FROM THE IRISH TIMES >>

DOCTORS COULD find themselves facing disciplinary action if they fail to be upfront with patients and their families about medical errors when they happen.

A revised guide to professional conduct and ethics for doctors, published by the Medical Council, makes it clear patients and their families are entitled to honest, open and prompt communication from doctors about adverse events that may have caused them harm.

It says doctors should therefore acknowledge the event happened, explain how it happened, apologise if appropriate and give an assurance as to how lessons have been learned to minimise the chance of the event recurring.

It also says doctors must report serious adverse events and near-misses to the appropriate health authority to ensure they are investigated.

Prof Kieran Murphy, president of the council, said he believed the profession would welcome this new advice.

He said research suggested open disclosure was associated with improved patient safety.

The document also provides more detailed guidance to doctors on issues such as advance care directives and assisted human reproduction. But Prof Murphy said a lack of legislation in the area of assisted human reproduction raised great difficulties. He said the council would prepare more detailed guidance on this issue in coming months.

There is no reference to stem-cell research in the guide but it says doctors should not participate in creating new forms of life solely for experimental purposes and should not engage in cloning.

It says assisted reproduction services should only be provided by suitably qualified professionals, in appropriate facilities, and according to international best practice.

“Regular clinical audit and follow-up of outcomes should be the norm,” it says. If a doctor offers donor programmes they “should be altruistic and non-commercial”.

In a clear reference to recent abuse scandals, it advises doctors that where adult patients disclose abuse that took place during their childhood a doctor must assess the current risk to the patient or any other person who may be in contact with the alleged abuser. “If you consider that anyone is at risk, you should report this to the appropriate authorities, preferably with your patient’s consent.”

In relation to end-of-life care, the guide says a doctor should respect the right of patients to refuse medical treatment or to request the withdrawal of medical treatment.

“You should also respect a patient’s Advance Healthcare Plan [also known as a living will],” it says.

On giving under-16s treatment like the morning-after pill, the guide states that in exceptional circumstances the patient might seek to make a healthcare decision on her own without the knowledge or consent of her parents.

“In such cases you should encourage the patient to involve their parents in the decision, bearing in mind your paramount responsibility to act in the patient’s best interests.”

It adds though that these young patients should be told that a doctor cannot give an absolute guarantee to confidentiality as a parent may apply to see their medical records under the Freedom of Information Act.

The guide also says doctors have a duty to assist “in the efficient and effective use of healthcare resources”.

Doctors are encouraged to prescribe cheaper generic drugs where they are safe and effective, it adds.

Another entry in the guide states doctors should ensure they have appropriate training, facilities and support before treating patients with drug dependency or abuse problems.

Doctors are also advised not to accept gifts including hospitality from pharmaceutical companies.

And if they get a locum to stand in for them the guide says they must ensure the locum “is appropriately qualified, registered and in good standing” with the council.

The guide also warns if a doctor has a financial interest in a private clinic or pharmacy to which they refer patients, they must inform patients of this and make sure that financial considerations do not influence their management of patients.

NEW GUIDE: PROFESSIONAL CONDUCT AND ETHICS

  • A doctor’s paramount professional responsibility is to act in the best interests of patients. This takes priority over responsibilities to colleagues and employers.
  • Patients and their families are entitled to honest, open and prompt communication with them about adverse events that may have caused them harm.
  • Assisted human reproduction services should only be provided by suitably qualified professionals in appropriate facilities. There should be regular clinical audit and follow-up of outcomes.
  • Doctors have a duty to provide care, support and follow-up services for women who have had an abortion abroad.
  • Given that abortion is illegal in Ireland except where there is a real and substantial risk to the life of the mother arising from a threat of suicide, a doctor should undertake a full assessment of any such risk.
  • A doctor should respect a patient’s living will on condition that the decision in the will was an informed one and that the patient hasn’t changed their mind. A doctor should ensure as far as possible that a patient’s privacy is maintained at all times and that accidental disclosure of confidential information does not occur. Giving information to patients while in busy corridors should be avoided.
  • When treating a patient aged under 16 a doctor should encourage the patient to involve his or her parents in the decision around treatment.
  • Doctors must maintain competence throughout their careers by taking part in the professional competence schemes established by the Medical Council.
  • When a doctor has a concern in relation to a colleague or potentially unsafe system, he or she must act to ensure patients are protected.
  • When disputes arise between doctors, they should be settled privately and as quickly as possible.
  • Fees charged should be appropriate to the service provided.
  • Doctors should be aware of the dangers of drug dependency when prescribing benzodiazepines, opiates and other potentially addictive drugs.
  • Doctors are advised under the guidelines not to accept gifts, including hospitality, from pharmaceutical companies.

Eithne Donnellan

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