Duties of a Doctor: (GMC 2006)

Patients must be able to trust doctors with their lives and well-being. To justify that trust, we as a profession, have a duty to maintain a good standard of practice and care and to show respect for human life. In particular as a doctor you must:

  • Make the care of your patient your first concern
  • Protect and promote the health of patients and the public
  • Provide a good standard of practice and care
    • Keep your professional knowledge and skills up to date
    • Recognise and work within the limits of your competence
    • Work with colleagues in the ways that best serve patients' interests
    • Treat patients as individuals and respect their dignity
    • Treat patients politely and considerately
    • Respect patients' right to confidentiality

  • Work in partnership with patients
    • Listen to patients and respond to their concerns and preferences
    • Give patients the information they want or need in a way they can understand
    • Respect patients' right to reach decisions with you about their treatment and care
    • Support patients in caring for themselves to improve and maintain their health

  • Be honest and open and act with integrity
    • Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk
    • Never discriminate unfairly against patients or colleagues
    • Never abuse your patients' trust in you or the public's trust in the profession.
    • You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.

In all these matters you must never discriminate unfairly against your patients or colleagues and you must always be prepared to justify your actions to them.

For further information on how to apply these principles, please read our booklet ‘Good Medical Practice’.

THE NEED FOR A CHAPERONE

Members are reminded that it is advisable to have a chaperone present when examining female patients. In saying this, the MDU realises that it may not be possible to have a chaperone on every occasion. We would however, make some comments.

1. It is only when there has been an incident that a lack of chaperone can be a source of bitterness, recrimination and regret. Nevertheless, each doctor should exercise his or her own discretion.

2. The circumstances that pose problems include particularly: darkening the room for retinoscopy or similar procedures, and examining the torso of younger female patients without proper explanation.

3. Gynaecological examinations sometimes give rise to problems, but problems are not restricted to this class of consultation.

4. Complaints of indecent assault have been made by patients of both sexes and such complaints are not limited to allegations against a doctor of the opposite sex.

In general the MDU does not think that a doctor puts himself or herself at added risk because a chaperone is considered appropriate on some occasions but not on others.

The MDU is aware of the practical difficulties of providing chaperones on every occasion, but experience has shown that it is an area in which it is all too easy to be wise after a distressing event.

* Text taken from “Journal of Medical and Dental Defence Union. Vol. 11 No 2, April 1995”.

CONSENT

12 Key Points on Consent:

When do health professionals need Consent from patients?

1. Before you examine, treat or care for competent adult patients you must obtain their consent.

2. Adults are always assumed to be competent, unless demonstrated otherwise. If you have doubts about their competence, the question to ask is: “can this patient understand and weigh up the information needed to make this decision?” Unexpected decisions do not prove the patient is incompetent, but may indicate a need for further information or explanation.

3. Patients may be competent to make some health care decisions, even if they are not competent to make others.

4. Giving and obtaining consent is usually a process, not a one-off event. Patients can change their minds and withdraw consent at any time. If there is any doubt, you should always check that the patient still consents to your caring for or treating them.

Can children consent for themselves?

5. Before examining, treating or caring for a child you must also seek consent. Young people aged 16 and 17 are presumed to have the competence to give consent for themselves. Younger children who understand fully what is involved in the proposed procedure can also give consent (although their parents will ideally be involved).

In other cases, someone with parental responsibility must give consent on the child’s behalf, unless they can not be reached in an emergency. If a competent child consents to treatment, a parent cannot over ride that consent. Legally, a parent can consent if a competent child refuses, but is likely that taking such a serious step will be rare.

Who is the right person to seek consent?

6. It is always best for the person actually treating the patient to seek the patient’s consent. However, you may seek consent on behalf of colleagues if you are capable of performing the procedure in question, or if you have been specially trained to seek consent for that procedure.

What information should be provided?

7. Patients need sufficient information before they can decide whether to give their consent, for example information about the benefits and risks of the proposed treatment, and alternative treatments. If the patient is not offered as much information as they reasonably need to make their decision, and in a form they can understand, their consent may not be valid.

Is the patient’s consent voluntary?

8. Consent must be given voluntarily, not under any form of duress or undue influence from health professionals, family or friends.

Does it matter how the patient gives consent?

9. Consent can be written, oral or non-verbal. A signature on a consent form does not itself prove the consent is valid – the point of the form is to record the patient’s decision, and also increasingly the discussions that have taken place. Your Trust or organisation may have a policy setting out when you need to obtain written consent.

Refusals of Treatment

10.Competent adult patients are entitled to refuse treatment, even where it would clearly benefit their health. The only exception to this rule is where the treatment is for a mental disorder and the patient is detained under the Mental Health Act 1983. A competent pregnant woman may refuse any treatment, even if this would be detrimental to the foetus.

Adults who are not competent to give Consent

11. No-one can give consent on behalf of an incompetent adult. However, you may still treat such a patient if the treatment would be in their best interest. ‘Best interests’ go wider than best medical interests, to include factors such as the wishes and beliefs of the patient when competent, their current wishes, their general well-being and their spiritual and religious welfare. People close to the patient may be able to give you information on some of these factors. Where the patient has never been competent, relatives, carers and friends may be best placed to advise on the patient’s needs and preferences.

12. If an incompetent patient clearly indicated in the past, while competent, that they would refuse treatment in certain circumstances (an ‘advance refusal’) and those circumstances arise, you must abide by that refusal.

This summary cannot cover all situations. For more details, consult the Reference Guide to Consent for Examination or Treatment, available from the NHS Response 0870 1555 455 www.dh.gov.uk