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Outline of the session Professionalism:
Approaches and Dimensions of professionalism Clinicians’ Professional Relationships and Duties
■Saudi Code of Ethics for Medical Practitioners
References:1. This presentation is based on the Professionalism and
Ethics Handbook for Residents Citation: Hussein GM, Kasule OH, Al-Kaabba AF. Professionalism and Ethics Handbook for Residents. Ware J, Kattan T, editors. Riyadh, Saudi Arabia 2015 2. Presentation by Prof. Mohamed Alrukban, KSU
Levels of Behavioural ‘Control’
Morality
Ethics
Laws & Regulations
Professional standards
Institutional Policies
Personal beliefs
Why can’t/don’t we do what we want to?
Isla
m is
cro
ss-c
uttin
g th
roug
h al
l lev
els
Factor Originates from Developed by Written as
Binding/ voluntary
Committing to
Morality General unchallenged community values
Inherited values; not argued; changes slowly with time
Not written
Voluntarily Community members
Ethics Argued through logically established literature (moral philosophy)
Philosophers Inspires codes, policies, & laws
Voluntarily Not universal
Professional standards
Professional values Professional bodies Codes (Professional codes of Ethics)
Binding those in profession
Laws & Regulations
Legal and moral values
Legislators Laws Binding ALL
Institutional Policies
Professional and institutional values
Healthcare institutions
Codes, policies, guidelines
Binding Those in institution
Personal beliefs &preferences
Personal belief system
Individuals (persons) Not written
? The person only
Professionalism relates the doctor to the world
COUNTRY/REGION
Policy maker
Planner
Manager
COMMUNITY
Advocate
Researcher
Educator
CLINIC/HOSPITALProvider Manage
rEducato
rResearch
er
So your expected roles are…CanMEDS (http://www.royalcollege.ca/) SaudiMEDS
Saudi Meds: A competence specification for Saudi medical graduatesRania G. Zaini , Khalid A. Bin Abdulrahman , Abdulaziz A. Al-Khotani , Abdol Monem A. Al-Hayani , Ibrahim A. Al-Alwan , Saddig D. Jastaniah (Medical Teacher , Vol. 33, Iss. 7, 2011)
Do You Still Remember A Role Model Who Influenced Your Education?
If Yes? Mention Some of Their Qualities and Attributes.
What is Professionalism?• ‘Profession: A self-disciplined group of individuals who
hold themselves out to the public as possessing a special skill derived from training or education, and who are prepared to exercise that skill primarily in the interests of others.’ (CMA)
• It is not easy to define a profession, but it is likely to have all or some of the following characteristics:– It is a vocation or calling that implies service to others– It has a distinctive knowledge base which is kept up to date– It determines its own standards and sets its own examinations– It has a special relationship with those whom it serves e.g. patients,
students….– It has particular ethical principles
Definition of Professionalism (ABMS)
Medical professionalism is a belief system in which group members (“professionals”) declare (“profess”) to each other and the public:the shared competency standards and ethical
values they promise to uphold in their work and
what the public and individual patients can and should expect from medical professionals.” American Board for Medical Specialties (ABMS)
“Medical professionalism describes the skills, attitudes, values and behaviours common to those undertaking the practice of medicine” World Medical Association (WMA)
بطبعه مهنٌي المسلم الطبيب
“ويؤثرون على أنفسهم ولو كان بهم خصاصة”“إن الله يحب من العامل إذا عمل أن يتقن”“.........إذا ذبحتم فأحسنوا الذبحة” ال يؤمن أحدكم حتى يحب ألخيه ما يحب ”
لنفسه..“
What is professionalism about?DON’T Undesirable
conductDO-Desirable Behaviors
Abuse of powerBiasHarassment (verbal/physical)Breach of confidentialityArroganceGreedMisrepresentationImpairmentLack of conscientiousness &Conflicts of interest
AltruismAccountabilityExcellenceDutyRespect for others, &commitment to lifelong learningmaintenance of competence, Honor & integrity,Adherence to ethical codes of conduct,Dedication to self-regulation
'Project Professionalism' (ABIM, 2001)Developed by the Physician Charter and
identified six key elements of professionalism: 1- Altruism:
giving priority to patient interests rather than self-interests
2- Accountability: being answerable to patients, society and
profession3- Excellence:
conscientious effort to perform beyond ordinary expectation, and
commitment to life-long learning
'Project Professionalism' (ABIM, 2001)4- Duty:
free acceptance of commitment to service – i.e. undergoing inconvenience to achieve a high standard of patient care
5- Honor and integrity: being fair, truthful, straightforward
6- Respect for others: patients and families, colleagues, other healthcare professionals and students and trainees
Examples of Unprofessional BehaviorsClassroom Setting-Students/Trainee
• Arriving for class late and/or leaving early• Being unprepared for group sessions• Not completing assigned tasks• Disrupting class sessions• Cheating on an exam• Using Mobile Phone during class• Chatting during class• Focusing on the test vs. learning• Prejudging content in advance• Intolerance of the opinions of others
Examples of Unprofessional Behaviors:Clinical Setting-Students
• Dressing inappropriately• Avoiding work and/or responsibilities• Exhibiting little empathy for patients• Demonstrating lack of sensitivity to patients’
cultural backgrounds• Not protecting patient confidentiality
Signs of Lack of professionalism (ABIM, 2001)
Sign Examples1- Abuse of power • Abuse of patients &/or colleagues; bias and harassment
2- Arrogance • Offensive display of superiority and self-importance
3- Greed • when money becomes the driving force for work
4- Misrepresentation • Lying: consciously failing to tell the truth; • Fraud: conscious misrepresentation of material fact with the intent to
mislead
5- Impairment • any disability that may prevent the physician from discharging his/her duties
6- Lack of conscientiousness
• failure to fulfil responsibilities
7- Conflicts of interests
• Self-promotion/ advertising • Unethical collaboration with industry; acceptance of gifts; • Misuse of services – overcharging, inappropriate treatment or
prolonging contact with patients
So your expected roles are…CanMEDS (http://www.royalcollege.ca/) SaudiMEDS
Saudi Meds: A competence specification for Saudi medical graduatesRania G. Zaini , Khalid A. Bin Abdulrahman , Abdulaziz A. Al-Khotani , Abdol Monem A. Al-Hayani , Ibrahim A. Al-Alwan , Saddig D. Jastaniah Medical Teacher , Vol. 33, Iss. 7, 2011
Saudi Code ofEthics for healthcare practitioners
http://www.scfhs.org.sa/Reglations/CR/Documents/%D8%A3%D8%AE%D9%84%D8%A7%D9%82%D9%8A%D8%A7%D8%AA%20%D8%A7%D9%84%D9%85%D9%85%D8%A7%D8%B1%D8%B3%20%D8%A7%D9%84%D8%B5%D8%AD%D9%8A.pdf
Healthcare Practitioner’s Duties Towards Patients Healthcare Practitioner’s Duties Towards Patients
Good Treatment of PatientAchieving Patient’s Interest and Guarding His/Her
RightsPatient’s Consent Reassurance of Patient Maintaining Patient’s Secrets - Confidentiality
Duties Towards Professional Colleagues1. Behave well with his/her colleagues and treat them the
way he/she would like them to treat him/her.2. Do not indulge in their private issues3. Avoid direct criticism of a colleague in front of patients4. Doing his/her best in teaching them 5. Envisage integrity of those working or trained by him6. Follow religious standards (relations with colleagues of other
sex)7. To accept peer-review of his/her work8. respect his/her non-doctor colleagues, and appreciate their
role in healthcare9. To report to the responsible authority any of his colleague’s
attitudes or conditions that would affect the safety of or inflict harm on the patients
clinician’s Duties Towards his/her Profession1. Protect the nobleness of the profession
2. Scientific and practical contributions to the development of the profession,through research, studies, writing articles, and continuous education.
3. Maintain the medical professional standards and work on improving themin all the professional activities (that he/she takes part in).
4. Do not abuse professional status by achieving privileges, material or moralbenefits, apart from those granted through the system and professionalcustoms.
5. Avoid whatever leads (or could lead) to insulting the profession: maltreatment, or lack of commitment to appointments, lying, falsification, arrogance, pretending to know what he/she does not
Duties Towards his/her Profession6. Refrain from any act that would breach his/her honesty, or integrity while dealing with the patient, 7. Avoid hastening to take action with high risk medical procedures unless he/she is sure of its necessity and that the benefits exceed their risks (of harm).8. Take the appropriate action if he/she knows that one of the healthcare team is sick, ignorant, or negligent in his/her responsibilities, 9. Avoid seeking fame on account of the basics and ethics of the profession.
clinician’s Duties Towards his/her ProfessionReflect sincere devotion and dedication to
the medical profession.To avoid any action that could lead to
contempt of the medical profession and to maintain the standards of medical profession
To contribute in the development of the profession through research and continuous learning.
The physician should not take advantage of his profession position for obtaining any material or moral gains, which are not in conformity with or violate the laws and tradition.
clinician’s Duties Towards his/her ProfessionTo take the appropriate procedure when he
comes to know that one of the members of the health team is sick, ignorant or negligent of his duties; in furtherance of protecting the patient in the first place and the medical profession next.
The physician should refrain, when dealing with the patient, from any act or conduct that would infringe his honesty and integrity.
To avoid seeking fame at the expense of the profession ethics and principles.
clinician’s Role Towards CommunityPositive interaction with the community’s affairsProtect the community by reporting
reportable/epidemic diseases Improve health in the community through advocacy
and health education, and involvement in community health activities
Rational use of the healthcare institutions’ resources
Effective contribution to the development of policies and health systems that respond to the community needs and facilitates easier access to health care.
Source: Islamic Code of Medical & Health Ethics
clinician’s Role Towards CommunityTo be as a role model in his/her attitude and religion
Promotion of health equity among the society members
Maintenance of health resources and the ideal utilization of such resources.
Use his skills, knowledge and expertise to improve the standards and quality of health services rendered to the society.
The round with Mr. Butcher (Case)See : Module 3 in Professionalism and Ethics Handbook forResidents (PEHR): A Practical GuideHussein GM, Alkabba AF, Kasule OH. Professionalism and Ethics Handbook forResidents (PEHR): A Practical Guide. Ware J, Kattan T (eds). 1st Edition. Riyadh,Saudi Arabia: Saudi Commission for Health Specialties, 2015.
Summary points Being a clinician is about being part of a team. You
have rights and duties as part of this team. Central to your care is your patient (not your ego
and not your bank account). Many of the positive attitudes and skills can be
developed through training, and self-development. Developing and adhering to these standards
develops you, improves health care, and enhances public trust in the health system.
By respecting your patients, colleagues, and the community in general, you build better relations and a better reputation for being a faithful model clinician
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