s3 l5 doctor-doctor and doctor- other health professionals v2

8/7/2019 S3 L5 Doctor-Doctor and Doctor- Other Health Professionals V2

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S3 L3: Peer Relationship

INTRODUCTION

The team's ability to care effectively for the patient depends on

the ability of individual persons to treat each other with integrity,

honesty, and respect in daily professional interactions regardless of

race, religion, ethnicity, nationality, sex, sexual orientation, age, or

disability.

PEER RELATIONSHIP

Types of Relationship In Health Care Doctor-Colleague Relationship Malpractice and Remedies Peer ReviewArranging Reliever Working in Teams Leading Teams Referral Relationships Delegation and Arranging Relievers Doctor treating another doctor Doctors and physicians in training The Impaired Physician Conflict Resolution

Accepted types of relationships in health care:

1. Patient-doctor relationship2. Doctor-colleague relationship3. Doctor-allied health professionals relationship

All the above are related to one another in a bond of relationship

based on trust.

SIR Smooth inter-personal relationship can easily be detected

in health care when:

compliance with ones duties is easily done & perfected;people behave they know each other well; openness of heart and communication lines

Relationships maybe:

formal informal

Everyone is recognized for his distinct role, skill and

knowledge. All health professionals are important because they

have their distinct characteristic and no one among them canmonopolize the immense art of healing.

Doctor-colleague Relationship:

Professionalism-they are allies and friends.

Cooperation Coordination Competition must be in how to combat the disease

The Health Care Profession is:

Collaborative collegial ally-based

Anathema in the world of cure:

Personal and professional bickering; Jealousy and envy

When doctors and colleagues become competitors or enemies rather

than allies, they become a disgrace to the profession.

Professional Relationship Need for good personal relationship: Leadership and accountability Common decision making Cooperation in carrying decisions Adequate communications Mutual support

Wisdom on Professional Relationship:SirWilliam Osler

Many a physician whose daily work is a daily round o

beneficence will say hard things and think hard thought of a colleague

No sin will so easily beset you as uncharitableness towards you

brother practitioner. So strong is the personal element in the practice

of medicine, and so many are the wagging tongues in every parish, tha

evil-speaking, lying, and slandering find a shining mark in the lapses

and mistakes which are inevitable in our work. From the day you begin

practice never under any circumstances listen to a tale to th

detriment of a brother practitioner. And when any dispute or trouble

arise, go frankly, ere sunset, and talk the matter over, in which way you

may gain a brother and a friend.

Dr. Aimee A. Silva, MD, (2002):

It takes more than going through years of studying, training

and passing exams to become a good doctor. Years of practice can

never guarantee perfection of craft. Values and virtues will serve as

beacon to guide the healers through the perils they encounter.

Declaration of Geneva & International Code ofMedical Ethics, 35th

assembly, Venice, 1983

My colleagues will be my brothers.

DUTIES OF PHYSICIAN TO EACH OTHER:

A physician shall behave towards his colleagues ashe would have them behave towards him.

A physician shall not entice patients from his colleagues. A physician shall observe the principles of the Declaration

of Geneva approved by the worldMedical Association

Malpractice suits frequently result from:

Lack of training in communication skills of doctors; poor communication between physicians and patients; inadequate informed consent on the patients part; Doctors unresponsive to patients complaints Patients misinformed, unrealistic expectations

MALPRACTICE

DOCTOR-COLLEAGUE RELATIONSHIP

PEER RELATIONSHIP

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Defensive attitude of consumers towards arrogant& self-serving professionals

patients frustration because physicians seem unresponsiveto their complaints;

patients mis-informed, unrealistic expectations about thebenefits of treatment;

TWO OPPOSITE REMEDIES FOR THEMALPRACTICE PROBLEMS:

1. Peer review in a field so highly technical asmedicine, noone is competent to evaluateprofessional performanceexcept peers in theprofession or even in the same medical

specialty.

Fraternal correction- members do not simply ignore or

hide the defects of colleagues out of indifference or self-interest,

but are seriously concerned to help them overcome these defects

and repair the consequences.

Some observers argue that peer discipline has never been

successful in protecting the patient or even in maintaining high

standards of medical competence.

A profession is too concerned with its own autonomy to be very

diligent in disciplining its members. Consequently, they

believe that disciplining a profession must first of all concern thosewho suffer from malpractice or neglect.

Health care consumers must know and defend their own rights by

all available economic, legal, and political means. Since the primary

responsibility for health must remain with each person to whom the

professional is only a servant, the ultimate right to call the medical

profession to account must be in the hands of those the profession

exists to servethe users of health services have the fundamental right

to the final word in regulating the profession through public law.

2. Public evaluation- The medical professional stands for truth,but provides a service to human physical or mental health, a

service which must ultimately be judged in terms of its

practical enhancement of human well-being. Consequently,the medical profession must accept a public, practical

evaluation of its service. In this regard, medical

professionals have no complete autonomy in the realm of

medical practice.

RESPONSIBILITIES OF COLLEAGUES

All physicians have a duty to participate in peer review. Fears

of retaliation, ostracism by colleagues, loss of referrals, or

inconvenience are not adequate reasons for refusing to participate in

peer review.

It is unethical for a physician to disparage the professional

competence, knowledge, qualifications, or services of another

physician to a patient or a third party or to state or imply that a patienthas been poorly managed or mistreated by a colleague without

substantial evidence.

In the absence of substantial evidence of professional

misconduct, negligence, or incompetence, it is unethical to use the

peer review process to exclude another physician from practice, to

restrict clinical privileges, or to otherwise harm the physician's practice

Points to Ponder

Unless we know how to be true, just and kind Unless we practice virtue always Unless we consider our colleagues equally

Unless we reward meritorious acts Unless we deal fairly with misbehaviors Unless we unite to act for the common goodThe Medical Profession will suffer attacks within and without and

no one is to blame but those in the profession who do nothing to

correct its own wrong doings.

Points to Ponder

Can we blame the lack of trust among our colleaguestowards each other?

Politics in electing officers in medical societies Employ a padrino to enter into residency training Use influence or money to practice in a hospital Expose questionable practice in media Few resolved cases of malpractice Continue to allow unfair and unethical practice in

the operating room or in the wards

Gossip of others misdemeanor in public

The best patient care is often a team effort, and mutualrespect, cooperation, and communication should govern thiseffort.

Each member of the patient care team has equal moralstatus.

When a health professional has significant ethical objectionsto an attending physician's order, both should discuss the

matter thoroughly.

Mechanisms should be available in hospitals and outpatientsettings to resolve differences of opinion among members of

the patient care team.

Working in a team does not change your personalaccountability for your professional conduct and the care

you provide.

When working in a team, you must: respect the skills and contributions of your

colleagues;

maintain professional relationships with patients; communicate effectively with colleagues within

and outside the team;

When working in a team, you must: make sure that your patients and colleagues

understand your professional status and specialty

your role and responsibilities in the team and who

is responsible for each aspect of patients' care;

participate in regular reviews and audit of thestandards and performance of the team, taking

steps to remedy any deficiencies; be willing to deal openly and supportively with

problems in the performance, conduct or health of

team members

If you lead a team, you must ensure that:

medical team members meet the standards of conduct andcare;

any problems that might prevent colleagues from otherprofessions following guidance from their own regulatory

bodies are brought to your attention and addressed;

LEADING A TEAM

WORKING IN TEAMS


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all team members understand their personal and collectiveresponsibility for the safety of patients, and for openly and

honestly recording and discussing problems;

each patient's care is properly co-ordinated and managedand that patients know who to contact if they have questions

or concerns;

arrangements are in place to provide cover at all times; regular reviews and audit of the standards and performance

of the team are undertaken and any deficiencies are

addressed; systems are in place for dealing supportively with problems

in the performance, conduct or health of team members.

THE ETHICAL REFERRAL SYSTEMAMONG HEALTH

PROFESSONIALS:

Life is too vast for a single doctor to be an expert in all the

dimensions of medical care, the reason why specializations must be

pursued.

there is no single therapy for a single disease; there is plurality of diagnosis as every condition can be seen differently since a diagnosis is just an opinion; recognition of ones limitations even as one has to work above all for the best interest of the patient. referring a patient to another doctor is never a sign of

ones incompetence but a sign of professionalism,

and a matter of principled nobility and honor.

ETHICAL REFERRAL SYSTEM

Warnings to Health professionals:

referral system can only work best when doctors honor SIR

smooth Interpersonal relationship that must be pursued and

promoted at alltimes;solicitation of patients is very unprofessionaland

is awfully distasteful.

Referral involves transferring some or all of theresponsibility for the patient's care, usually temporarily and

for a particular purpose, such as additional investigation,

care or treatment, which falls outside your competence.

In order to utilize fully the expertise of specially trainedconsultants, it is recommended that referrals be made by

generalists as well as by specialties whenever appropriately

provided.

The referral is the attending physicians soledecision.

The reason for the referral and expected outcomesare adequately explained to and accepted by the

patient or his qualified guardian.

Good judgment, communication, honesty andgoodwill underlie the process.

The consultant must be informed of the referral directly bythe attending physician or through his or her delegated

authority (resident physician or staff nurse) after the request

is duly recorded in the patients chart.

The purpose of the referral must be specified: evaluation,diagnostic procedure, co-management, etc

A consultant can refuse to accept a referral. Once he or she accepts, he/she cannot delegate the

responsibility to another

His or her responsibility will depend upon the specifiedpurpose of the referral.

If a consultant accepts the referral it is his or herduty to answer the same as soon as possible and

to write his evaluation/ recommendations on the

consultation sheet provided by the hospital.

If the referral is for evaluation, the consultantsprimary responsibility is to the attending

physician. It is to him that the consultant must

give his or her opinions and suggestions, not tothe patient.

His or her responsibility will depend upon the specifiedpurpose of the referral. (continued)

If the referral is for co-management, his or herprimary responsibility is as co-attending

physician. The consultant must, however,

continue to communicate with the referring

physician under whose service the patient was

admitted.

A consultant cannot delegate responsibility to anassistant, fellow, or resident. It is precisely to

utilize his or her expertise that the consultation is

made. If during the course of treatment the consultant

cannot continue attending to then patient, the

attending physician must be notified for

appropriate action.

To assure a coordinated effort that is in the best interest ofthe patient, the attending physician should remain in charge

of overall care, communicating with the patient and

coordinating care on the basis of information derived from

the consultations.

Consultants should not make cross referrals but maysuggest it to the attending physician.

The attending physician who does not agree with theconsultant's recommendations is free to call in anotherconsultant.

After the condition for which the patient was originallyreferred has been resolved, the consultant should submit a

separate professional fee and end his/her services.

Follow-up, future consultation, etc. should be by the originalattending physician, unless these are delegated to the

consultant through a subsequent referral.

In case of life threatening conditions, when the attendingphysician is not available, any physician involved in the case

must do what he deems as necessary for the best interest of

the patient.

In case of readmission or consultation for a new complaint,patients autonomy should be respected. The consultantshould however encourage the patient to return to his or her

original physician

Delegation involves asking a nurse, doctor, medical studentor other health care worker to provide treatment or care on

your behalf.

It is unethical to delegate authority for patient care toanyone, including another physician, who is not

appropriately qualified and experienced.

ARRANGING RELIEVER

DELEGATION

REFERRAL RELATIONSHIPS


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