Good Medical Practice

Introduction

In Myanmar, excellent doctor-patient relation has been achieved for more than ten decades. It has now started to erode due to unfortunate circumstances. Being the providers of healthcare, professionals need to improve the standard of practice by creating a good working environment to maintain long-lasting excellent, mutually respectful doctor-patient relationship.

Good doctors

Good doctors are those who make the care of their patients first concern. They are competent and always keep their knowledge and skills up-to-date, establish and maintain good relationships with patients and colleagues. They are honest, trustworthy, and act with integrity and within the law.¹

Good doctors work in partnership with patients and respect their right to privacy and dignity. They treat each patient as an individual. They do their best to make sure all patients receive good care and treatment that will support them to live as well as possible, whatever their illness or disability.

Good doctors use their judgement in applying the principles to the various situations which will be faced as a doctor, whether or not they hold a licence to practice, whatever field of medicine they work in, and whether or not they routinely see patients. They must be prepared to explain and justify their decisions and actions.

There are seven core aspects of a good doctor:¹

1. Good clinical care
2. Maintaining good medical practice
3. Teaching and training, appraising and assessing
4. Relationships with patients
5. Working with colleagues
6. Probity
7. Health

1. Good Clinical Care

Components of good clinical care must include

( a ) Adequately assessing the patient’s conditions, history, where necessary examining the patient

( b ) Providing or arranging advice, investigations or treatment

( c ) Referring a patient when this is in the patient’s best interests

In providing care, doctors must

( a ) Recognize and work within the limits of one’s concern

( b ) Prescribe drugs or treatment, only with adequate knowledge of the patient’s health, and are satisfied that drugs or treatment serve the patient’s needs

( c ) Provide effective treatments based on the best available evidence. Example: Should avoid advising all of the pre-set investigations and prescribing unnecessary or inappropriate medications to patients

( d ) Take steps to alleviate pain and distress whether or not a cure may be possible

( e )  Respect the patient’s right to seek a second opinion

( f ) Keep clear, accurate and legible records, relevant clinical findings, the decisions, information given, drugs prescribed or other investigations or treatment

Examples of act against good clinical care:

• Not offering second opinion,
• Not recorded though job has been done: regarded as not done

 

( g ) Make records at the same time or as soon as possible

( h ) Be readily accessible when on duty

( i ) Consult and take advice from colleagues, when appropriate

( j ) Make good use of the resources available

Example of act against good clinical are:

• A doctor who does not come and see when emergency problem occurs
• No prior consultation with physician or anaesthetist before operation
• No use of the proper resources

Supporting self-care

Supporting self-care consists of encouraging patients and the public to take an interest in their health and take action to improve and maintain it. This includes advising patient on the effects of their life choices on their health and well-being and the possible outcomes of their treatments.

It includes advising patients on the effects of their life choices on their health and well-being as well as the possible outcomes of their treatments.

Patient safety

If a doctor has good reason to think that patient safety is or may be seriously compromised because of inadequate premises, equipment, or other resources, policies or systems, concerns about patient safety must be raised and put the matter right if it is possible. The attention of employing or contracting body should be drawn and independent advice to be taken. All the concerns and steps taken trying to resolve the concerns must be recorded.

There are seven steps to attain patient’s safety as follow:²

Step 1: Build a safety culture

Step 2: Lead and support the staff

Step 3: Integrate in risk management activity

Step 4: Promote reporting

Step 5: Involve and communicate with patients and the public

Step 6: Learn and share safety lessons

Step 7: Implement solutions to prevent harm

Information is as critical to the provision of safe health care. To develop a treatment plan, a doctor must have access to complete patient information and to the most current science base. The doctor and the patient must also be aware of other environmental factors that affect the ability to implement a treatment plan, such as the availability of hospital beds, current waiting times to obtain specific providers.³

Decisions about access to medical care¹

The provided or arranged investigations or treatment must be based on the assessment made of patients’ needs and priorities and on the clinical judgement about the likely effectiveness of the treatment options. Doctors must not refuse or delay treatment because of the belief that a patient’s actions have contributed to their choices and beliefs. Patients must not be unfairly discriminated because of the doctors’ personal view. If the behavior of other colleagues does not comply with the guidance, they should be challenged.

Does the patient have the right to seek second opinion?¹

If carrying out a particular procedure or giving advice about it conflicts with one’s religious or moral beliefs, this conflict might affect the treatment or advice to be provided. In such situation, the patient must be explained about their right to see another doctor. If it is not practical for a patient to arrange to see another doctor, arrangements should be made for another suitably qualified colleague to take over the role of previous doctor.

Regarding decision about access to medical care, doctors should give priority to the investigation and treatment of patients on the basis of clinical need. If inadequate resources, policies or systems prevent doing this, and patient safety is or may be seriously compromised, the guidance in patient safety must to be followed.

Can you refuse to treat a patient because of potential risk to you?

All patients are entitled to have care and treatment. Doctors must not refuse to treat a patient because of the medical condition that may put them at risk. If a patient poses a risk to health or safety of health care professionals, they should take all available steps/precaution to minimise the risk.

Example: Examination and taking blood from a child with proven HIV infection/COVID infection.

Treatment in emergencies

Wherever emergency arises, doctors must offer assistance, while taking account on own’s safety, competence and the availability of other options for care.

2. Maintaining Good Medical Practice

Doctors should keep up-to-date professional knowledge and skills and have to maintain and improve their performance.

Examples against good medical practice

• failure to provide controller to a child with persistent asthma
• a practitioner who never attends a CME/Continuous Medical Education activities
• Not knowing or ignoring to report a suspected case of notifiable disease

Teaching and training, appraising and assessing¹

The good doctors must be honest and objective in assessing colleagues. The act of “prescribing someone who has not maintained a satisfactory standard of practice to be the competent one” put the patients at risk and such kind of act should be avoided.

3. Teaching and training appraising and assessing

Teaching, training, appraising and assessing are important and doctors should involve in these activities. If doctors get involved in teaching, they must develop their own’s skills, attitudes and practices to be competent teacher.

It is necessary to ensure that all staffs are trained and supervised properly.

The literal meaning of “Doctor” is “Teacher”

Examples of act against good medical practice:

• A general practitioner who does not want to teach
• An incompetent teacher
• A private clinic which has not trained the staffs on basic life support

4. Patient-Doctor relationship

To be the good doctors, they must be polite, considerate and honest. They should treat patients with dignity and treat each as an individual. They should respect privacy and confidentiality of patients. They should support patients to improve or maintain their health and should encourage patients to have knowledge and make decision.

Regarding with relationship with patients, communication should be effective and safeguarding of children, young people and vulnerable groups should be maintained. If things go wrong, doctors should be honest with the patients and should maintain trust in the profession. If the trust has been broken down for justifiable reason, doctors should be fair about ending professional relationship.

There has been evidence that race, ethnicity, and language all affect the quality of the doctor-patient relationship. These factors have all be linked to patient satisfaction, patient compliance and care outcomes in the doctor-patient relationship.⁴

Causes of complaints

The main reasons of complaints are due to communication failure, underperformance of doctors, system failure and criminal doctors take account for only small incidences.

Medical professionalism

Medical professionalism is our behavior as physicians. It is how we conduct ourselves as physicians in our interactions with our patients and society. Medical professionalism is a behavior that is predicated on our personal beliefs and our ideas. It encompasses the values, behaviors, and attitudes inculcated into us by our medical school education and post- graduate training along with our daily experiences interacting with patients and fellow physicians. Medical professionalism is greatly influenced by our contemporaneous social values and norms. Therefore, it remains a flexible concept from age to age, despite maintaining a core set of values.⁵

5. Working with colleagues

Colleagues should be treated fairly with respect. Adequate cover as well as effective handover have to be ensured. All relative information should be provided during handover. Treating colleagues fairly, with respect for their skills as well as for their contribution. Communication within and outside the team should be effective and ensure about one’s role within the team. Work together with the team in regular review and audit. Colleagues should be supported and patient safety should be prioritised.

6. Probity¹

Doctors should have adherence to highest principles and ideals. They should be honest and trustworthy while providing and publishing information about their services, writing reports and CVs, giving evidence and signing documents and research.

Research

Research involving people directly or indirectly is vital in improving care and reducing uncertainty for patients now and in the future, and improving the health of the population as a whole.

7. Health

All healthcare professionals should have vaccination against serious communicable disease. If a medical practitioner has a serious condition which could be passed on to patients or if one’s judgement or performance could be significantly affected by a condition or treatment, advice from colleagues should be taken and followed on whether and how the practice should be modified¹. Examples:

• A traditional medical practitioner with open case of pulmonary TB continuing practice with young children
• Hepatitis B, C or HIV status in doctor

Draft for new edition of Good Medical Practice (2023)

The following are some changes proposed in the draft for new edition of Good Medical Practice.⁶

Changes includes

• Tackling discrimination and prompting fairness and inclusion, racial, sex, etc.
• Working in partnership with patients- to help them make decision by themselves
• Working effectively with colleagues
• respect for the skills of colleagues, listen to their contribution
• Making it work in place
• working with patients
• working with colleagues
• professional capabilities and
• maintaining trust

Summary

Our medical science empowers us as physicians with the authority to provide the best healing. Our codes and covenants are evolutionary and must always meet the needs of patients and society. Failure to meet these needs would be the loss of our professionalism.

References

1. General Medical Council. The duties of a doctor registered with the General MedicalCouncil. Practice [Internet]. 2006;327(7425):52. Available from: http://www.gmc-uk.org/guidance/good_medical_practice.asp
2. National Patient Safety Agency. Seven steps to patient safety The full reference guide. Npsa [Internet]. 2004;(August):188. Available from: http://www.nrls.npsa.nhs.uk/resources/collections/seven-steps-to-patient-safety/?entryid45=59787
3. Aspden P, Corrigan JM, Wolcott J, Erickson SM. Committee on Data Standards for Patient Safety. Iom. 2004
4. Ferguson W. Culture , language , and the doctor-patient relationship. 2002;(May 2014).
5. Anthony-Pillai R. Medical professionalism. Med (United Kingdom). 2016;44(10):586–8.
6. Consultation draft of revised Good medical practice The purpose of Good medical practice.

Author Information

Saw Win¹, Myat Thida Seinn²

1. Senior Consultant Paediatrician, Parami General Hospital
   MBBS, DCH, MMedSc(Paed), FRCP(Edin), MRCP(UK), MRCPCH(UK),
   DCH(Glascow), DTM&H(London), DipMedEdu
2. Consultant Paediatrician, Neonatal Intensive Care Unit, Yangon Children Hospital
   MBBS, MMedSc (Paed), MRCPCH, DipUKMP, FRCPCH