treatment and informed

consent21

31. You must familiarise yourself with the:

Code of Health and Disability Services Consumers Rights22

Health Informaon Privacy Code23.

32. With rare and specic excepons you should not provide

treatment unless:

the paent has received all the informaon that a

reasonable paent, in that paents circumstances,

would expect to receive about their condion and

treatment opons, including the expected risks, side

eects, costs and benets of each opon; and

you have determined that he or she has an adequate

understanding of that informaon; and

you have provided the paent with an opportunity to

consider and discuss the informaon with you; and

the paent has made an informed choice; and

the paent consents to treatment.

20 The Royal Australasian College ofPhysicians Consensus Statement

on the Health Benets of Work

outlines the evidence that work

is generally good for health and

wellbeing, and that long-term

work absence and unemployment

generally have a negave impact

on health and wellbeing. A copy of

this paper can be downloaded from

hp://www.racp.edu.au/page/

policy-and-advocacy/occupaonal-

and-environmental-medicine.


Informaon, choice of treatment

and informed consent.

22 For a copy of the Code of Health

and Disability Services Consumers

Rightsgo tohp://www.hdc.org.

nz/the-act--code/the-code-of-rights

23 For a copy of the Health

Informaon Privacy Code go to

hp://privacy.org.nz/health-

informaon-privacy-code/


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33. In order that you can appropriately advise paents on their

treatment opons, you should have a reasonable knowledge

of the range of evidence based treatments that are available

to treat their condion, and of how paents can access

those that you yourself do not provide.34. You must respect and support the paents right to seek

a second opinion or to decline treatment, or to decline

involvement in educaon or research.

Supplementary guidance Informed consent

in specic situaons24

You should obtain separate wrien consent for research,

experimental procedures, general or regional anaesthesia,

blood transfusion or any procedure with a signicant risk of

adverse eects.

You should pay careful aenon to the process of informed

choice and consent when a proposed treatment is expensive

or in any way innovave. If a paent is choosing between

evidence based medicine and innovave treatments for which

there is no scienc evidence, you should aempt to present

to the paent a clear and balanced summary of the scienc

informaon available.

Before providing treatment you should seek the advice of a

senior colleague, or obtain legal advice, if you are unsure

whether the paent is competent to make a parcular

decision, and:

the paents wishes, or the wishes of a parent, guardian

or caregiver, conict with your assessment of the paents

best interests; or

the treatment is risky or controversial.

24 Addional requirements apply

in certain circumstances, such

as where the paent is a minor

or not competent to make an

informed decision. In addion,

there are several pieces of law that

can override the requirements of

the Code of Rights. The Councils

statement onInformaon, choice

of treatment and informed consent

outlines these requirements.


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Supplementary guidance Use of interpreters

When treang paents whose English language ability is

limited, you should arrange to use a competent interpreter.

When an interpreter has been used to assist in obtaining

the paents informed consent you should note this in

the records, along with the interpreters name and status

(professional interpreter, family member etc) and, if possible,

a note signed by the interpreter to cerfy that they believe

the paent understands the informaon provided.

Advance direcves

35. An advance direcve is a formal document that clearly

and specically outlines or describes the paents wishes.

Advance direcves have legal standing in the Code of Health

and Disability Services Consumers Rights. There may be

exceponal circumstances in which it may not be appropriate

to comply with the wishes outlined in an advance direcve25,

however you must always respect and consider those wishes.

If a paent has an advance direcve that is relevant to their

care you should, where possible, conrm that it is consistent

with their current views before providing treatment.

Support persons

36. Patients have the right to have one or more support

persons of their choice present26, except where safety

may be compromised or another patients rights

unreasonably infringed.

Adversing27

37. Make sure that any informaon you publish or broadcast

about your medical services is factual and veriable. It

must not put undue pressure on people to use a service,

for example by arousing ill-founded fear for their future

health or by fostering unrealisc expectaons. The

informaon must conform to the requirements of the

Councils Statement on adversing, the Fair Trading Act

1986 and the Adversing Standards Authority guidelines.

25 For example, where the paent

is being treated under specic

legislaon such as the Mental

Health (Compulsory Assessment

and Treatment) Amendment Act1992 or when signicant changes

in the paents circumstances or

condion or available treatments

arising since the advance direcve

was made appear to counteract its

validity or relevance.

26 This right is outlined in Right 8 of

the Health and Disability Services

Consumers Rights.

27 See the Councils Statement on

adversing.


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Use of tles

38. Paents can nd medical tles confusing. To reduce confusion,

you should not use a tle such as specialist or consultant

that refers to an area of experse unless you are registered with

the Council in an appropriate vocaonal scope.

Working with colleagues28

39. You must be aware of the impact of your conduct on

members of your pracce team and colleagues, and how

that may aect quality care and treatment for paents29.

40. You should respect the skills and contribuons of your

colleagues.

41. Treat your colleagues courteously, respecully and

reasonably . Do not bully or harass them. You must not

discriminate against colleagues.

42. Do not make malicious or unfounded cricisms of colleagues

that may undermine paents trust in the care or treatment

they receive, or in the judgement of those treang them.

Management

43. You must always strive to work with managers and

administrators in a construcve manner to create and sustain

an environment that upholds good medical pracce. If you are

working in a managerial or leadership role you should adhere

to the guidance contained in the Councils statement on

Responsibilies of doctors in management and governance.

Being accessible

44. Be readily accessible when you are on duty. Depending on

the situaon, this may mean you are accessible to paents,

or it may mean that you are accessible to colleagues or a

triage service.

28 Colleagues are those you work

with, including doctors and other

health professionals.

29 For more informaon, refer

to the Councils statement on

Unprofessional behavior in the

healthcare team.


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Going o duty

45. When you are going o duty, make suitable arrangements

for your paents medical care. Use eecve handover

procedures and communicate clearly with colleagues.

Supplementary guidance Shi handover

In an environment where doctors work in rotang shis, you

should insist that me is set aside for the sole purpose of

organising appropriate handover.

Supplementary guidance - Arranging a locumWhether in private or public pracce, you must take parcular

care when arranging locum cover. You must be sure that the

locum has the qualicaons, experience, knowledge and skills

to perform the dues he or she will be responsible for.

Sharing informaon with colleagues

46. You should ensure that paents know how informaon isshared among those who provide their care.

47. You should seek the paents permission to, and explain the

benets of, sharing relevant informaon with other health

praconers and agencies involved in their care, including

their principal health provider (who will usually be their

general praconer).

48. Once you have the paents permission to share

informaon, you must provide your colleagues with the

informaon they need to ensure that the paent receivesappropriate care without delay.

49. In most situaons you should not pass on informaon if

the paent does not agree. Some situaons exist in which

colleagues should be informed even if the paent does not

agree (for example where disclosure is necessary to ensure

appropriate ongoing care). Under the Health Act 1956 you

may share informaon in these situaons when a colleague

is providing ongoing care and has asked for the informaon.


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Connuity of care

50. Work collaboravely with colleagues to improve care, or

maintain good care for paents, and to ensure connuity of

care wherever possible.

51. Make sure that your paents and colleagues understand

your responsibilies in the team and who is responsible for

each aspect of paent care.

52. If you are the paents principal health provider, you are

responsible for maintaining connuity of care.

Supplementary guidance Transferring

paents

Transfer of care involves transferring some or all of the

responsibility for the paents ongoing care. When you

transfer care of a paent to another praconer, you must

ensure that the paent remains under the care of one of

you at all mes. You should also provide your colleague

with appropriate informaon about the paent and his or

her care, and must ensure that the chain of responsibility is

clear throughout the transfer. Where the transfer is for acute

care, you should provide this informaon in a face-to-face or

telephone discussion with the adming doctor.

You must appropriately document all transfers.

You should ensure that the paent is aware of who is

responsible for their care throughout the transfer, and how

informaon about them is being shared.

Supplementary guidance Referring paents30

Referring involves transferring some or all of the responsibility

for some aspects of the paents care. Referring the paent

is usually temporary and for a parcular purpose, such as

addional invesgaon, or treatment that is outside your

scope of pracce. When you refer a paent, you should

provide all relevant informaon about the paents history

and present condion.

30 Coles Medical pracce in

New Zealandcontains some

useful advice in the chapter

on The management of clinical

invesgaons.


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You must appropriately document all referrals.

When you order a test and expect that the result may mean

urgent care is needed, your referral must include one of the

following:

your out-of-hours contact details

the contact details of the another health praconer who

will be providing aer-hours cover in your absence.

You must also have a process for idenfying and following up

on overdue results.

You should ensure that the paent is aware of how

informaon about them is being shared and who is

responsible for providing treatment, undertaking aninvesgaon and reporng results.

Supplementary guidance Delegang paent

care to colleagues

Delegang involves asking a colleague to provide treatment

or care on your behalf. When you delegate care to a

colleague, you must make sure that they have the appropriate

qualicaons, skill and experience to provide care for thepaent. Although you are not responsible for the decisions

and acons of those to whom you delegate, you remain

responsible for your decision to delegate and for the overall

management of the paent.

You should pass on complete, relevant informaon about

paents and the treatment they need.

You should ensure that the paent is aware of who is

responsible for all aspects of their care, and how informaon

about them is being shared.


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Supplementary guidance Prescribing and

administering of medicines by other health

praconers

You should support any non-doctor colleagues who are involved

in prescribing or administering medicines as outlined below.

When other health professionals have prescribing rights

Some other health professionals have legal and independent

prescribing rights. If you are working in a team with other health

professionals who have prescribing rights, you should oer

appropriate advice when needed to help ensure paent safety.

When non-doctor colleagues are supplying or administering

medicines

Some teams delegate to non-doctors the responsibility for

iniang and/or changing drug therapy. If a colleague is

working from standing orders31that have been issued under

your authority, then you are responsible for the eects of

the medicine being supplied or administered. You should be

available to give them advice, and should regularly review how

the standing order arrangement is working.

Supplementary guidance Planning fortransfer of care

You should have a plan in place to ensure connuity of care if

you become unexpectedly ill.

If you are thinking of rering or reducing your paent list, you

should put transfer arrangements in place and let your paents

know before these arrangements take eect. With the paents

consent, all relevant medical records should be sent to the

health praconer taking over the care of the paent.

31 Refer to the Ministry of Healths

Standing Order Guidelines.You can

view or download a copy of these

guidelines athp://www.health.

govt.nz/publicaon/standing-order-

guidelines


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Acting honestly

and ethically

Principles

Be honest and open when working with paents; act ethically

and with integrity by:

acng without delay to prevent risk to paents

acng without delay if you have good reason to

believe that a colleague may be pung paents at risk

never discriminang unfairly against paents or

colleagues

never abusing your paents trust in you or the

publics trust of the profession.

Work cooperavely with, and be honest, open and construcve

in your dealings with managers, employers, the Medical

Council, and other authories.

Integrity in professional pracce

53. You must be honest and trustworthy in your professional

pracce and in all communicaons with paents.

Sexual and emoonal boundaries

32

54. Do not become involved in any sexual or inappropriate

emoonal relaonship with a paent. In most circumstances

you should also avoid becoming sexually or inappropriately

emoonally involved with someone close to a paent, or a

former paent.

32 See the Councils guidance on

Sexual boundaries in the doctor-

paent relaonship.


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Wring reports, giving evidence and signing

documents33

55. If you have agreed or are required to write reports, complete

or sign documents or give evidence, you should do sopromptly, honestly, accurately, objecvely and based on

clear and relevant evidence.

Supplementary guidance Providing

objecve assessments of performance

Be honest and objecve when appraising or assessing the

performance of colleagues, including those whom you have

supervised or trained. Paents may be put at risk if you

describe as competent someone who has not reached or

maintained a sasfactory standard of pracce.

Supplementary guidance Wring references

and reports

Provide only honest, jusable and accurate comments when

giving references for, or wring reports about, colleagues.

When providing references do so promptly and include all

relevant informaon about your colleagues competence,

performance and conduct.

Financial and commercial dealings34

56. Be honest and open in any nancial or commercial dealings

with paents, employers, insurers or other organisaons or

individuals.57. Act in your paents best interests when making referrals

and providing or arranging treatment or care. You must not

allow any nancial or commercial interests to aect the way

you prescribe for, treat or refer paents. In parcular:

do not ask for or accept any inducement, gi, or

hospitality that may aect, or be perceived to have the

capacity to aect, the way you prescribe for, treat or refer

paents. The same applies to oering such inducements.


Medical cercaon.

34 See also the Councils statement

on Doctors and health related

commercial organisaons.


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do not exploit paents vulnerability or lack of medical

knowledge when making charges for treatment or services

do not encourage paents to give, lend or bequeath

money or gis that will benet you

do not put pressure on paents or their families to

make donaons to other people or organisaons

do not put inappropriate pressure on paents to accept

private treatment.

Conicts of interest35

58. If you have a conict of interest, you must be open about

the conict, declaring your interest. You should also beprepared to exclude yourself from related decision making.

Openness and invesgatory or legal processes

59. You must cooperate fully with any formal inquiry or inquest

(although you have the right not to give evidence that may

lead to criminal proceedings being taken against you). When

you provide informaon you must be honest, accurate,

objecve and the informaon provided must be based on

clear and relevant clinical evidence.

60. You must not withhold relevant informaon from any

formal inquiry or inquest, or aempt to contact or inuence

complainants or witnesses except where directed by the

relevant authority.

Supplementary guidance Giving evidence

If you are asked to give evidence or act as a witness in

ligaon or formal proceedings, be honest in all your spoken

and wrien statements. Make clear the limits of your

knowledge or competence.

61. You have addional responsibilies if you are involved in

management or governance36. In parcular, you must ensure

that procedures are in place for raising and responding to

concerns.

35 See also the Councils statement

on Doctors and health related

commercial organisaons.


Responsibilies of doctors in

management and governance.


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Raising concerns about paent safety37

62. Protect paents from risk of harm posed by a colleagues

conduct, performance or health.

63. If a colleague behaves in a manner which is inappropriateor unprofessional you should speak to them and raise your

concerns in a construcve manner.

64. If your colleague does not respond to your concerns and

connues to act inappropriately or unprofessionally, raise

your concerns with a manager, appropriate senior colleague

or the relevant external authority. Your comments about

colleagues must be made honestly and in good faith. If you

are not sure how to raise your concerns, ask an experienced

colleague for advice.

65. If a colleague is concerned about the conduct, competence

or health of another praconer, or about a problem in the

workplace, you should treat their concerns with respect

and support them in taking acon to address the concerns

and in nofying the relevant authories. You may need to

provide less experienced colleagues with addional support

to ensure that they have the condence to raise concerns.

66. If you have reasonable grounds to believe that paents are,

or may be, at risk of harm for any reason, do your best tond out the facts. Then you should follow your employers

procedures or policies, or tell an appropriate person or

organisaon straight away. Do not delay taking acon because

you yourself are not in a posion to put the maer right.

67. Under the Health Praconers Competence Assurance Act

2003 you must tell the Council if you have reason to believe

that a doctors ill-health is adversely aecng paent care.

68. You should also tell the Council about:

concerns you have that another doctor is not t to pracse

or is not providing an appropriate standard of care

behaviour by another doctor that risks causing harm

to paents.

69. If a colleague raises concerns about your pracce, you

should respond construcvely.


Raising concerns about a colleague.


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Concerns about premises, equipment,

resources, policies and systems

70. If you are concerned that paent safety may be at risk from

inadequate premises, equipment or other resources, policiesor systems, put the maer right if possible. In all other cases

you should record your concerns and tell the appropriate body.

Your health

71. You should register with an independent general praconer

so that you have access to objecve medical care. You should

not treat yourself38.

72. Protect your paents, your colleagues and yourself by:

following standard precauons and infecon control

pracces

undergoing appropriate screening

being immunised against common serious

communicable diseases where vaccines are available.

73. You must tell the Councils Health Commiee if you have

a condion that may aect your pracce, judgement or

performance. The Commiee will help you decide how to

change your pracce if needed. You should not rely on your

own assessment of the risk you may pose to paents39.

74. If you think you have a condion that you could pass on to

paents, you must consult a suitably qualied colleague. Ask

for and follow their advice about invesgaons, treatment

and changes to your pracce that they consider necessary.

Disclosing concerns to the Council

75. You must inform the Council without delay if, anywhere in

the world:

you have been charged with or found guilty of a criminal

oence

you have been suspended or dismissed from dues by

your employer

38 Refer to the Councils statement on

Providing care to yourself and those

close to you.

39 See The HRANZ joint guidelines for

registered healthcare workers on

transmissible major viral infecons

(a statement developed by the

Council with other regulatory

bodies).


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you have resigned for reasons relang to competence

another professional body has made a nding against

you as a result of tness to pracse procedures.

Being open about concerns and restricons on

your pracce

76. If you are suspended from working, or have restricons or

condions placed on your pracce because of a concern

about your competence, conduct or health, you must inform

without delay:

any other persons, or organisaons, in which you are in

partnership or associaon, or for whom you undertakemedical work

any paents who would have a reasonable expectaon

to receive that informaon.

77. You must also give paents honest and accurate answers to

any quesons they have about restricons or condions on

your pracce.

Supporng colleagues

78. You should support colleagues who have problems with

performance, conduct or health.


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Accepting the

obligation tomaintain and

improve standards

Principles

Act in accordance with relevant standards.

Keep your professional knowledge and skills up to date

Recognise, and work within, the limits of your competence.

Be commied to autonomous maintenance and improvement

in your clinical standards.

Demonstrate reecveness, personal awareness, the ability toseek and respond construcvely to feedback and the willingness

to share your knowledge and to learn from others.

Accept a responsibility for maintaining the standards of the

profession.

Applying your knowledge and experience to

pracce

79. You must be competent in each professional role you hold.

You must follow relevant guidance, including the guidance

published by the Council, and connue to develop your

knowledge and skills. This applies to all doctors, and to all

aspects of your medical pracce including management,

research and teaching.

80. Recognise and work within the limits of your competence.


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Research

81. When designing, organising or carrying out research:

make sure that a properly accredited research ethics

commiee has approved the research protocol, andthat the research meets all regulatory and ethical

requirements

do not allow payments or gis to inuence your conduct

do not make unjused claims for authorship when

publishing results

report any concerns to an appropriate person or authority

be honest and accurate in reporng the results of your

research.

Maintaining and improving your professional

performance40

82. Work with paents and colleagues to maintain and improve

the quality of your work and promote paent safety. In

parcular:

take part in audit, peer review and connuing medicaleducaon

respond construcvely to the outcome of audit,

appraisals and performance reviews, undertaking

further training where necessary

contribute to inquiries and sennel event recognion,

analysis and reporng

report suspected drug reacons using the relevant

reporng scheme

cooperate with legimate requests for informaon from

organisaons monitoring public health

parcipate in regular reviews and audit of the standards

and performance of any teams of group in which you

are a member, taking steps to remedy any deciencies

idened.

40 See the Councils guidelines

onConnuing professional

development and recercaon


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Keeping up to date

83. Keep your knowledge and skills up to date throughout your

working life:

familiarise yourself with relevant guidelines anddevelopments that aect your work

take part regularly in professional development

acvies that maintain and further develop your

competence and performance

adhere to and keep up to date with all laws and codes

of pracce relevant to your work.

Mentoring, teaching, training, appraising andassessing doctors and students41

84. Teaching and the passing on of knowledge is a professional

responsibility. When you are involved in teaching you should

demonstrate the atudes, awareness, knowledge, skills and

pracces of a competent teacher.

Supplementary guidance Providingsupervision42

Make sure that all sta for whom you are responsible and

who require supervision, including locums, less experienced

colleagues, and internaonal medical graduates who are new

to pracce in New Zealand are properly supervised. If you are

responsible for supervising sta, you should make sure you

supervise at an appropriate level taking into account the work

situaon and the level of competence of those being supervised.

41 See the Councils publicaon

Educaon and supervision for

interns.

42 See the Councils booklet on

Inducon and supervision for newly

registered doctors.


35/38

Related documents

The guidelines contained in Good Medical Praccedo notcover all forms of professional pracce or discuss all types of

misconduct that may bring your registraon into queson.

You should familiarise yourself with the series of statements

and other publicaons produced by the Council. The Councils

statements expand on points raised in this document. Some

statements also cover issues not addressed in this document,

such as internet medicine and alternave medicine.


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Standards set by

the Council43

Below we list relevant Council statements and other publicaons.

Denions

Clinical pracce and non-clinical pracce

Fitness to pracse

Pracce of medicine

Administrave pracce

Non-treang doctors performing medical assessments of paents

for third pares

Raising concerns about a colleague

Responsibilies of doctors in management and governance

Safe pracce in an environment of resource limitaon

General subjects

Adversing

Complementary and alternave medicine

Condenality and the public safety

Cosmec procedures

Disclosure of harm following an adverse event

A doctors duty to help in a medical emergency

Ending a doctor-paent relaonship

Good prescribing pracce

Informaon, choice of treatment and informed consent

The maintenance and retenon of paent records

Medical cercaon

Doctors and health related commercial organisaons

43 For the most recent versions of the

statements, go to www.mcnz.org.nz

under the heading News and

Publicaons. New and updated

statements are sent to all doctors

with the Councils newsleer.


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Use of the internet and electronic communicaon

When another person is present during a consultaon

Sexual boundaries in the doctor-paent relaonship, a resource

for doctors

Health

HRANZ Joint guidelines for registered health care workers on

transmissible major viral infecons

Providing care to yourself and those close to you

Cultural competence

Best pracces when providing care to Mori paents and their

whnau

Cultural competence

Other Council publicaons

Best health outcomes for Mori: Pracce implicaons

Best health outcomes for Pacic peoples: Pracce implicaons

Coles Medical pracce in New Zealand

Connuing professional development and recercaon

Deciding whether to make a competence referral

Doctors health, a guide to how the Council manages doctors

with health condions

Educaon and supervision for interns, a resource for new

registrants and their supervisors

Inducon and supervision for newly registered doctors

The importance of clear sexual boundaries in the paent-doctor

relaonship, a guide for paents

Medical registraon in New Zealand

What you can expect. The performance assessment

You and your doctor, guidance and advice for paents


38/38

Legislation and

standards set byother agencies

The Code of Health and Disability Services Consumers Rights

gives rights to consumers, and places obligaons on all people

and organisaons providing health and disability services,

including doctors.

Tradionally the Code of Ethics for the medical profession in

New Zealand is that of the New Zealand Medical Associaon.

The Health Informaon Privacy Code 1994 governs the collecon

and use of health informaon. A plain English edion has been

published by the Oce of the Privacy Commissioner and is

available fromwww.privacy.org.nz

New Zealand is a signatory to the United Naons Convenon on

Persons with Disabilies. This convenon is intended to protect

the rights and dignity of persons with disabilies. The convenon

includes provisions to ensure that persons with disabilies enjoy

full equality under the law, and have their rights and dignies

protected.

Legislaon places further legal obligaons on doctors consult

your lawyer if you need advice about your legal obligaons.

medical council of new zealand, good medical practice, a guide for doctors

Documents