Contemporary issues in the new Guide to Professional Conduct and Ethics for Registered Medical Practitioners (8th Edition 2016).

The new Guide to Professional Conduct and Ethics for registered Medical Practitioners (8th Edition 2016)1 was launched by the Medical Council of Ireland on 17th of May last. The last version was published in 2009 and the latest edition attempts to address some of the more contemporary issues  affecting the medical profession such as social media, telemedicine, managing conflict interest, advertising of medical services, management and leadership roles and relationships with colleagues. On some of these subjects the new Guide provides more detailed guidance while on others the new text falls short. 

In relation to the use of information and communication technology new guidance is provided on the use of social media and telemedicine.

Doctors are increasingly using social media in medical education, professional networking, to inform patients as well as for personal use. A new section in the Guide on the use of social media reflects the IMO (Irish Medical Organisation) and the EJD (European Junior Doctors) common sense advice on the use of social media2,3. Doctors are advised to maintain the professional standards expected when using other forms of communication, be respectful and avoid abusive, unsustainable or malicious comments, keep personal and professional use of social media separate and remember that social media sites cannot guarantee confidentiality. You must also take reasonable steps to ensure that any information or advice you give is accurate and valid.

The section in the new Guide on telemedicine on the other hand is disappointing. On first sight the provisions in relation to telemedicine services seem more comprehensive however on closer examination they have been weakened. The Guide states that in order to maintain public confidence in telemedicine doctors providing telemedicine services in Ireland should be registered with the Medical Council but this is no longer a requirement. Some explanation is also needed on what constitutes safe and suitable services for telemedicine. While telemedicine services can be suitable in certain scenarios such as emergency situations, chronic disease management or when distance is an issue there is some debate over whether telemedicine services can adequately replace face-to-face consultations in general practice.

A new section on managing conflicts of interest is included in the 8th edition of the Guide and reflects many of the recommendations in the IMO’s Position Paper on Preserving Medical Professionalism in an Increasingly Commercial Healthcare Environment4. The IMO Paper launched earlier this year highlighted some of the potential issues arising from Ireland’s mixed public-private healthcare system and doctors’ relationships with the pharmaceutical industry and highlighting the importance of transparency.  Under the new Guide doctors must tell patients of any beneficial interest held by the doctor or his family in a private clinic, hospital pharmacy or other institution to which the patient is being referred. Similarly the Guide recommends that doctors should tell patients and any other relevant party about any professional relationship they have with a pharmaceutical company or related enterprise. 

The IMO Position Paper also raised concerns about the advertising practices of some private clinics and while the Medical Council does have a more detailed section relating to the provision of information to the public and advertising, how these provisions are enforced remains to be seen.

The new Guide also contains revised sections on doctors in management roles and relationships between colleagues.

For doctors in management roles, the Guide reminds doctors that their primary objective is the health, safety and care of patients and that they may still be accountable to the Medical Council for their conduct. The section also reminds doctors as managers that they have a duty to advocate for appropriate resources and to ensure the effective and efficient use of resources. The section also reminds doctors that as managers they have a responsibility for patient safety and that appropriate systems are in place including a system whereby the staff they manage can raise concerns about patient safety.

In the section on Relationships between Colleagues the new Guide makes some reference to bullying and harassment but fails to address the issue in any substantive way despite the fact that recent Medical Councils surveys5,6, have highlighted a high prevalence of bullying, harassment and undermining behaviour experienced by medical trainees in Ireland. In 2015, 35% of trainee doctors had a personal experience of bullying, while 56% witnessed someone else being bullied and 46% experienced undermining behaviour from a consultant or GP. 7 out of 10 doctors who experienced bullying did not report the behaviour to someone in authority.  While the new Guide states that doctors should avoid any form of sexual harassment, bullying or undermining of colleagues particularly when doctors are in a position of authority or trust, a stronger stance from the Medical Council and other parties is needed to tackle these issues. Bullying, harassment and undermining behaviour is unacceptable and as a priority the IMO is working with relevant bodies to address these issues in the workplace.

The IMO, as the representative body for doctors in Ireland, will continue to make submissions and raise issues of concern to the Medical Council.

Correspondence:

Vanessa Hetherington, Assistant Director, Policy and International Affairs, Irish Medical Organisation

Email: vhetherington@imo.ie

1- Medical Council, Guide to Professional Conduct and Ethics for registered Medical Practitioners, 8th Ed. 2016 (http://www.medicalcouncil.ie/News-and-Publications/Reports/Guide-to-Professional-Conduct-and-Ethics-8th-Edition-2016-.pdf June 09, 2016)

2- IMO Position Paper on Social Media, April 2013, (http://www.imo.ie/policy-international-affair/documents/imo-submissions-archive/IMO-Position-Paper-on-Social-Media.pdf June 09, 2016)

3- EJD, Ask yourself: Could your social media activity have affected your patients, your colleagues or your career? 2014 (http://juniordoctors.eu/system/files/EJD_Social%20Media%20Flyer%20042_0.pdf June 09, 2016)

4- IMO Position Paper on Preserving Medical Professionalism in an Increasingly Commercial healthcare Environment, April 2016 (http://www.imo.ie/policy-international-affair/documents/Preserving-Medical-Professionalism-in-an-Increasingly-Commercial-Healthcare-Environment.pdf June 09, 2016)

5 Medical Council, Your Training Counts – Trainee Experiences of Clinical Learning Environments in Ireland,  2015 (http://www.medicalcouncil.ie/News-and-Publications/Reports/Your-Training-Counts-2015-.html June 09, 2016 )

6- Medical Council, Your Training Counts Your Training Counts -Spotlight on health and wellbeing, A Special Report from the Trainee National Experience Survey 2014 (http://www.medicalcouncil.ie/News-and-Publications/Reports/Your-Training-Counts-health-and-Wellbeing.pdf June 09, 2016)

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