Bien u NinaJohn

Rachel
 Jocelle GienahKathuJeNickieTeacherNiňauVivsRico F.MaiMavis Yana
Serge!Tope

g
 


 

INTRODUCTION
The team's ability to care effectively for the patient depends on DOCTOR-COLLEAGUE RELATIONSHIP
the ability of individual persons to treat each other with integrity, Anathema in the world of cure:
honesty, and respect in daily professional interactions regardless of º Personal and professional bickering;
race, religion, ethnicity, nationality, sex, sexual orientation, age, or º Îealousy and envy
disability.
hen doctors and colleagues become competitors or enemies rather
PEER RELATIONSHIP than allies, they become a disgrace to the profession.
º Types of Relationship In Health Care º Professional Relationship
º Doctor-Colleague Relationship º Need for good personal relationship:
º ÿalpractice and Remedies º Leadership and accountability
º Peer Review º Common decision making
º Arranging Reliever º Cooperation in carrying decisions
º orking in Teams º Adequate communications
º Leading Teams º ÿutual support
º Referral Relationships
º Delegation and Arranging Relievers isdom on Professional Relationship:
º Doctor treating another doctor Sir illiam Osler
º Doctors and physicians in training ³ÿany a physician whose daily work is a daily round of
º The Impaired Physician beneficence will say hard things and think hard thought of a colleague.
º Conflict Resolution No sin will so easily beset you as uncharitableness towards your
brother practitioner. So strong is the personal element in the practice
PEER RELATIONSHIP of medicine, and so many are the wagging tongues in every parish, that
Accepted types of relationships in health care: evil-speaking, lying, and slandering find a shining mark in the lapses
1. Patient-doctor relationship and mistakes which are inevitable in our work. From the day you begin
2. Doctor-colleague relationship practice never under any circumstances listen to a tale to the
3. 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:
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, ÿD, (2002):
³It takes more than going through years of studying, training,
and passing exams to become a good doctor. Years of practice can
º compliance with one¶s duties is easily done & perfected; never guarantee perfection of craft. Values and virtues will serve as
º people behave they know each other well; beacon to guide the healers through the perils they encounter.´
º openness of heart and communication lines
Declaration of Geneva & International Code of ÿedical Ethics, 35th
Relationships maybe: assembly, Venice, 1983
º formal ÿy colleagues will be my brothers.
º informal
Everyone is recognized for his distinct role, skill and DUTIES OF PHYSICIAN TO EACH OTHER:
knowledge. All health professionals are important because they º A physician shall behave towards his colleagues as
have their distinct characteristic and no one among them can he would have them behave towards him.
monopolize the immense art of healing. º A physician shall not entice patients from his colleagues.
º A physician shall observe the principles of the ³Declaration
Doctor-colleague Relationship: of Geneva´ approved by the world ÿedical Association
Professionalism-they are allies and friends.
º Cooperation ÿALPRACTICE
º Coordination ÿalpractice suits frequently result from:
º Competition must be in how to combat the disease º Lack of training in communication skills of doctors;
The Health Care Profession is: º poor communication between physicians and patients;
º Collaborative º inadequate informed consent on the patient¶s part;
º collegial º Doctors¶ unresponsive to patients¶ complaints
º ally-based º Patients¶ misinformed, unrealistic expectations

c
Y 

 º Defensive attitude of consumers towards arrogant& self- º Unless we reward meritorious acts
serving professionals º Unless we deal fairly with misbehaviors
º patient¶s frustration because physicians seem unresponsive º Unless we unite to act for the common good
to their complaints;
º patient¶s mis-informed, unrealistic expectations about the The ÿedical Profession will suffer attacks within and without and
benefits of treatment; no one is to blame but those in the profession who do nothing to
correct its own wrong doings.
TO OPPOSITE REÿEDIES FOR THE ÿALPRACTICE PROBLEÿS:
1. Peer review± in a field so highly technical asmedicine, no Points to Ponder
one is competent to evaluateprofessional performance º Can we blame the lack of trust among our colleagues
except peers in theprofession or even in the same medical towards each other?
specialty. [ Politics in electing officers in medical societies
[ Employ a padrino to enter into residency training
Fraternal correction- members do not simply ignore or [ Use influence or money to practice in a hospital
hide the defects of colleagues out of indifference or self-interest, [ Expose questionable practice in media
but are seriously concerned to help them overcome these defects [ Few resolved cases of malpractice
and repair the consequences. [ Continue to allow unfair and unethical practice in
Some observers argue that peer discipline has never been the operating room or in the wards
successful in protecting the patient or even in maintaining high [ Gossip of other¶s misdemeanor in public
standards of medical competence.
A profession is too concerned with its own autonomy to be very ORKING IN TEAÿS
diligent in disciplining its members. Consequently, they º The best patient care is often a team effort, and mutual
believe that disciplining a profession must first of all concern those respect, cooperation, and communication should govern this
who suffer from malpractice or neglect. effort.
Health care consumers must know and defend their own rights by º Each member of the patient care team has equal moral
all available economic, legal, and political means. Since the primary status.
responsibility for health must remain with each person to whom the º hen a health professional has significant ethical objections
professional is only a servant, the ultimate right to call the medical to an attending physician's order, both should discuss the
profession to account must be in the hands of those the profession matter thoroughly.
exists to servethe users of health services have the fundamental right º ÿechanisms should be available in hospitals and outpatient
to the final word in regulating the profession through public law. settings to resolve differences of opinion among members of
the patient care team.
2. Public evaluation- The medical professional stands for truth, º orking in a team does not change your personal
but provides a service to human physical or mental health, a accountability for your professional conduct and the care
service which must ultimately be judged in terms of its you provide.
practical enhancement of human well-being. Consequently, º hen working in a team, you must:
the medical profession must accept a public, practical [ respect the skills and contributions of your
evaluation of its service. In this regard, medical colleagues;
professionals have no complete autonomy in the realm of [ maintain professional relationships with patients;
medical practice. [ communicate effectively with colleagues within
and outside the team;
RESPONSIBILITIES OF COLLEAGUES º hen working in a team, you must:
All physicians have a duty to participate in peer review. Fears [ make sure that your patients and colleagues
of retaliation, ostracism by colleagues, loss of referrals, or understand your professional status and specialty,
inconvenience are not adequate reasons for refusing to participate in your role and responsibilities in the team and who
peer review. is responsible for each aspect of patients' care;
It is unethical for a physician to disparage the professional [ participate in regular reviews and audit of the
competence, knowledge, qualifications, or services of another standards and performance of the team, taking
physician to a patient or a third party or to state or imply that a patient steps to remedy any deficiencies;
has 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
[ be willing to deal openly and supportively with
problems in the performance, conduct or health of
team members
LEADING A TEAÿ
If you lead a team, you must ensure that:
restrict clinical privileges, or to otherwise harm the physician's practice º medical team members meet the standards of conduct and
care;
Points to Ponder º any problems that might prevent colleagues from other
º Unless we know how to be true, just and kind professions following guidance from their own regulatory
º Unless we practice virtue always bodies are brought to your attention and addressed;
º Unless we consider our colleagues equally

c
D 

 º all team members understand their personal and collective º His or her responsibility will depend upon the specified
responsibility for the safety of patients, and for openly and purpose of the referral.
honestly recording and discussing problems; [ If a consultant accepts the referral it is his or her
º each patient's care is properly co-ordinated and managed duty to answer the same as soon as possible and
and that patients know who to contact if they have questions to write his evaluation/ recommendations on the
or concerns; consultation sheet provided by the hospital.
º arrangements are in place to provide cover at all times; [ If the referral is for evaluation, the consultant¶s
º regular reviews and audit of the standards and performance primary responsibility is to the attending
of the team are undertaken and any deficiencies are physician. It is to him that the consultant must
addressed; give his or her opinions and suggestions, not to
º systems are in place for dealing supportively with problems the patient.
in the performance, conduct or health of team members. º His or her responsibility will depend upon the specified
purpose of the referral. (continued)
REFERRAL RELATIONSHIPS [ If the referral is for co-management, his or her
primary responsibility is as co-attending
THE ETHICAL REFERRAL SYSTEÿ AÿONG HEALTH physician. The consultant must, however,
PROFESSONIALS: continue to communicate with the referring
Life is too vast for a single doctor to be an expert in all the physician under whose service the patient was
dimensions of medical care, the reason why specializations must be admitted.
pursued. [ A consultant cannot delegate responsibility to an
º there is no single therapy for a single disease; assistant, fellow, or resident. It is precisely to
º there is plurality of diagnosis as every condition can be utilize his or her expertise that the consultation is
º seen differently since a diagnosis is just an opinion; made.
º recognition of one¶s limitations even as one has to work [ If during the course of treatment the consultant
º above all for the best interest of the patient. cannot continue attending to then patient, the
º referring a patient to another doctor is never a sign of attending physician must be notified for
one¶s incompetence but a sign of professionalism, appropriate action.
and a matter of principled nobility and honor. º To assure a coordinated effort that is in the best interest of
ETHICAL REFERRAL SYSTEÿ the patient, the attending physician should remain in charge
arnings to Health professionals: of overall care, communicating with the patient and
referral system can only work best when doctors honor SIR coordinating care on the basis of information derived from
³smooth Interpersonal relationship´ that must be pursued and the consultations.
promoted at alltimes;solicitation of patients is very unprofessionaland º Consultants should not make cross referrals but may
is awfully distasteful. suggest it to the attending physician.
º The attending physician who does not agree with the
º Referral involves transferring some or all of the consultant's recommendations is free to call in another
responsibility for the patient's care, usually temporarily and consultant.
for a particular purpose, such as additional investigation, º After the condition for which the patient was originally
care or treatment, which falls outside your competence. referred has been resolved, the consultant should submit a
º In order to utilize fully the expertise of specially trained separate professional fee and end his/her services.
consultants, it is recommended that referrals be made by º Follow-up, future consultation, etc. should be by the original
generalists as well as by specialties whenever appropriately attending physician, unless these are delegated to the
provided. consultant through a subsequent referral.
[ The referral is the attending physician¶s sole º In case of life threatening conditions, when the attending
decision. physician is not available, any physician involved in the case
[ The reason for the referral and expected outcomes must do what he deems as necessary for the best interest of
are adequately explained to and accepted by the the patient.
patient or his qualified guardian. º In case of readmission or consultation for a new complaint,
[ Good judgment, communication, honesty and patient¶s autonomy should be respected. The consultant
goodwill underlie the process. should however encourage the patient to return to his or her
º The consultant must be informed of the referral directly by original physician
the attending physician or through his or her delegated DELEGATION
authority (resident physician or staff nurse) after the request º Delegation involves asking a nurse, doctor, medical student
is duly recorded in the patient¶s chart. or other health care worker to provide treatment or care on
º The purpose of the referral must be specified: evaluation, your behalf.
diagnostic procedure, co-management, etc º It is unethical to delegate authority for patient care to
º A consultant can refuse to accept a referral. anyone, including another physician, who is not
º Once he or she accepts, he/she cannot delegate the appropriately qualified and experienced.
responsibility to another ARRANGING RELIEVER

c
~ 

 º hen you are off duty you should see to it that suitable THE ÿEDICAL PROFESSIONAL FEE
arrangements are made for your patients' medical care. Paradigms for Charging Professional Fee:
These arrangements should include effective hand-over 1. Socialized Fee: - based on the capacity of the patient to
procedures and clear communication between doctors. pay as his economic status would allow. No
º If you arrange cover for your own practice, you must ensure physician must turn a patient away due to his inability
that doctors who stand in for you have the qualifications, to pay his professional fee, most especially during
experience, knowledge and skills to perform the duties for an emergency situation.
which they will be responsible. 2. Experienced-based, Expert-based or Socialization-based
DOCTOR TREATING ANOTHER DOCTOR Fee: - the more experienced the doctor is, the costlier his
º ³professional courtesy´ wherein physicians do not charge specialized service and product of expertise becomes.
their colleagues for medical treatment 3. The Theory of Free Enterprise: - service depends on the
º practice has declined in countries where third party demand and supply of commodities and each commodity or
reimbursement is available service has a price. Those who wish to avail themselves of
º Doctor & Trainees health and its benefits must pay for it in a way that they want.
º Doctor = docere = "to teach" 4. Level of Difficulty Standard Fee:- the more difficult the
º physician has a responsibility to teach the science, art, and condition of the patient is, the larger should be the financial
ethics of medicine to medical students, resident physicians, implications because such condition will necessarily need
and others and to supervise physicians in training more time, effort, gadgets and instruments and
º Attending physicians must treat trainees and colleagues with certainly deeper intellectual diagnostic, therapeutic and
respect, empathy, and compassion. prognostic undertakings heaped up on the shoulder of the
º Attending physicians, chiefs of service, or consultants medical professional.
should encourage residents to acknowledge their limitations and ask
for help or supervision when concerns arise about patient care or the
ability of others to perform their duties. CONFLICT RESOLUTIONS,Guidelines, ÿA
DOCTOR & TRAINEES º The usual conflicts that physicians and health care providers
º The training environment should also encourage trainees to encounter focus more on patient care.
raise ethical issues they may encounter. º Ideally, health care decisions will reflect agreement among
º In the teaching environment, graduated authority for patient the patient, physicians and others involve in the patient care.
management can be delegated to residents, with adequate º However, uncertainty and diverse viewpoints give rise to
supervision. disagreement about the goals of care or the means of
º On a teaching service, the ultimate responsibility for patient achieving those goals.
welfare and quality of care remains with the patient's º These disagreements should be clarified and resolved by the
attending physician of record. members of the healthcare team so as not to compromise
º All trainees should inform patients of their training status their relationships with the patient.
and role in the medical team. [ Conflicts should be resolved as informally as
THE IÿPAIRED PHYSICIAN possible,
º Physicians who are impaired for any reason must refrain [ The opinions of all those directly involve should be
from assuming patient responsibilities that they may not be elicited and given respectful consideration.
able to discharge safely and effectively [ The informed choice of the patient or authorized
º Impairment may result from use of habit-forming agents substitute decision-maker, regarding the treatment
(alcohol or other substances) or from psychiatric, should be the primary consideration in resolving
physiologic, behavioral disorders, and diseases that affect disputes.
the cognitive or motor skills necessary to provide adequate [ If the dispute is about which options the patient
care. should be offered, a broader rather than a
º Physicians should assist their impaired colleagues in narrower range of option is usually preferable.
identifying appropriate sources of help [ If, after reasonable effort, agreement or
º The impaired physician is entitled to full confidentiality as in compromise cannot be reached through a
any other patient-physician relationship when undergoing dialogue, the decision of a person with the right or
therapy. responsibility for making decision should be
º Every physician is responsible for protecting patients from accepted.
an impaired physician and for assisting an impaired º If healthcare providers cannot support the decision that
colleague prevails as a matter of professional judgment or personal
º There is a clear ethical responsibility to report a physician morality, they should be allowed to withdraw from
who seems to be impaired to an appropriate authority participation in carrying out the decision, after ensuring that
º Physicians should assist their impaired colleagues in the person receiving care is not at risk of harm and
identifying appropriate sources of help abandonment.
º The impaired physician is entitled to full confidentiality as in
any other patient-physician relationship when undergoing
therapy.

c