Professionalism in medical practice(Farabi, 06.03.2017)

Prof Mohamed AlrukbanDr Ghaiath Hussein,

Outline of the session Professionalism:

Approaches and Dimensions of professionalism Clinicians’ Professional Relationships and Duties

■Saudi Code of Ethics for Medical Practitioners

References:1. This presentation is based on the Professionalism and

Ethics Handbook for Residents Citation: Hussein GM, Kasule OH, Al-Kaabba AF. Professionalism and Ethics Handbook for Residents. Ware J, Kattan T, editors. Riyadh, Saudi Arabia 2015 2. Presentation by Prof. Mohamed Alrukban, KSU

Levels of Behavioural ‘Control’

Morality

Ethics

Laws & Regulations

Professional standards

Institutional Policies

Personal beliefs

Why can’t/don’t we do what we want to?

Isla

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uttin

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Factor Originates from Developed by Written as

Binding/ voluntary

Committing to

Morality General unchallenged community values

Inherited values; not argued; changes slowly with time

Not written

Voluntarily Community members

Ethics Argued through logically established literature (moral philosophy)

Philosophers Inspires codes, policies, & laws

Voluntarily Not universal

Professional standards

Professional values Professional bodies Codes (Professional codes of Ethics)

Binding those in profession

Laws & Regulations

Legal and moral values

Legislators Laws Binding ALL

Institutional Policies

Professional and institutional values

Healthcare institutions

Codes, policies, guidelines

Binding Those in institution

Personal beliefs &preferences

Personal belief system

Individuals (persons) Not written

? The person only

Professionalism relates the doctor to the world

COUNTRY/REGION

Policy maker

Planner

Manager

COMMUNITY

Advocate

Researcher

Educator

CLINIC/HOSPITALProvider Manage

rEducato

rResearch

er

So your expected roles are…CanMEDS (http://www.royalcollege.ca/) SaudiMEDS

Saudi Meds: A competence specification for Saudi medical graduatesRania G. Zaini , Khalid A. Bin Abdulrahman , Abdulaziz A. Al-Khotani , Abdol Monem A. Al-Hayani , Ibrahim A. Al-Alwan , Saddig D. Jastaniah (Medical Teacher , Vol. 33, Iss. 7, 2011)

professionalismclinician’s Professional Duties & Relationships

Do You Still Remember A Role Model Who Influenced Your Education?

If Yes? Mention Some of Their Qualities and Attributes.

What is Professionalism?• ‘Profession: A self-disciplined group of individuals who

hold themselves out to the public as possessing a special skill derived from training or education, and who are prepared to exercise that skill primarily in the interests of others.’ (CMA)

• It is not easy to define a profession, but it is likely to have all or some of the following characteristics:– It is a vocation or calling that implies service to others– It has a distinctive knowledge base which is kept up to date– It determines its own standards and sets its own examinations– It has a special relationship with those whom it serves e.g. patients,

students….– It has particular ethical principles

Definition of Professionalism (ABMS)

Medical professionalism is a belief system in which group members (“professionals”) declare (“profess”) to each other and the public:the shared competency standards and ethical

values they promise to uphold in their work and

what the public and individual patients can and should expect from medical professionals.” American Board for Medical Specialties (ABMS)

“Medical professionalism describes the skills, attitudes, values and behaviours common to those undertaking the practice of medicine” World Medical Association (WMA)

بطبعه مهنٌي المسلم الطبيب

“ويؤثرون على أنفسهم ولو كان بهم خصاصة”“إن الله يحب من العامل إذا عمل أن يتقن”“.........إذا ذبحتم فأحسنوا الذبحة” ال يؤمن أحدكم حتى يحب ألخيه ما يحب ”

لنفسه..“

What is professionalism about?DON’T Undesirable

conductDO-Desirable Behaviors

Abuse of powerBiasHarassment (verbal/physical)Breach of confidentialityArroganceGreedMisrepresentationImpairmentLack of conscientiousness &Conflicts of interest

AltruismAccountabilityExcellenceDutyRespect for others, &commitment to lifelong learningmaintenance of competence, Honor & integrity,Adherence to ethical codes of conduct,Dedication to self-regulation

'Project Professionalism' (ABIM, 2001)Developed by the Physician Charter and

identified six key elements of professionalism: 1- Altruism:

giving priority to patient interests rather than self-interests

2- Accountability: being answerable to patients, society and

profession3- Excellence:

conscientious effort to perform beyond ordinary expectation, and

commitment to life-long learning

'Project Professionalism' (ABIM, 2001)4- Duty:

free acceptance of commitment to service – i.e. undergoing inconvenience to achieve a high standard of patient care

5- Honor and integrity: being fair, truthful, straightforward

6- Respect for others: patients and families, colleagues, other healthcare professionals and students and trainees

Examples of Unprofessional BehaviorsClassroom Setting-Students/Trainee

• Arriving for class late and/or leaving early• Being unprepared for group sessions• Not completing assigned tasks• Disrupting class sessions• Cheating on an exam• Using Mobile Phone during class• Chatting during class• Focusing on the test vs. learning• Prejudging content in advance• Intolerance of the opinions of others

Examples of Unprofessional Behaviors:Clinical Setting-Students

• Dressing inappropriately• Avoiding work and/or responsibilities• Exhibiting little empathy for patients• Demonstrating lack of sensitivity to patients’

cultural backgrounds• Not protecting patient confidentiality

Signs of Lack of professionalism (ABIM, 2001)

Sign Examples1- Abuse of power • Abuse of patients &/or colleagues; bias and harassment

2- Arrogance • Offensive display of superiority and self-importance

3- Greed • when money becomes the driving force for work

4- Misrepresentation • Lying: consciously failing to tell the truth; • Fraud: conscious misrepresentation of material fact with the intent to

mislead

5- Impairment • any disability that may prevent the physician from discharging his/her duties

6- Lack of conscientiousness

• failure to fulfil responsibilities

7- Conflicts of interests

• Self-promotion/ advertising • Unethical collaboration with industry; acceptance of gifts; • Misuse of services – overcharging, inappropriate treatment or

prolonging contact with patients

So your expected roles are…CanMEDS (http://www.royalcollege.ca/) SaudiMEDS

Saudi Meds: A competence specification for Saudi medical graduatesRania G. Zaini , Khalid A. Bin Abdulrahman , Abdulaziz A. Al-Khotani , Abdol Monem A. Al-Hayani , Ibrahim A. Al-Alwan , Saddig D. Jastaniah Medical Teacher , Vol. 33, Iss. 7, 2011

Saudi Code ofEthics for healthcare practitioners

http://www.scfhs.org.sa/Reglations/CR/Documents/%D8%A3%D8%AE%D9%84%D8%A7%D9%82%D9%8A%D8%A7%D8%AA%20%D8%A7%D9%84%D9%85%D9%85%D8%A7%D8%B1%D8%B3%20%D8%A7%D9%84%D8%B5%D8%AD%D9%8A.pdf

Healthcare Practitioner’s Duties Towards Patients Healthcare Practitioner’s Duties Towards Patients

Good Treatment of PatientAchieving Patient’s Interest and Guarding His/Her

RightsPatient’s Consent Reassurance of Patient Maintaining Patient’s Secrets - Confidentiality

Duties Towards Professional Colleagues1. Behave well with his/her colleagues and treat them the

way he/she would like them to treat him/her.2. Do not indulge in their private issues3. Avoid direct criticism of a colleague in front of patients4. Doing his/her best in teaching them 5. Envisage integrity of those working or trained by him6. Follow religious standards (relations with colleagues of other

sex)7. To accept peer-review of his/her work8. respect his/her non-doctor colleagues, and appreciate their

role in healthcare9. To report to the responsible authority any of his colleague’s

attitudes or conditions that would affect the safety of or inflict harm on the patients

clinician’s Duties Towards his/her Profession1. Protect the nobleness of the profession

2. Scientific and practical contributions to the development of the profession,through research, studies, writing articles, and continuous education.

3. Maintain the medical professional standards and work on improving themin all the professional activities (that he/she takes part in).

4. Do not abuse professional status by achieving privileges, material or moralbenefits, apart from those granted through the system and professionalcustoms.

5. Avoid whatever leads (or could lead) to insulting the profession: maltreatment, or lack of commitment to appointments, lying, falsification, arrogance, pretending to know what he/she does not

Duties Towards his/her Profession6. Refrain from any act that would breach his/her honesty, or integrity while dealing with the patient, 7. Avoid hastening to take action with high risk medical procedures unless he/she is sure of its necessity and that the benefits exceed their risks (of harm).8. Take the appropriate action if he/she knows that one of the healthcare team is sick, ignorant, or negligent in his/her responsibilities, 9. Avoid seeking fame on account of the basics and ethics of the profession.

clinician’s Duties Towards his/her ProfessionReflect sincere devotion and dedication to

the medical profession.To avoid any action that could lead to

contempt of the medical profession and to maintain the standards of medical profession

To contribute in the development of the profession through research and continuous learning.

The physician should not take advantage of his profession position for obtaining any material or moral gains, which are not in conformity with or violate the laws and tradition.

clinician’s Duties Towards his/her ProfessionTo take the appropriate procedure when he

comes to know that one of the members of the health team is sick, ignorant or negligent of his duties; in furtherance of protecting the patient in the first place and the medical profession next.

The physician should refrain, when dealing with the patient, from any act or conduct that would infringe his honesty and integrity.

To avoid seeking fame at the expense of the profession ethics and principles.

clinician’s Role Towards CommunityPositive interaction with the community’s affairsProtect the community by reporting

reportable/epidemic diseases Improve health in the community through advocacy

and health education, and involvement in community health activities

Rational use of the healthcare institutions’ resources

Effective contribution to the development of policies and health systems that respond to the community needs and facilitates easier access to health care.

Source: Islamic Code of Medical & Health Ethics

clinician’s Role Towards CommunityTo be as a role model in his/her attitude and religion

Promotion of health equity among the society members

Maintenance of health resources and the ideal utilization of such resources.

Use his skills, knowledge and expertise to improve the standards and quality of health services rendered to the society.

The round with Mr. Butcher (Case)See : Module 3 in Professionalism and Ethics Handbook forResidents (PEHR): A Practical GuideHussein GM, Alkabba AF, Kasule OH. Professionalism and Ethics Handbook forResidents (PEHR): A Practical Guide. Ware J, Kattan T (eds). 1st Edition. Riyadh,Saudi Arabia: Saudi Commission for Health Specialties, 2015.

Summary points Being a clinician is about being part of a team. You

have rights and duties as part of this team. Central to your care is your patient (not your ego

and not your bank account). Many of the positive attitudes and skills can be

developed through training, and self-development. Developing and adhering to these standards

develops you, improves health care, and enhances public trust in the health system.

By respecting your patients, colleagues, and the community in general, you build better relations and a better reputation for being a faithful model clinician