The Irish Medical Council’s revised guide to professional conduct and ethics says patients are entitled to ‘honest, open and prompt communication from doctors about adverse events that may have caused them harm’
DOCTORS AND patients alike have been urged to familiarise themselves with the revised guide to professional conduct and ethics for doctors published by the Irish Medical Council at the weekend.
The 61-page code provides guidelines in areas such as end-of-life care, prescribing generic drugs, hiring locums, reporting suspected abuse and dealing with situations when a medical procedure goes wrong.
Medical professionals who breach these guidelines could find themselves facing disciplinary action.
Donal Duffy, assistant secretary general of the Irish Hospital Consultants Association, said the key message from the association was that “every doctor in the country should acquaint themselves with this guide as soon as possible”.
The Irish Medical Organisation (IMO), which represents GPs and some consultants, welcomed the publication and Dr Ronan Boland said it brought clarity to a number of matters that may have been of concern to patients and doctors.
He said the IMO would be meeting the Irish Medical Council next week to discuss a range of issues and he expected that the guidelines would be raised.
Much interest has focused on the section advising doctors on how to handle situations when something goes wrong.
It says that patients and their families are entitled to “honest, open and prompt communication from doctors about adverse events that may have caused them harm”.
Doctors should acknowledge that 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 happening again.
This area is fraught with legal concerns as doctors are often reluctant to accept blame or apologise, in case it would affect a case being taken by a patient against the hospital or medical practice.
The Medical Defence Union (MDU), which provides cover for hundreds of Irish doctors, welcomed the guidance, describing it as “unequivocal about the need for honesty and openness when something has gone wrong”.
Dr Michael Devlin, MDU deputy head of advisory services, said the union had advised members for many years that, if something went wrong, patients were entitled to a prompt, sympathetic and truthful account and a sincere apology.
“Such an apology is not an admission of liability and is one of a number of points that the MDU made in the consultation process to the new guidance,” he said.
“As well as being the right thing to do, in our experience, an explanation and apology at an early stage, as well as the reassurance that steps have been taken to prevent the same thing happening, is often all that a patient or a relative wants to hear.”
The State Claims Agency, which provides insurance cover to public hospitals, said it was examining the guidelines and intended to publish advice for the medical profession.
Ciarán Breen, director of the agency, said its position had always been that where a mistake had clearly been made, the doctor should always admit the error, inform the patient and offer the appropriate medical care.
The agency expected to be in a position to publish its advice within weeks, he said.
Prof Kieran Murphy, Irish Medical Council president, said he hoped the public would also read the guide to allow them to understand the standards expected of doctors.
This was echoed by Cathriona Molloy of the Patient Focus advocacy group. She said the majority of people did not know what the Medical Council was, or that there was such a code of conduct and ethics for doctors.
She encouraged the Medical Council to engage in a publicity drive to highlight the revised guide.
Ms Molloy also welcomed the guidance on adverse events. “We would welcome anything that would improve patient safety.
“There are so many things that patients are not told about. When something goes wrong, you might never be told by the hospital.
“In some cases, people only find out when they are being treated in another hospital and it’s seen in their file.”
She said patients did not make complaints in a vindictive way. “So many people who come to us say they are making the complaint because they don’t want another person to go through what they went through.”
- The code can be read at www.medicalcouncil.ie
The following are some of the revised guidelines published by the Irish Medical Council:
- Respect the right of patients to refuse medical treatment or request the withdrawal of medical treatment.
- Acknowledge when something goes wrong and apologise if appropriate.
- The best interests of your patients must take priority over responsibilities to your colleagues and employers.
- Do not allow your personal moral standards to influence your treatment of patients. If you have a conscientious objection, explain this to the patient and provide the names of other doctors.
- Do not burden patients by excessive contact with medical students.
- Assisted reproduction services should be provided only by suitably qualified professionals in appropriate facilities, according to best international practice.
- Ensure you have appropriate training, facilities and support before treating patients with drug dependency or abuse problems.
- Encourage under-16s seeking treatment without their parents' knowledge to involve their parents in the decision.
- Prescribe cheaper generic drugs where they are safe and effective.
- Do not accept gifts, including hospitality, from pharmaceutical companies.
- Ensure that a locum providing cover is appropriately qualified, registered and in good standing with the Medical Council.
- If adult patients disclose abuse that took place in the past, assess the current risk to the patient and others.
