Duties and Ethics


Duties of a Doctor and Student Ethics

Guidance issued by the General Medical Council, the body that oversees the medical profession and ensures standards of practice and medical education in Great Britain, applies to medical students as well as to qualified doctors in practice. The guidance is summarised in the 14 points below and can be found on the GMC website: http://www.gmc-uk.org/ Patients must be able to trust doctors with their lives and health. To justify that trust, you must show respect for human life and 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 skills and knowledge up-to-date
  • Recognise and work within the limits of your competence
  • Work with colleagues in the ways which best serve the patients’ interest.
  • 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 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 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
  • Students are personally accountable for their professional conduct and must always be prepared to justify decisions and actions

(Taken from ‘Duties of a doctor – guidance from the General Medical Council’ 2006)

Standards of medical students fitness to train

This guidance has been produced by the Higher Education Occupational Physicians / Practitioners (HEOPS). It sets the standards for medical student’s fitness to train and meet the required standards on graduation.

 Students who have serious concerns that a medical condition may have implications for future fitness to train as a doctor should, at an early stage, contact the Medical School and if appropriate be offered professional advice. There is an obligation on the Medical Schools to make reasonable adjustments for students with disabilities where the disability would not prevent the student from fulfilling the required competencies to graduate. There is no requirement to make adjustments to competence standards themselves.

The full guidance can be accessed at: http://www.heops.org.uk/HEOPS_Medical_Students_fitness_standards_2015_v1...

Dress and behaviour

In order to gain and maintain the trust and confidence of patients, relatives and fellow professionals, Medical students must observe certain rules of dress, appearance and behaviour.
Clinical aspects of the course should be regarded as an apprenticeship for the future professional career as a doctor. Certain standards of appearance are necessary. It is important to remember that patients come from all sections of society and that people who are ill or worried may more easily become anxious about small details. Many of them will regard you in the same way they will a fully-trained doctor. If your standards of dress and behaviour are professional and reasonably conservative you will be unlikely to cause offence or anxiety to your patients, and you will find that your relationships with them and with hospital staff will be easier.

Students should be smartly dressed in an appropriate and professional manner and in compliance with NHS infection control policies whilst on hospitals wards, at GP surgeries, at clinical skills sessions with patients or simulated patients and at OSCEs.

  • bare below the elbow (short sleeves or sleeves neatly folded)
  • no white coats
  • no denim, no low cut tops, no bare midriffs
  • no trainers, no stilettos
  • no wrist watches, bracelets or charity wrist bands
  • no jewellery except:
    • rings – one single metal band, no stones
    • earrings – small studs only
    • necklaces – a simple chain if tucked inside clothing
  • no visible piercings (other than earrings)
  • face visible
  • religious head coverings are permitted
  • ties should be avoided or secured inside shirts
  • hair kept neat and tidy, long hair tied back,
  • fingernails short and clean, no false nails
  • Identification badges should be visible at all times including in operating theatres.

Family illness

Each year a small number of students will have an individual close to them who suffers from a serious illness or who dies. Those students may need additional support when they encounter patients with similar conditions to their loved ones during their course. Whilst there are many possible examples mental illness and cancer diagnoses probably illustrate the issues best.

The Schools policy is to ensure that students will be able to treat and manage these patients in their future medical practice whilst minimising the anxiety and distress caused to the student.

Hence, whilst the student should complete all aspects of the course without exception the Medical Student Support team would be keen to offer advice and support to individual students in this position.

The Medical Student Support can give limited advice on coping strategies and where appropriate onward referral to counselling services may be made.

Confidentiality

The GMC’s guidance should form the starting point for medical schools when considering confidentiality. The relevant paragraphs are set out below.

Tomorrow’s Doctors (2009)

143 Medical students who are ill have the same rights to confidentiality as other patients. Doctors providing medical care for students must consider their duties under the GMC’s Confidentiality  guidance. Passing on personal information without permission may  be justified if failure to do so may result in death or serious harm  to the patient or to others. Doctors should not pass on information  without the student’s permission, unless the risk to patients is so  serious that it outweighs the student’s rights to privacy. They must  remember that students will be in close contact with patients from  an early stage of their training.

Confidentiality (2009)

Principles

6 Confidentiality is central to trust between doctors and  patients. Without assurances about confidentiality, patients  may be reluctant to seek medical attention or to give doctors  the information they need in order to provide good care. But  appropriate information sharing is essential to the efficient  provision of safe, effective care, both for the individual patient and  for the wider community of patients.

Disclosures to protect the patient

51 It may be appropriate to encourage patients to consent to disclosures you consider necessary for their protection, and to warn them of the risks of refusing to consent; but you should usually abide by a competent adult patient’s refusal to consent to disclosure, even if their decision leaves them, but nobody else, at risk of serious harm.

Disclosures to protect others

53 Disclosure of personal information about a patient without consent may be justified in the public interest if failure to disclose may expose others to a risk of death or serious harm. You should still seek the patient’s consent to disclosure if practicable and consider any reasons given for refusal.

54 Such a situation might arise, for example, when a disclosure would be likely to assist in the prevention, detection or prosecution of serious crime, especially crimes against the person. When victims of violence refuse police assistance, disclosure may still be justified if others remain at risk, for example, from someone who is prepared to use weapons, or from domestic violence when children or others may be at risk.55 If a patient’s refusal to consent to disclosure leaves others exposed to a risk so serious that it outweighs the patient’s and the public’s interest in maintaining confidentiality, or if it is not practicable or safe to seek the patient’s consent, you should disclose information promptly to an appropriate person or authority. You should inform the patient before disclosing the information, if practicable and safe, even if you intend to disclose without their consent.