Doctors have a duty to make patient care their first concern and to practice medicine safely and effectively. They must be ethical and trustworthy and have the responsibility to protect and promote the health of individuals and community.
Good medical practice is patient-centered and involves doctors understanding that each patient is unique. Working in partnership with their patients, doctors need to adapt what they do to address the needs and reasonable expectations of each patient. This includes cultural awareness: being sensitive of their own culture and beliefs, being respectful of the belief and cultures of others, and recognizing that these cultural differences may impact the doctor-patient relationship and the delivery of health services.
Good communication underpins every aspect of good medical practice. Professionals face daily numerous ethical dilemmas and conflicts of values for which there are no magic solutions. This document offers a set of recommendations that will help doctors to deliberate about these conflicts.
The novelty is the contrast between good and bad scenarios of medical practice. The main goal is guiding professionals in their behavior and attitudes as the best guarantee for patient health. We must define the profile of a good doctor as possessing a firm commitment to the patient, society and the national health system.
It is possible that citizens are not familiar with professional terms ; however, when a citizen refers to a doctor as a ‘good doctor,’ he/she recognizes that in addition to his/her medical science , he/she has series of values related to the interests of patients. We should not ignore the importance of instilling future standards of conduct for all practicing physicians, GP and medical students for them to have a reliable reference for differentiating between good and bad habits in their practices.
Physicians must strive to provide optimal care at all times and always within the standard of quality, efficiency and effectiveness accepted by the profession. In order to achieve excellence in clinical practice, it is necessary to always stay updated and prepared at a formative level. We must be trained to know how to offer answers to our patients based on good medical practice, always with the sufficient independence and autonomy.
It is the responsibility of professionals to be familiar with the Code of Medical Ethics (CME). Good Medical Practice (GMP) must be a positive contribution for all professionals that facilitate daily professional practice. GMP is an open document that allows doctors to constantly think and reinterpret it according to both social changes and advance in clinical and technological knowledge.
Medicine involves uncertainty and in the field of values, uncertainty generates situations of great tension. Professional actions always imply a commitment to our values, which may not coincide with those of patients. Guiding action with the necessary prudence in difficult decisions is a clear intention of this document. Providing ethical, deontological and legal reference and identifying elements to be considered in decision making are aspects in which GMP can be an aid to professionals. However, it will always be doctors who, with their competence, responsibility and ethics, must identify and prioritize the values that determine the behavior that must be followed in each concrete circumstance.
There are eight elements in GMP.
- Professionalism in medical practice
* Principles inspiring good practice of doctors - Medical/patient relationship: a link of confidence
* Show respect for your patients
* Treat your patients fairly and without discrimination
* Always act with honesty, integrity, openness and transparency - Professional competence
* Maintain and improve the basics of professional competence: - Knowledge, skills and attitudes
* Incorporate reflection on professional experience to practice
* Register your work in a complete, clear, precise and intelligible manner - Communication and collaboration
* Communicate efficiently and nicely
* Get involved in the learning and evaluation of colleagues
* Enhance assistance continuity and coordination
* Support partnership/alliance with patients - Intra and inter professional relation and teamwork
* Collaborate with colleagues to maintain and improve patient care
* Take care of the health of doctors to protect patients from risks that may entail the possible psychological impairment - Safety and quality
* Comply with the protection process of patients
* Act against the risks that compromise the safety of patients - The Professional practice/learning relationship: a source of permanent improvement
* Reflect on professional practice to improve care for patients
* Teaching and research are essential for the improvement of doctors - Health organizations and health systems
* Understand the complexity, peculiarities and responsiveness of health systems
* Use the resources of the system to provide the best possible care
* Recognize the importance of the National Health System for the benefit of patients
Scenarios of bad medical practice
- The long experience with my patients is what teaches me; I cannot waste time constantly updating my knowledge.
- As a specialist, I am responsible for the problem consulted within my specialty; as for the rest of processes … I do not care.
- For the doctor, the professional revalidation and Periodic Validation of Registration is just another obstacle; schools and politicians are the ones to take care about being transparent.
- I have spent my whole life tending my patients well without having read the Code of Deontology; therefore, it is irrelevant to know it.
- I have no limitation in spreading my private life in social network; its dissemination does not have to affect my professional activity.
- I do not interfere with additional tests, even if they are not indicated. Patients like them and it saves me time and trouble.
- Ignoring medical mistakes of my colleagues or health system is the best way to not generate disagreements.
- I look for sponsors to finance the conferences I attended; the company will be satisfied and I do not hurt anyone.
- I try to refer public health parents to my private consultation.
- My professional experience is the best evidence. Evidence-based medicine is fiction.
- I do not take into account the health expenses that I generate with my professional activity.
- Clinical decisions are mine and I do not accept the autonomy of the patients. What does the patient have a right to decide about?
- I try not to accept a second opinion; it is not useful and it can be a headache; I do not want trouble.
- As head of the team, I do not have to listen to opinions of any of my subordinates.
- Patient safety and quality of care are not my daily or direct concern.
- The practice of care is essential for training while continuing education activities are a way of wasting time.
- Health expenditure is none of my business, I do not pay for it , so I never impose limitations on spending.
The practice of medicine is challenging and rewarding. No codes or guideline can ever encompass every situation or replace the insight and professional judgement of good doctors.Therefore, good medical practice means using this judgement to try to practice in a way that would meet the standards expected of you by your peer and the community.
References
1. Good Medical Practice
Guidelines for a professional performance of excellence
Scenarios of bad medical practice
November 2016
2nd revised edition
2. Good Medical Practice:
A Code of Conduct for Doctors
Medical Board of Australia
Dr Tin Maung Chit
FRCP, FACP
Senior Consultant Physician, Pathein
5th,October,2018
