The William Fry Healthcare team has reviewed the changes and highlights of the revised Guide to Professional Conduct and Ethics (8th Edition) which was updated on 17 May 2016. The previous edition of the Guide was published in 2009. The Guide has been revised based on research, consultation with relevant stakeholders and examination of emerging issues affecting both doctors and patients. There are a number of clarifications and interesting new additions to the eighth edition of the Guide which we have highlighted for you below.
The Guide, with its updates, clarifications and additions will be welcomed by doctors and patients alike as it is almost seven years since its predecessor was released. The eighth edition is also far more user friendly partly due to the input of the National Adult Literary Agency. As the boundaries of healthcare in Ireland continue to shift, it will be interesting to see if the new Guide can stay relevant particularly as advances in the eHealth arena emerge over the coming years.
If you have any questions on these amendments, please contact a member of our Healthcare team.
1. Professional Misconduct and Poor Professional Performance (Section 2.2)
A significant addition is the explanation of the recent Supreme Court decision in Corbally v Medical Council and Others (2015) which considered the definition of poor professional performance. The Supreme Court interpreted it to mean a ‘serious’ failure. Section 2.2 highlights this.
2. The Three Pillars of Professionalism – Partnership, Practice and Performance (Chapter 3)
These Pillars underpin good care and provide the framework for the Guide.
3. Equality and Diversity (Section 8.1)
Chapter three of the Guide contains a new paragraph on Equality and Diversity which stresses the importance of doctors trying to understand a patient's cultural background and ethnicity and respond to their individual needs
4. Consent (Section 15)
The guidance on Consent has also been revised and addresses issues such as effective communication to enable shared decision-making and the importance of the treating doctor taking the time to advise the patient of the proposed treatment and record consent. There have also been additions to the Guide in relation to the process of obtaining consent from minors and adolescents, namely taking into account the young person's maturity, physical or mental health and capacity to make decisions regarding their own healthcare (section 18.5).
5. Using Social Media (Section 20)
Chapter four of the Guide takes into account some of the more modern challenges facing the medical profession as a result of advances in communication and technology. A new and lengthy paragraph on using social media provides that doctors must adhere to the general rules regarding doctor-patient confidentiality. It is advised not to contact patients through social media sites and any information or images which may identify a patient should not be published online. The additional paragraph also recommends that doctors should regularly check that information about them or their practice which is available online is accurate and valid
6. Relationships Between Colleagues (Section 21)
These additions are a response to the findings of the Medical Council research entitled 'Your Training Counts' in 2014 which found that bullying and undermining behaviours were endemic in the clinical learning environment. The new guidelines address issues such as respect for colleagues, sexual harassment and the bullying and undermining of colleagues.
7. Clinical Handover (Section 23)
The Guide also contains new and interesting guidance on Clinical Handover. The guidance itself is carefully defined and provides that all doctors have a responsibility to ensure that they formally hand over patients to another person or professional group as well as all information relevant to the care of that patient.
8. Protection and Welfare of Vulnerable Persons (Section 27)
This addition places special emphasis on the protection of patients with a physical, intellectual or mental disability and who are incapable of independent living. It also provides for the reporting of the possible abuse of such vulnerable persons to the appropriate authorities.
9. Medical Records (Section 33)
There have also been revisions and additions to the guidelines on medical records to bring them in line with Freedom of Information and Data Protection principles. A notable change from the seventh edition of the Guide is the inclusion of visual and audio recordings and information provided by third parties in the definition of 'Medical Records'.
10. Recording (Section 34)
On Recording, the most significant change is the new guidance on sharing photographs or videos of patients and how such information is retained and shared.
11. Physical and Intimate Examinations (Section 35)
The guidelines have been expanded to highlight the need to "respect patients' dignity by giving them privacy to undress and dress, and keeping them covered as much as possible" (35.2). Whilst the requirement to offer a chaperone to a patient undergoing such an examination was provided for in the seventh edition of the Guide, the eighth edition adds that the offer of and presence of a chaperone must be documented in the patient's records (35.3). The eighth edition of the Guide goes further again by stressing that doctors must not carry out intimate examinations on patients who are under anaesthetic unless the patients' written consent has been obtained (35.4).
12. Telemedicine (Section 43)
Another significant change from the seventh edition of the Guide is the inclusion of a definition of Telemedicine. This new definition is in-depth and lengthy. There has been concern amongst medical professionals regarding data security in telemedicine and electronic media interactions with patients. The new guidelines require doctors to seek patient consent to a telemedicine consultation and to protect patient privacy and confidentiality. It also requires doctors to ensure that the services they provide through telemedicine are safe and to ensure that they explain to patients that there are aspects of telemedicine that are different to traditional medical practice.
13. Restraint (Section 52)
Comprehensive guidance is provided on the use of physical and/or chemical restraint of patients who present with challenging behaviour or patients who lack capacity to make a decision about treatment or examination and where this may cause harm to themselves or others. It emphasises that restraint must be appropriate, in the patients' best interests and for the minimum amount of time necessary. It also recommends the reporting of disproportionate, excessive or inappropriate restraint.
14. Doctors in Management Roles (Section 63.1.1)
In response to the constraints placed on the medical profession due to the under-resourcing of the health service, in a newly added section, the Guide specifies that doctors in such roles have "a responsibility to advocate for appropriate healthcare resources and facilities if insufficient resources are affecting or may affect patient safety and quality of care."
15. Whistleblowing (Section 61.1.3)
The Guide contains a new provision dealing with whistleblowing which states that "you should not start disciplinary measures against a staff member for raising concerns that they believe to be true."
16. Open Disclosure (Sections 67.1 and 67.2)
The Guide confirms that doctors have a duty to "promote and support this culture [of candour] and to support colleagues whose actions are investigated following an adverse event." It also provides useful guidelines to doctors conducting investigations into an adverse event as well as dealing with patients and family members affected by the adverse event.
17. Teaching and Medical Students (Section 70.1)
Additional guidelines have also been included in the new edition of the Guide to deal with Teaching and Medical students. It provides that where involving students in the care of a patient the needs and wishes of that patient should be respected if they do not want students to be involved in their care.