Good Medical Practice: A Code of Conduct for Doctors in...

Good Medical Practice: A Code of Conduct

for Doctors in Australia

This code was endorsed by all Australian State and Territory medical boards and the Australian Medical Council. It has been adopted by the Medical Board of Australia after minor revisions to ensure it is consistent with the Health Practitioner Regulation National Law Act 2009 (the National Law). It is issued under s 39 of the National Law.

Good Medical Practice: A Code of Conduct for Doctors in Australia

1 About this code 1

1.1 Purposeofthecode 1

1.2 Useofthecode 1

1.3 Whatthecodedoesnotdo 1

1.4 Professionalvaluesandqualitiesofdoctors 1

1.5 AustraliaandAustralianmedicine 2

1.6 Substitutedecisionmakers 2

2 Providing good care 3

2.1 Introduction 3

2.2 Goodpatientcare 3

2.3 Shareddecisionmaking 3

2.4 Decisionsaboutaccesstomedicalcare 3

2.5 Treatmentinemergencies 4

3 Working with patients 5

3.1 Introduction 5

3.2 Doctor–patientpartnership 5

3.3 Effectivecommunication 5

3.4 Confidentialityandprivacy 5

3.5 Informedconsent 5

3.6 Childrenandyoungpeople 6

3.7 Culturallysafeandsensitivepractice 6

3.8 Patientswhomayhaveadditionalneeds 6

3.9 Relatives,carersandpartners 6

3.10 Adverseevents 7

3.11 Whenacomplaintismade 7

3.12 End-of-lifecare 7

3.13 Endingaprofessionalrelationship 8

3.14 Personalrelationships 8

3.15 Closingyourpractice 8

4 Working with other health care professionals 9

4.1 Introduction 9

4.2 Respectformedicalcolleaguesand

otherhealthcareprofessionals 9

4.3 Delegation,referralandhandover 9

4.4 Teamwork 9

4.5 Coordinatingcarewithotherdoctors 9

5 Working within the health care system 10

5.1 Introduction 10

5.3 Healthadvocacy 10

5.4 Publichealth 10

6 Minimising risk 11

6.1 Introduction 11

6.2 Riskmanagement 11

6.3 Doctors’performance—

youandyourcolleagues 11

7 Maintaining professional performance 12

7.1 Introduction 12

7.2 Continuingprofessionaldevelopment 12

8 Professional behaviour 13

8.1 Introduction 13

8.2 Professionalboundaries 13

8.3 Reportingobligations 13

8.4 Medicalrecords 13

Contents


Contents

8.5 Insurance 13

8.6 Advertising 13

8.7 Medico-legal,insuranceandother

assessments 14

8.8 Medicalreports,certificatesand

givingevidence 14

8.9 Curriculumvitae 14

8.10 Investigations 14

8.11 Conflictsofinterest 14

8.12 Financialandcommercialdealings 15

9 Ensuring doctors’ health 16

9.1 Introduction 16

9.2 Yourhealth 16

9.3 Otherdoctors’health 16

10 Teaching, supervising and assessing 17

11 Undertaking research 18

11.1 Introduction 18

11.2 Researchethics 18

11.3 Treatingdoctorsandresearch 18

Acknowledgements 19


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1 About this code

1.1 Purpose of the code

Good Medical Practice (thecode)describeswhatisexpectedofalldoctorsregisteredtopractisemedicineinAustralia.Itsetsouttheprinciplesthatcharacterisegoodmedicalpracticeandmakesexplicitthestandardsofethicalandprofessionalconductexpectedofdoctorsbytheirprofessionalpeersandthecommunity.Thecodewasdevelopedfollowingwideconsultationwiththemedicalprofessionandthecommunity.Thecodeisaddressedtodoctorsandisalsointendedtoletthecommunityknowwhattheycanexpectfromdoctors.Theapplicationofthecodewillvaryaccordingtoindividualcircumstances,buttheprinciplesshouldnotbecompromised.

ThiscodecomplementstheAustralianMedicalAssociationCode of Ethics1 andisalignedwithitsvalues,andisalsoconsistentwiththeDeclaration ofGeneva and the International Code of Medical Ethics,2issuedbytheWorldMedicalAssociation.

Thiscodedoesnotsetnewstandards.Itbringstogether,intoasingleAustraliancode,standardsthathavelongbeenatthecoreofmedicalpractice.

Thepracticeofmedicineischallengingandrewarding.Nocodeorguidelinescaneverencompasseverysituationorreplacetheinsightandprofessionaljudgmentofgooddoctors.Goodmedicalpracticemeansusingthisjudgmenttotrytopractiseinawaythatwouldmeetthestandardsexpectedofyoubyyourpeersandthecommunity.

1.2 Use of the code

DoctorshaveaprofessionalresponsibilitytobefamiliarwithGood Medical Practiceandtoapplytheguidanceitcontains.

Thiscodewillbeused:

• Tosupportindividualdoctorsinthechallengingtaskofprovidinggoodmedicalcareandfulfillingtheirprofessionalroles,andtoprovideaframeworktoguideprofessionaljudgment.

• Toassistmedicalboardsintheirroleofprotectingthepublic,bysettingandmaintainingstandardsofmedicalpractice.Ifyourprofessionalconductvariessignificantlyfromthisstandard,youshouldbepreparedtoexplainandjustifyyourdecisionsandactions.Seriousorrepeatedfailuretomeetthesestandardsmayhaveconsequencesforyourmedicalregistration.

• AsanadditionalresourceforarangeofusesthatcontributetoenhancingthecultureofmedicalprofessionalismintheAustralianhealthsystem;forexample,inmedicaleducation;orientation,inductionandsupervisionofjuniordoctorsandinternationalmedicalgraduates;andbyadministratorsandpolicymakersinhospitals,healthservicesandotherinstitutions.

1.3 What the code does not do

Thiscodeisnotasubstitutefortheprovisionsoflegislationandcaselaw.Ifthereisanyconflictbetweenthiscodeandthelaw,thelawtakesprecedence.

Thiscodeisnotanexhaustivestudyofmedicalethicsoranethicstextbook.Itdoesnotaddressindetailthestandardsofpracticewithinparticularmedicaldisciplines;thesearefoundinthepoliciesandguidelinesissuedbymedicalcollegesandotherprofessionalbodies.

Whilegoodmedicalpracticerespectspatients’rights,thiscodeisnotacharterofrights.3

1.4 Professional values and qualities of doctors

Whileindividualdoctorshavetheirownpersonalbeliefsandvalues,therearecertainprofessionalvaluesonwhichalldoctorsareexpectedtobasetheirpractice.

Doctorshaveadutytomakethecareofpatientstheirfirstconcernandtopractisemedicinesafelyandeffectively.Theymustbeethicalandtrustworthy.

Patientstrusttheirdoctorsbecausetheybelievethat,inadditiontobeingcompetent,theirdoctorwillnottakeadvantageofthemandwilldisplayqualitiessuchasintegrity,truthfulness,dependabilityandcompassion.Patientsalsorelyontheirdoctorstoprotecttheirconfidentiality.

Doctorshavearesponsibilitytoprotectandpromotethehealthofindividualsandthecommunity.

Goodmedicalpracticeispatient-centred.Itinvolvesdoctorsunderstandingthateachpatientisunique,andworkinginpartnershipwiththeirpatients,adaptingwhattheydotoaddresstheneedsandreasonableexpectationsofeachpatient.Thisincludesculturalawareness:beingawareoftheirowncultureandbeliefsandrespectfulofthebeliefsandculturesofothers,recognisingthattheseculturaldifferencesmayimpactonthedoctor–patientrelationshipandonthedeliveryofhealthservices.

Goodcommunicationunderpinseveryaspectofgoodmedicalpractice.

1Seehttp://www.ama.com.au/codeofethics2Seehttp://www.wma.net/e/policy/c8.htm3SeetheAustralianCommissiononSafetyandQualityinHealthCare’sAustralianCharterofHealthcareRights(http://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/52533CE922D6F58BCA2573AF007BC6F9/$File/17537-charter.pdf)


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Professionalismembodiesallthequalitiesdescribedhere,andincludesself-awarenessandself-reflection.Doctorsareexpectedtoreflectregularlyonwhethertheyarepractisingeffectively,onwhatishappeningintheirrelationshipswithpatientsandcolleagues,andontheirownhealthandwellbeing.Theyhaveadutytokeeptheirskillsandknowledgeuptodate,refineanddeveloptheirclinicaljudgmentastheygainexperience,andcontributetotheirprofession.

1.5 Australia and Australian medicine

Australiaisculturallydiverse.Weinhabitalandthat,formanyages,washeldandcaredforbyIndigenousAustralians,whosehistoryandculturehaveuniquelyshapedournation.OursocietyisfurtherenrichedbythecontributionofpeoplefrommanynationswhohavemadeAustraliatheirhome.

DoctorsinAustraliareflecttheculturaldiversityofoursociety,andthisdiversitystrengthensourprofession.

TherearemanywaystopractisemedicineinAustralia.Thecoretasksofmedicinearecaringforpeoplewhoareunwellandseekingtokeeppeoplewell.Thiscodefocusesprimarilyonthesecoretasks.Forthedoctorswhoundertakerolesthathavelittleornopatientcontact,notallofthiscodemayberelevant,buttheprinciplesunderpinningitwillstillapply.

1.6 Substitute decision makers

Inthiscode,referencetotheterm‘patient’alsoincludessubstitutedecisionmakersforpatientswhodonothavethecapacitytomaketheirowndecisions.Thiscanbetheparents,oralegallyappointeddecisionmaker.Ifindoubt,seekadvicefromtherelevantguardianshipauthority.


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2 Providing good care

2.1 Introduction

Inclinicalpractice,thecareofyourpatientisyourprimaryconcern.Providinggoodpatientcareincludes:

2.1.1 Assessingthepatient,takingintoaccountthehistory,thepatient’sviews,andanappropriatephysicalexamination.Thehistoryincludesrelevantpsychological,socialandculturalaspects.

2.1.2 Formulatingandimplementingasuitablemanagementplan(includingarranginginvestigationsandprovidingtreatmentandadvice).

2.1.3 Facilitatingcoordinationandcontinuityofcare.

2.1.4 Referringapatienttoanotherpractitionerwhenthisisinthepatient’sbestinterests.

2.1.5 Recognisingandrespectingpatients’rightstomaketheirowndecisions.

2.2 Good patient care

Maintainingahighlevelofmedicalcompetenceandprofessionalconductisessentialforgoodpatientcare.Goodmedicalpracticeinvolves:

2.2.1 Recognisingandworkingwithinthelimitsofyourcompetenceandscopeofpractice.

2.2.2 Ensuringthatyouhaveadequateknowledgeandskillstoprovidesafeclinicalcare.

2.2.3 Maintainingadequaterecords(seeSection8.4).

2.2.4 Consideringthebalanceofbenefitandharminallclinical-managementdecisions.

2.2.5 Communicatingeffectivelywithpatients(seeSection3.3).

2.2.6 Providingtreatmentoptionsbasedonthebestavailableinformation.

2.2.7 Takingstepstoalleviatepatientsymptomsanddistress,whetherornotacureispossible.

2.2.8 Supportingthepatient’srighttoseekasecondopinion.

2.2.9 Consultingandtakingadvicefromcolleagues,whenappropriate.

2.2.10 Makingresponsibleandeffectiveuseoftheresourcesavailabletoyou(seeSection5.2).

2.2.11 Encouragingpatientstotakeinterestin,andresponsibilityfor,themanagementoftheirhealth,andsupportingtheminthis.

2.2.12 Ensuringthatyourpersonalviewsdonotadverselyaffectthecareofyourpatient.

2.3 Shared decision making

Makingdecisionsabouthealthcareisthesharedresponsibilityofthedoctorandthepatient.Patientsmaywishtoinvolvetheirfamily,carerorothers.SeeSection1.6onsubstitutedecisionmakers.

2.4 Decisions about access to medical care

Yourdecisionsaboutpatients’accesstomedicalcareneedtobefreefrombiasanddiscrimination.Goodmedicalpracticeinvolves:

2.4.1 Treatingyourpatientswithrespectatalltimes.

2.4.2 Notprejudicingyourpatient’scarebecauseyoubelievethatapatient’sbehaviourhascontributedtotheircondition.

2.4.3 Upholdingyourdutytoyourpatientandnotdiscriminatingonmedicallyirrelevantgrounds,includingrace,religion,sex,disabilityorothergrounds,asdescribedinantidiscriminationlegislation.4

2.4.4 Givingprioritytoinvestigatingandtreatingpatientsonthebasisofclinicalneedandeffectivenessoftheproposedinvestigationsortreatment.

2.4.5 Keepingyourselfandyourstaffsafewhencaringforpatients.Ifapatientposesarisktoyourhealthandsafetyorthatofyourstaff,takeactiontoprotectagainstthatrisk.Suchapatientshouldnotbedeniedcare,ifreasonablestepscanbetakentokeepyouandyourstaffsafe.

2.4.6 Beingawareofyourrighttonotprovideordirectlyparticipateintreatmentstowhichyouconscientiouslyobject,informingyourpatientsand,ifrelevant,colleagues,ofyourobjection,andnotusingyourobjectiontoimpedeaccesstotreatmentsthatarelegal.

4Seehttp://www.hreoc.gov.au/info_for_employers/law/index.html


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2.4.7 Notallowingyourmoralorreligiousviewstodenypatientsaccesstomedicalcare,recognisingthatyouarefreetodeclinetopersonallyprovideorparticipateinthatcare.

2.5 Treatment in emergencies

Treatingpatientsinemergenciesrequiresdoctorstoconsiderarangeofissues,inadditiontothepatient’sbestcare.Goodmedicalpracticeinvolvesofferingassistanceinanemergencythattakesaccountofyourownsafety,yourskills,theavailabilityofotheroptionsandtheimpactonanyotherpatientsunderyourcare;andcontinuingtoprovidethatassistanceuntilyourservicesarenolongerrequired.


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3 Working with patients

3.1 Introduction

Relationshipsbasedonopenness,trustandgoodcommunicationwillenableyoutoworkinpartnershipwithyourpatients.

3.2 Doctor–patient partnership

Agooddoctor–patientpartnershiprequireshighstandardsofprofessionalconduct.Thisinvolves:

3.2.1 Beingcourteous,respectful,compassionateandhonest.

3.2.2 Treatingeachpatientasanindividual.

3.2.3 Protectingpatients’privacyandrighttoconfidentiality,unlessreleaseofinformationisrequiredbylaworbypublic-interestconsiderations.

3.2.4 Encouragingandsupportingpatientsand,whenrelevant,theircarerorfamily,incaringforthemselvesandmanagingtheirhealth.

3.2.5 Encouragingandsupportingpatientstobewellinformedabouttheirhealthandtousethisinformationwiselywhentheyaremakingdecisions.

3.2.6 Recognisingthatthereisapowerimbalanceinthedoctor–patientrelationship,andnotexploitingpatientsphysically,emotionally,sexuallyorfinancially.

3.3 Effective communication

Animportantpartofthedoctor–patientrelationshipiseffectivecommunication.Thisinvolves:

3.3.1 Listeningtopatients,askingforandrespectingtheirviewsabouttheirhealth,andrespondingtotheirconcernsandpreferences.

3.3.2 Encouragingpatientstotellyouabouttheirconditionandhowtheyarecurrentlymanagingit,includinganyalternativeorcomplementarytherapiestheyareusing.

3.3.3 Informingpatientsofthenatureof,andneedfor,allaspectsoftheirclinicalmanagement,includingexamination

andinvestigations,andgivingthemadequateopportunitytoquestionorrefuseinterventionandtreatment.

3.3.4 Discussingwithpatientstheirconditionandtheavailablemanagementoptions,includingtheirpotentialbenefitandharm.

3.3.5 Endeavouringtoconfirmthatyourpatientunderstandswhatyouhavesaid.

3.3.6 Ensuringthatpatientsare informedofthematerialrisksassociatedwithanypartoftheproposedmanagementplan.

3.3.7 Respondingtopatients’questionsandkeepingtheminformedabouttheirclinicalprogress.

3.3.8 Makingsure,whereverpractical,thatarrangementsaremadetomeetpatients’specificlanguage,culturalandcommunicationneeds,andbeingawareofhowtheseneedsaffectunderstanding.

3.3.9 Familiarisingyourselfwith,andusingwhenevernecessary,qualifiedlanguageinterpretersorculturalinterpreterstohelpyoutomeetpatients’communicationneeds.Informationaboutgovernment-fundedinterpreterservicesisavailableontheAustralianGovernmentDepartmentofImmigrationandCitizenshipwebsite.5

3.4 Confidentiality and privacy

Patientshavearighttoexpectthatdoctorsandtheirstaffwillholdinformationabouttheminconfidence,unlessreleaseofinformationisrequiredbylaworpublicinterestconsiderations.Goodmedicalpracticeinvolves:

3.4.1 Treatinginformationaboutpatientsasconfidential.

3.4.2 Appropriatelysharinginformationaboutpatientsfortheirhealthcare,consistentwithprivacylawandprofessionalguidelinesaboutconfidentiality.

3.4.3 Beingawarethattherearecomplexissuesrelatedtogeneticinformationandseekingappropriateadviceaboutdisclosureofsuchinformation.

3.5 Informed consent

Informedconsentisaperson’svoluntarydecisionaboutmedicalcarethatismadewithknowledgeand

5TheAustralianGovernmentDepartmentofImmigrationandCitizenship’sTranslatingandInterpretingService(TIS)Nationalcanbecontactedon131450,orviathewebsite(http://www.immi.gov.au/living-in-australia/help-with-english/help_with_translating/index.htm).


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understandingofthebenefitsandrisksinvolved.TheinformationthatdoctorsneedtogivetopatientsisdetailedinguidelinesissuedbytheNationalHealthandMedicalResearchCouncil.6Goodmedicalpracticeinvolves:

3.5.1 Providinginformationtopatientsinawaythattheycanunderstandbeforeaskingfortheirconsent.

3.5.2 Obtaininginformedconsentorothervalidauthoritybeforeyouundertakeanyexamination,investigationorprovidetreatment(exceptinanemergency),orbeforeinvolvingpatientsinteachingorresearch.

3.5.3 Ensuringthatyourpatientsareinformedaboutyourfeesandcharges.

3.5.4 Whenreferringapatientforinvestigationortreatment,advisingthepatientthattheremaybeadditionalcosts,whichpatientsmaywishtoclarifybeforeproceeding.

3.6 Children and young people

Caringforchildrenandyoungpeoplebringsadditionalresponsibilitiesfordoctors.Goodmedicalpracticeinvolves:

3.6.1 Placingtheinterestsandwellbeingofthechildoryoungpersonfirst.

3.6.2 Ensuringthatyouconsideryoungpeople’scapacityfordecisionmakingandconsent.

3.6.3 Ensuringthat,whencommunicatingwithachildoryoungperson,you:

• treatthemwithrespectandlistentotheirviews

• encouragequestionsandanswertheirquestionstothebestofyourability

• provideinformationinawaythattheycanunderstand

• recognisetheroleofparentsandwhenappropriate,encouragetheyoungpersontoinvolvetheirparentsindecisionsabouttheircare.

3.6.4 Beingalerttochildrenandyoungpeoplewhomaybeatrisk,andnotifyingappropriateauthorities,asrequiredbylaw.

3.7 Culturally safe and sensitive practice

Goodmedicalpracticeinvolvesgenuineeffortstounderstandtheculturalneedsandcontextsofdifferentpatientstoobtaingoodhealthoutcomes.Thisincludes:

3.7.1 Havingknowledgeof,respectfor,andsensitivitytowards,theculturalneedsofthecommunityyouserve,includingthoseofIndigenousAustralians.

3.7.2 Acknowledgingthesocial,economic,culturalandbehaviouralfactorsinfluencinghealth,bothatindividualandpopulationlevels.

3.7.3 Understandingthatyourowncultureandbeliefsinfluenceyourinteractionswithpatients.

3.7.4 Adaptingyourpracticetoimprovepatientengagementandhealthcareoutcomes.

3.8 Patients who may have additional needs

Somepatients(includingthosewithimpaireddecision-makingcapacity)haveadditionalneeds.Goodmedicalpracticeinmanagingthecareofthesepatientsinvolves:

3.8.1 Payingparticularattentiontocommunication.

3.8.2 Beingawarethatincreasedadvocacymaybenecessarytoensurejustaccesstohealthcare.

3.8.3 Recognisingthattheremaybearangeofpeopleinvolvedintheircare,suchascarers,familymembersoraguardian,andinvolvingthemwhenappropriate.

3.8.4 Beingawarethatthesepatientsmaybeatgreaterrisk.

3.9 Relatives, carers and partners

Goodmedicalpracticeinvolves:

3.9.1 Beingconsideratetorelatives,carers,partnersandothersclosetothepatient,andrespectfuloftheirroleinthecareofthepatient.

3.9.2 Withappropriateconsent,beingresponsiveinprovidinginformation.

6SeetheNationalHealthandMedicalResearchCouncil’sdocuments,General Guidelines for Medical Practitioners on Providing Information to Patients(2004;http://www.nhmrc.gov.au/publications/synopses/e57syn.htm)andCommunicating with Patients: Advice for Medical Practitioners(2004;http://www.nhmrc.gov.au/publications/synopses/e58syn.htm)


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3.10 Adverse events

Whenadverseeventsoccur,youhavearesponsibilitytobeopenandhonestinyourcommunicationwithyourpatient,toreviewwhathasoccurredandtoreportappropriately.7Whensomethinggoeswrong,goodmedicalpracticeinvolves:

3.10.1 Recognisingwhathashappened.

3.10.2 Actingimmediatelytorectifytheproblem,ifpossible,includingseekinganynecessaryhelpandadvice.

3.10.3 Explainingtothepatientaspromptlyandfullyaspossiblewhathashappenedandtheanticipatedshort-termandlong-termconsequences.

3.10.4 Acknowledginganypatientdistressandprovidingappropriatesupport.

3.10.5 Complyingwithanyrelevantpolicies,proceduresandreportingrequirements,subjecttoadvicefromyourmedicalindemnityinsurer.

3.10.6 Reviewingadverseeventsandimplementingchangestoreducetheriskofrecurrence(seeSection6).

3.10.7 Reportingadverseeventstotherelevantauthority,asnecessary(seeSection6).

3.10.8 Ensuringpatientshaveaccesstoinformationabouttheprocessesformakingacomplaint(forexample,throughtherelevanthealthcarecomplaintscommissionormedicalboard).

3.11 When a complaint is made

Patientswhoaredissatisfiedhavearighttocomplainabouttheircare.Whenacomplaintismade,goodmedicalpracticeinvolves:

3.11.1 Acknowledgingthepatient’srighttocomplain.

3.11.2 Workingwiththepatienttoresolvetheissue,wherepossible.

3.11.3 Providingaprompt,openandconstructiveresponse,includinganexplanationand,ifappropriate,anapology.

3.11.4 Ensuringthecomplaintdoesnotadverselyaffectthepatient’scare.Insomecases,itmaybeadvisabletoreferthepatienttoanotherdoctor.

3.11.5 Complyingwithrelevantcomplaintslaw,policiesandprocedures.

3.12 End-of-life care

Doctorshaveavitalroleinassistingthecommunitytodealwiththerealityofdeathanditsconsequences.Incaringforpatientstowardstheendoftheirlife,goodmedicalpracticeinvolves:

3.12.1 Takingstepstomanageapatient’ssymptomsandconcernsinamannerconsistentwiththeirvaluesandwishes.

3.12.2 Providingorarrangingappropriatepalliativecare.

3.12.3 Understandingthelimitsofmedicineinprolonginglifeandrecognisingwheneffortstoprolonglifemaynotbenefitthepatient.

3.12.4 Understandingthatyoudonothaveadutytotrytoprolonglifeatallcost.However,youdohaveadutytoknowwhennottoinitiateandwhentoceaseattemptsatprolonginglife,whileensuringthatyourpatientsreceiveappropriaterelieffromdistress.

3.12.5 Acceptingthatpatientshavetherighttorefusemedicaltreatmentortorequestthewithdrawaloftreatmentalreadystarted.

3.12.6 Respectingdifferentculturalpracticesrelatedtodeathanddying.

3.12.7 Strivingtocommunicateeffectivelywithpatientsandtheirfamiliessotheyareabletounderstandtheoutcomesthatcanandcannotbeachieved.

3.12.8 Facilitatingadvancecareplanning.

3.12.9 Takingreasonablestepstoensurethatsupportisprovidedtopatientsandtheirfamilies,evenwhenitisnotpossibletodelivertheoutcometheydesire.

3.12.10Communicatingbadnewstopatientsandtheirfamiliesinthemostappropriatewayandprovidingsupportforthemwhiletheydealwiththisinformation.

3.12.11Whenyourpatientdies,beingwillingtoexplain,tothebestofyourknowledge,thecircumstancesofthedeathtoappropriatemembersofthepatient’sfamilyandcarers,unlessyouknowthepatientwouldhaveobjected.

7Seehttp://www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/PriorityProgram-02


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3.13 Ending a professional relationship

Insomecircumstances,therelationshipbetweenadoctorandpatientmaybecomeineffectiveorcompromised,andyoumayneedtoendit.Goodmedicalpracticeinvolvesensuringthatthepatientisadequatelyinformedofyourdecisionandfacilitatingarrangementsforthecontinuingcareofthepatient,includingpassingonrelevantclinicalinformation.

3.14 Personal relationships

Wheneverpossible,avoidprovidingmedicalcaretoanyonewithwhomyouhaveaclosepersonalrelationship.Inmostcases,providingcaretoclosefriends,thoseyouworkwithandfamilymembersisinappropriatebecauseofthelackofobjectivity,possiblediscontinuityofcare,andriskstothedoctorandpatient.Insomecases,providingcaretothoseclosetoyouisunavoidable.Wheneverthisisthecase,goodmedicalpracticerequiresrecognitionandcarefulmanagementoftheseissues.

3.15 Closing your practice

Whenclosingorrelocatingyourpractice,goodmedicalpracticeinvolves:

3.15.1 Givingadvancenoticewherethisispossible.

3.15.2 Facilitatingarrangementsforthecontinuingmedicalcareofallyourcurrentpatients,includingthetransferorappropriatemanagementofallpatientrecords.Youmustfollowthelawgoverninghealthrecordsinyourjurisdiction.


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4 Working with other health care professionals

4.1 Introduction

Goodrelationshipswithmedicalcolleagues,nursesandotherhealthcareprofessionalsstrengthenthedoctor–patientrelationshipandenhancepatientcare.

4.2 Respect for medical colleagues and other health care professionals

Goodpatientcareisenhancedwhenthereismutualrespectandclearcommunicationbetweenallhealthcareprofessionalsinvolvedinthecareofthepatient.Goodmedicalpracticeinvolves:

4.2.1 Communicatingclearly,effectively,respectfullyandpromptlywithotherdoctorsandhealthcareprofessionalscaringforthepatient.

4.2.2 Acknowledgingandrespectingthecontributionofallhealthcareprofessionalsinvolvedinthecareofthepatient.

4.3 Delegation, referral and handover

Delegationinvolvesyouaskinganotherhealthcareprofessionaltoprovidecareonyourbehalfwhileyouretainoverallresponsibilityforthepatient’scare.Referral involvesyousendingapatienttoobtainopinionortreatmentfromanotherdoctororhealthcareprofessional.Referralusuallyinvolvesthetransfer(inpart)ofresponsibilityforthepatient’scare,usuallyforadefinedtimeandforaparticularpurpose,suchascarethatisoutsideyourareaofexpertise.Handoveristheprocessoftransferringallresponsibilitytoanotherhealthcareprofessional.Goodmedicalpracticeinvolves:

4.3.1 Takingreasonablestepstoensurethatthepersontowhomyoudelegate,referorhandoverhasthequalifications,experience,knowledgeandskillstoprovidethecarerequired.

4.3.2 Understandingthatwhenyoudelegate,althoughyouwillnotbeaccountableforthedecisionsandactionsofthosetowhomyoudelegate,youremainresponsiblefortheoverallmanagementofthepatient,andforyourdecisiontodelegate.

4.3.3 Alwayscommunicatingsufficientinformationaboutthepatientandthetreatmenttheyneedtoenablethecontinuingcareofthepatient.

4.4 Teamwork

Mostdoctorsworkcloselywithawiderangeofhealthcareprofessionals.Thecareofpatientsisimprovedwhenthereismutualrespectandclearcommunication,aswellasanunderstandingoftheresponsibilities,capacities,constraintsandethicalcodesofeachother’sprofessions.Workinginateamdoesnotalteradoctor’spersonalaccountabilityforprofessionalconductandthecareprovided.Whenworkinginateam,goodmedicalpracticeinvolves:

4.4.1 Understandingyourparticularroleintheteamandattendingtotheresponsibilitiesassociatedwiththatrole.

4.4.2 Advocatingforacleardelineationofrolesandresponsibilities,includingthatthereisarecognisedteamleaderorcoordinator.

4.4.3 Communicatingeffectivelywithotherteammembers.

4.4.4 Informingpatientsabouttherolesofteammembers.

4.4.5 Actingasapositiverolemodelforteammembers.

4.4.6 Understandingthenatureandconsequencesofbullyingandharassment,andseekingtoeliminatesuchbehaviourintheworkplace.

4.5 Coordinating care with other doctors

Goodpatientcarerequirescoordinationbetweenalltreatingdoctors.Goodmedicalpracticeinvolves:

4.5.1 Communicatingalltherelevantinformationinatimelyway.

4.5.2 Facilitatingthecentralcoordinatingroleofthegeneralpractitioner.

4.5.3 Advocatingthebenefitofageneralpractitionertoapatientwhodoesnotalreadyhaveone.

4.5.4 Ensuringthatitiscleartothepatient,thefamilyandcolleagueswhohasultimateresponsibilityforcoordinatingthecareofthepatient.


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5 Working within the health care system

5.1 Introduction

Doctorshavearesponsibilitytocontributetotheeffectivenessandefficiencyofthehealthcaresystem.

5.2 Wiseuseofhealthcareresources

Itisimportanttousehealthcareresourceswisely.Goodmedicalpracticeinvolves:

5.2.1 Ensuringthattheservicesyouprovidearenecessaryandlikelytobenefitthepatient.

5.2.2 Upholdingthepatient’srighttogainaccesstothenecessarylevelofhealthcareand,wheneverpossible,helpingthemtodoso.

5.2.3 Supportingthetransparentandequitableallocationofhealthcareresources.

5.2.4 Understandingthatyouruseofresourcescanaffecttheaccessotherpatientshavetohealthcareresources.

5.3 Health advocacy

TherearesignificantdisparitiesinthehealthstatusofdifferentgroupsintheAustraliancommunity.Thesedisparitiesresultfromsocial,cultural,geographic,health-relatedandotherfactors.Inparticular,theIndigenouspeopleofAustraliabeartheburdenofgrosssocial,culturalandhealthinequity.Goodmedicalpracticeinvolvesusingyourexpertiseandinfluencetoprotectandadvancethehealthandwellbeingofindividualpatients,communitiesandpopulations.

5.4 Public health

Doctorshavearesponsibilitytopromotethehealthofthecommunitythroughdiseasepreventionandcontrol,educationandscreening.Goodmedicalpracticeinvolves:

5.4.1 Understandingtheprinciplesofpublichealth,includinghealtheducation,healthpromotion,diseasepreventionandcontrolandscreening.

5.4.2 Participatingineffortstopromotethehealthofthecommunityandbeingawareofyourobligationsindiseaseprevention,screeningandreportingnotifiablediseases.


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6 Minimising risk

6.1 Introduction

Riskisinherentinhealthcare.Minimisingrisktopatientsisanimportantcomponentofmedicalpractice.Goodmedicalpracticeinvolvesunderstandingandapplyingthekeyprinciplesofriskminimisationandmanagementinyourpractice.

6.2 Risk management

Goodmedicalpracticeinrelationtoriskmanagementinvolves:

6.2.1 Beingawareoftheimportanceoftheprinciplesofopendisclosureandanonpunitiveapproachtoincidentmanagement.

6.2.2 Participatinginsystemsofqualityassuranceandimprovement.

6.2.3 Participatinginsystemsforsurveillanceandmonitoringofadverseeventsand‘nearmisses’,includingreportingsuchevents.

6.2.4 Ifyouhavemanagementresponsibilities,makingsurethatsystemsareinplaceforraisingconcernsaboutriskstopatients.

6.2.5 Workinginyourpracticeandwithinsystemstoreduceerrorandimprovepatientsafety,andsupportingcolleagueswhoraiseconcernsaboutpatientsafety.

6.2.6 Takingallreasonablestepstoaddresstheissueifyouhavereasontothinkthatpatientsafetymaybecompromised.

6.3 Doctors’ performance — you and your colleagues

Thewelfareofpatientsmaybeputatriskifadoctorisperformingpoorly.Ifyouconsiderthereisarisk,goodmedicalpracticeinvolves:

6.3.1 Complyingwithanystatutoryreportingrequirements,includingthemandatoryreportingrequirementsundertheNationalLaw.8

6.3.2 Recognisingandtakingstepstominimisetherisksoffatigue,includingcomplyingwithrelevantStateandTerritoryoccupationalhealthandsafetylegislation.

6.3.3 Ifyouknoworsuspectthatyouhaveahealthconditionthatcouldadverselyaffectyourjudgmentorperformance,followingtheguidanceinSection9.2.

6.3.4 Takingstepstoprotectpatientsfromriskposedbyacolleague’sconduct,practiceorillhealth.

6.3.5 Takingappropriatestepstoassistyourcolleaguetoreceivehelpifyouhaveconcernsaboutacolleague’sperformanceorfitnesstopractise.

6.3.6 Ifyouarenotsurewhattodo,seekingadvicefromanexperiencedcolleague,youremployer,doctors’healthadvisoryservices,professionalindemnityinsurers,theMedicalBoardofAustraliaoraprofessionalorganisation.

7Part8Division2ss140–143,Health Practitioner Regulation National Law Act 2009(theNationalLaw)


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7 Maintaining professional performance

7.1 Introduction

Maintaininganddevelopingyourknowledge,skillsandprofessionalbehaviourarecoreaspectsofgoodmedicalpractice.Thisrequiresself-reflectionandparticipationinrelevantprofessionaldevelopment,practiceimprovementandperformance-appraisalprocesses,tocontinuallydevelopyourprofessionalcapabilities.Theseactivitiesmustcontinuethroughoutyourworkinglife,asscienceandtechnologydevelopandsocietychanges.

7.2 Continuing professional development

TheMedialBoardofAustraliahasestablishedregistrationstandardsthatsetouttherequirementsforcontinuingprofessionaldevelopmentandforrecencyofpracticeundertheNationalLaw.9

Developmentofyourknowledge,skillsandprofessionalbehaviourmustcontinuethroughoutyourworkinglife.Goodmedicalpracticeinvolves:

7.2.1 Keepingyourknowledgeandskillsuptodate.

7.2.2 Participatingregularlyinactivitiesthatmaintainandfurtherdevelopyourknowledge,skillsandperformance.

7.2.3 Ensuringthatyourpracticemeetsthestandardsthatwouldbereasonablyexpectedbythepublicandyourpeers.

7.2.4 RegularlyreviewingyourcontinuingmedicaleducationandcontinuingprofessionaldevelopmentactivitiestoensurethattheymeettherequirementsoftheMedicalBoardofAustralia.

7.2.5 Ensuringthatyourpersonalcontinuingprofessionaldevelopmentprogramincludesself-directedandpractice-basedlearning.

7Section38(1)(c)and(e)oftheNationalLawandregistrationstandardsissuedbytheMedicalBoardofAustralia.


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8 Professional behaviour

8.1 Introduction

Inprofessionallife,doctorsmustdisplayastandardofbehaviourthatwarrantsthetrustandrespectofthecommunity.Thisincludesobservingandpractisingtheprinciplesofethicalconduct.

TheguidancecontainedinthissectionemphasisesthecorequalitiesandcharacteristicsofgooddoctorsoutlinedinSection1.4.

8.2 Professional boundaries

Professionalboundariesareintegraltoagooddoctor–patientrelationship.Theypromotegoodcareforpatientsandprotectbothparties.Goodmedicalpracticeinvolves:

8.2.1 Maintainingprofessionalboundaries.

8.2.2 Neverusingyourprofessionalpositiontoestablishorpursueasexual,exploitativeorotherinappropriaterelationshipwithanybodyunderyourcare.Thisincludesthoseclosetothepatient,suchastheircarer,guardianorspouseortheparentofachildpatient.

8.2.3 Avoidingexpressingyourpersonalbeliefstoyourpatientsinwaysthatexploittheirvulnerabilityorthatarelikelytocausethemdistress.

8.3 Reporting obligations

DoctorshavestatutoryobligationsundertheNationalLawtoreportvariousproceedingsorfindingstotheMedicalBoardofAustralia.10Theyalsohaveprofessionalobligationstoreporttothemedicalboardandtheiremployeriftheyhavehadanylimitationsplacedontheirpractice.Goodmedicalpracticeinvolves:

8.3.1 Beingawareofthesereportingobligations.

8.3.2 Complyingwithanyreportingobligationsthatapplytoyourpractice.

8.3.3 Seekingadvicefromthemedicalboardoryourprofessionalindemnityinsurerifyouareunsureaboutyourobligations.

8.4 Medical records

Maintainingclearandaccuratemedicalrecordsisessentialforthecontinuinggoodcareofpatients.Goodmedicalpracticeinvolves:

8.4.1 Keepingaccurate,up-to-dateandlegiblerecordsthatreportrelevantdetailsofclinicalhistory,clinicalfindings,investigations,informationgiventopatients,medicationandothermanagement.

8.4.2 Ensuringthatyourmedicalrecordsareheldsecurelyandarenotsubjecttounauthorisedaccess.

8.4.3 Ensuringthatyourmedicalrecordsshowrespectforyourpatientsanddonotincludedemeaningorderogatoryremarks.

8.4.4 Ensuringthattherecordsaresufficienttofacilitatecontinuityofpatientcare.

8.4.5 Makingrecordsatthetimeoftheevents,orassoonaspossibleafterwards.

8.4.6 Recognisingpatients’righttoaccessinformationcontainedintheirmedicalrecordsandfacilitatingthataccess.

8.4.7 Promptlyfacilitatingthetransferofhealthinformationwhenrequestedbythepatient.

8.5 Insurance

Youhaveaprofessionalobligationtoensurethatyourpracticeisappropriatelycoveredbyprofessionalindemnityinsurance.YoumustmeettherequirementssetoutintheRegistrationStandardforProfessionalIndemnityInsuranceestablishedbytheMedicalBoardofAustraliaundertheNationalLaw.11

8.6 Advertising

Advertisementsformedicalservicescanbeusefulinprovidinginformationforpatients.Alladvertisementsmustconformtorelevantconsumerprotectionlegislation,theadvertisingprovisionsintheNationalLawandAdvertising GuidelinesissuedbytheMedicalBoardofAustralia.12Goodmedicalpracticeinvolves:

8.6.1 Makingsurethatanyinformationyoupublishaboutyourmedicalservicesisfactualandverifiable.

8.6.2 Makingonlyjustifiableclaimsaboutthequalityoroutcomesofyourservicesinanyinformationyouprovidetopatients.

8.6.3 Notguaranteeingcures,exploitingpatients’vulnerabilityorfearsabouttheirfuturehealth,orraisingunrealisticexpectations.

10Sections140–143oftheNationalLaw11Section38(1)(a)oftheNationalLawandtheregistrationstandardissuedbytheMedicalBoardofAustralia12Section133ofNationalLawandAdvertising Guidelines issuedbytheMedicalBoardofAustralia


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8.6.4 Notofferinginducementsorusingtestimonials.

8.6.5 Notmakingunfairorinaccuratecomparisonsbetweenyourservicesandthoseofcolleagues.

8.7 Medico-legal, insurance and other assessments

Whenyouarecontractedbyathirdpartytoprovideamedico-legal,insuranceorotherassessment13ofapersonwhoisnotyourpatient,theusualtherapeuticdoctor–patientrelationshipdoesnotexist.Inthissituation,goodmedicalpracticeinvolves:

8.7.1 Applyingthestandardsofprofessionalbehaviourdescribedinthiscodetotheassessment;inparticular,beingcourteous,alerttotheconcernsoftheperson,andensuringthatyouhavetheperson’sconsent.

8.7.2 Explainingtothepersonyourareaofmedicalpractice,yourrole,andthepurpose,natureandextentoftheassessmenttobeconducted.

8.7.3 Anticipatingandseekingtocorrectanymisunderstandingsthatthepersonmayhaveaboutthenatureandpurposeofyourassessmentandreport.

8.7.4 Providinganimpartialreport(seeSection8.8).

8.7.5 Recognisingthat,ifyoudiscoveranunrecognised,seriousmedicalproblemduringyourassessment,youhaveadutyofcaretoinformthepatientortheirtreatingdoctor.

8.8 Medical reports, certificates and giving evidence

Thecommunityplacesagreatdealoftrustindoctors.Consequently,doctorshavebeengiventheauthoritytosignavarietyofdocuments,suchasdeathcertificatesandsicknesscertificates,ontheassumptionthattheywillonlysignstatementsthattheyknow,orreasonablybelieve,tobetrue.Goodmedicalpracticeinvolves:

8.8.1 Beinghonestandnotmisleadingwhenwritingreportsandcertificates,andonlysigningdocumentsyoubelievetobeaccurate.

8.8.2 Takingreasonablestepstoverifythecontentbeforeyousignareportor

certificate,andnotomittingrelevantinformationdeliberately.

8.8.3 Preparingorsigningdocumentsandreportsifyouhaveagreedtodoso,withinareasonableandjustifiabletimeframe.

8.8.4 Makingclearthelimitsofyourknowledgeandnotgivingopinionbeyondthoselimitswhenprovidingevidence.

8.9 Curriculum vitae

Whenprovidingcurriculumvitae,goodmedicalpracticeinvolves:

8.9.1 Providingaccurate,truthfulandverifiableinformationaboutyourexperienceandyourmedicalqualifications.

8.9.2 Notmisrepresenting,bymisstatementoromission,yourexperience,qualificationsorposition.

8.10 Investigations

Doctorshaveresponsibilitiesandrightsrelatingtoanylegitimateinvestigationoftheirpracticeorthatofacolleague.Inmeetingtheseresponsibilities,itisadvisabletoseeklegaladviceoradvicefromyourprofessionalindemnityinsurer.Goodmedicalpracticeinvolves:

8.10.1 Cooperatingwithanylegitimateinquiryintothetreatmentofapatientandwithanycomplaintsprocedurethatappliestoyourwork.

8.10.2 Disclosing,toanyoneentitledtoaskforit,informationrelevanttoaninvestigationintoyourownoracolleague’sconduct,performanceorhealth.

8.10.3 Assistingthecoronerwhenaninquestorinquiryisheldintoapatient’sdeathbyrespondingtotheirenquiriesandbyofferingallrelevantinformation.

8.11 Conflicts of interest

Patientsrelyontheindependenceandtrustworthinessofdoctorsforanyadviceortreatmentoffered.Aconflictofinterestinmedicalpracticeariseswhenadoctor,entrustedwithactingintheinterestsofapatient,alsohasfinancial,professionalorpersonalinterests,orrelationshipswiththirdparties,whichmayaffecttheircareofthepatient.

Multipleinterestsarecommon.Theyrequireidentification,carefulconsideration,appropriatedisclosureandaccountability.Whentheseinterestscompromise,ormight

10SeeIndependent Medical Assessments on Behalf of Parties Other Than the Patient —1998(revised2002)(http://www.ama.com.au/node/510)


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reasonablybeperceivedbyanindependentobservertocompromise,thedoctor’sprimarydutytothepatient,doctorsmustrecogniseandresolvethisconflictinthebestinterestsofthepatient.


8.11.1 Recognisingpotentialconflictsofinterestthatmayariseinrelationtoinitiatingorcontinuingaprofessionalrelationshipwithapatient.

8.11.2 Actinginyourpatients’bestinterestswhenmakingreferralsandwhenprovidingorarrangingtreatmentorcare.

8.11.3 Informingpatientswhenyouhaveaninterestthatcouldaffect,orcouldbeperceivedtoaffect,patientcare.

8.11.4 Recognisingthatpharmaceuticalandothermedicalmarketinginfluencesdoctors,andbeingawareofwaysinwhichyourpracticemaybebeinginfluenced.

8.11.5 Recognisingpotentialconflictsofinterestinrelationtomedicaldevicesandappropriatelymanaginganyconflictthatarisesinyourpractice.

8.11.6 Notaskingfororacceptinganyinducement,giftorhospitalityofmorethantrivialvalue,fromcompaniesthatsellormarketdrugsorappliancesthatmayaffect,orbeseentoaffect,thewayyouprescribefor,treatorreferpatients.

8.11.7 Notaskingfororacceptingfeesformeetingsalesrepresentatives.

8.11.8 Notofferinginducementstocolleagues,orenteringintoarrangementsthatcouldbeperceivedtoprovideinducements.

8.11.9 Notallowinganyfinancialorcommercialinterestinahospital,otherhealthcareorganisation,orcompanyprovidinghealthcareservicesorproductstoadverselyaffectthewayinwhichyoutreatpatients.Whenyouoryourimmediatefamilyhavesuchaninterestandthatinterestcouldbeperceivedtoinfluencethecareyouprovide,youmustinformyourpatient.

8.12 Financial and commercial dealings

Doctorsmustbehonestandtransparentinfinancialarrangementswithpatients.Goodmedicalpracticeinvolves:

8.12.1 Notexploitingpatients’vulnerabilityorlackofmedicalknowledgewhenprovidingorrecommendingtreatmentorservices.

8.12.2 Notencouragingpatientstogive,lendorbequeathmoneyorgiftsthatwillbenefityoudirectlyorindirectly.

8.12.3 Avoidingfinancialinvolvement,suchasloansandinvestmentschemes,withpatients.

8.12.4 Notpressuringpatientsortheirfamiliestomakedonationstootherpeopleororganisations.

8.12.5 Beingtransparentinfinancialandcommercialmattersrelatingtoyourwork,includinginyourdealingswithemployers,insurersandotherorganisationsorindividuals.Inparticular:

• declaringanyrelevantandmaterialfinancialorcommercialinterestthatyouoryourfamilymighthaveinanyaspectofthepatient’scare

• declaringtoyourpatientsyourprofessionalandfinancialinterestinanyproductyoumightendorseorsellfromyourpractice,andnotmakinganunjustifiableprofitfromthesaleorendorsement.


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9 Ensuring doctors’ health

9.1 Introduction

Asadoctor,itisimportantforyoutomaintainyourownhealthandwellbeing.Thisincludesseekinganappropriatework–lifebalance.

9.2 Your health


9.2.1 Havingageneralpractitioner.

9.2.2 Seekingindependent,objectiveadvicewhenyouneedmedicalcare,andbeingawareoftherisksofself-diagnosisandself-treatment.

9.2.3 Makingsurethatyouareimmunisedagainstrelevantcommunicablediseases.

9.2.4 ConformingtothelegislationinyourStateorTerritoryinrelationtoself-prescribing.

9.2.5 Recognisingtheimpactoffatigueonyourhealthandyourabilitytocareforpatients,andendeavouringtoworksafehourswhereverpossible.

9.2.6 Beingawareofthedoctors’healthprograminyourStateorTerritoryifyouneedadviceonwheretoseekhelp.

9.2.7 Ifyouknoworsuspectthatyouhaveahealthconditionorimpairmentthatcouldadverselyaffectyourjudgment,performanceoryourpatient’shealth:

• notrelyingonyourownassessmentoftheriskyouposetopatients

• consultingyourdoctoraboutwhether,andinwhatways,youmayneedtomodifyyourpractice,andfollowingthedoctor’sadvice.

9.3 Other doctors’ health

Doctorshavearesponsibilitytoassistmedicalcolleaguestomaintaingoodhealth.AllhealthprofessionalshaveresponsibilitiesincertaincircumstancesformandatorynotificationundertheNationalLaw.14Goodmedicalpracticeinvolves:

9.3.1 Providingdoctorswhoareyourpatientswiththesamequalityofcareyouwouldprovidetootherpatients.

9.3.2 NotifyingtheMedicalBoardofAustraliaifyouaretreatingadoctorwhoseabilitytopractisemaybeimpairedandmaytherebybeplacingpatientsatrisk.Thisisalwaysaprofessional,andinsomejurisdictions,astatutory,responsibility.

9.3.3 Encouragingacolleague(whomyouarenottreating)toseekappropriatehelpifyoubelievetheymaybeillandimpaired.Ifyoubelievethisimpairmentisputtingpatientsatrisk,notifytheMedicalBoardofAustralia.Itmayalsobewisetoreportyourconcernstothedoctor’semployerandtoadoctors’healthprogram.

9.3.4 Recognisingtheimpactoffatigueonthehealthofcolleagues,includingthoseunderyoursupervision,andfacilitatingsafeworkinghourswhereverpossible.

14Sections140–143oftheNationalLawandMandatory Reporting GuidelinesissuedbytheMedicalBoardofAustralia.


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10 Teaching, supervising and assessing

10.1 Introduction

Teaching,supervisingandmentoringdoctorsandmedicalstudentsisimportantfortheirdevelopmentandforthecareofpatients.Itispartofgoodmedicalpracticetocontributetotheseactivitiesandprovidesupport,assessment,feedbackandsupervisionforcolleagues,doctorsintrainingandstudents.

10.2 Teaching and supervising


10.2.1 Seekingtodeveloptheskills,attitudesandpracticesofaneffectiveteacher,wheneveryouareinvolvedinteaching.

10.2.2 Makingsurethatanydoctorormedicalstudentforwhosesupervisionyouareresponsiblereceivesadequateoversightandfeedback.

10.3 Assessing colleagues

Assessingcolleaguesisanimportantpartofmakingsurethatthehigheststandardsofmedicalpracticeareachieved.Goodmedicalpracticeinvolves:

10.3.1 Beinghonest,objectiveandconstructivewhenassessingtheperformanceofcolleagues,includingstudents.Patientswillbeputatriskifyoudescribeascompetentsomeonewhoisnot.

10.3.2 Providingaccurateandjustifiableinformationwhengivingreferencesorwritingreportsaboutcolleagues.Dosopromptlyandincludeallrelevantinformation.

10.4 Medical students

Medicalstudentsarelearninghowbesttocareforpatients.Creatingopportunitiesforlearningimprovestheirclinicalpracticeandnurturesthefutureworkforce.Goodmedicalpracticeinvolves:

10.4.1 Treatingyourstudentswithrespectandpatience.

10.4.2 Makingthescopeofthestudent’sroleinpatientcarecleartothestudent,topatientsandtoothermembersofthehealthcareteam.

10.4.3 Informingyourpatientsabouttheinvolvementofmedicalstudents,andencouragingtheirconsentforstudentparticipationwhilerespectingtheirrighttochoosenottoconsent.


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11 Undertaking research

11.1 Introduction

Researchinvolvinghumans,theirtissuesamplesortheirhealthinformation,isvitalinimprovingthequalityofhealthcareandreducinguncertaintyforpatientsnowandinthefuture,andinimprovingthehealthofthepopulationasawhole.ResearchinAustraliaisgovernedbyguidelines15issuedinaccordancewiththeNational Health and Medical Research Council Act 1992.Ifyouundertakeresearch,youshouldfamiliariseyourselfwith,andfollow,theseguidelines.

ResearchinvolvinganimalsisgovernedbylegislationinStatesandTerritoriesandbyguidelinesissuedbytheNationalHealthandMedicalResearchCouncil(NHMRC).16

11.2 Research ethics

Beinginvolvedinthedesign,organisation,conductorreportingofhealthresearchinvolvinghumansbringsparticularresponsibilitiesfordoctors.Theseresponsibilities,drawnfromtheNHMRCguidelines,include:

11.2.1 Accordingtoparticipantstherespectandprotectionthatisduetothem.

11.2.2 Actingwithhonestyandintegrity.

11.2.3 Ensuringthatanyprotocolforhumanresearchhasbeenapprovedbyahumanresearchethicscommittee,inaccordancewiththeNational Statement on Ethical Conduct in Human Research.

11.2.4 Disclosingthesourcesandamountsoffundingforresearchtothehumanresearchethicscommittee.

11.2.5 Disclosinganypotentialoractualconflictsofinteresttothehumanresearchethicscommittee.

11.2.6 Ensuringthathumanparticipationisvoluntaryandbasedonanadequateunderstandingofsufficientinformationaboutthepurpose,methods,demands,risksandpotentialbenefitsoftheresearch.

11.2.7 Ensuringthatanydependentrelationshipbetweendoctorsandtheirpatientsistakenintoaccountintherecruitmentofpatientsasresearchparticipants.

11.2.8 Seekingadvicewhenresearchinvolveschildrenoradultswhoarenotabletogiveinformedconsent,toensurethatthereareappropriatesafeguardsinplace.Thisincludesensuringthatapersonempoweredtomakedecisionsonthepatient’sbehalfhasgiveninformedconsent,orthatthereisotherlawfulauthoritytoproceed.

11.2.9 Adheringtotheapprovedresearchprotocol.

11.2.10Monitoringtheprogressoftheresearchandpromptlyreportingadverseeventsorunexpectedoutcomes.

11.2.11Respectingtheentitlementofresearchparticipantstowithdrawfromanyresearchatanytimeandwithoutgivingreasons.

11.2.12Adheringtotheguidelinesregardingpublicationoffindings,authorshipandpeerreview.

11.2.13ReportingpossiblefraudormisconductinresearchasrequiredundertheAustralian Code for the Responsible Conduct of Research.

11.3 Treating doctors and research

Whenyouareinvolvedinresearchthatinvolvesyourpatients,goodmedicalpracticeincludes:

11.3.1 Respectingthepatients’righttowithdrawfromastudywithoutprejudicetotheirtreatment.

11.3.2 Ensuringthatapatient’sdecisionnottoparticipatedoesnotcompromisethedoctor–patientrelationshiportheircare.

15SeetheNational Statement on Ethical Conduct in Human Research(NHMRC2007;http://www.nhmrc.gov.au/publications/synopses/e72syn.htm)andtheAustralian Code for the Responsible Conduct of Research(NHMRC2007;http://www.nhmrc.gov.au/PUBLICATIONS/synopses/r39syn.htm)16SeetheAustralian Code of Practice for the Care and Use of Animals for Scientific Purposes,7thedition(NHMRC2004;http://www.nhmrc.gov.au/publications/synopses/ea16syn.htm)


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AcknowledgementsTheMedicalBoardofAustraliaacknowledgestheworkoftheAustralianMedicalCouncil(AMC)indevelopingthiscode.

Inthefirsteditionofthecode,theAustralianMedicalCouncilacknowledgedtheworkinggroupthatguidedthedevelopmentofthecode;thecontributionoftheorganisationsandindividualswhosethoughtfulfeedbackinformeditsdevelopment;thecontributionoftheAustralianGovernmentDepartmentofHealthandAgeingtotheextensiveconsultationprocessthatsupportedit;andStateandTerritorymedicalboardsthatendorsedit.

Indevelopingthiscode,theAMCconsideredanddrewonbothgeneralandspecificinformationaboutstandardsfromcodesofgoodmedicalpracticeissuedbyAustralianStateandTerritorymedicalboardsandtheAustralianMedicalAssociationCode of Ethics.TheprocesswasalsoinformedbysimilardocumentsissuedbytheGeneralMedicalCounciloftheUnitedKingdom,theMedicalCouncilofNewZealand,theNationalAllianceforPhysicianCompetenceintheUnitedStatesandtheRoyalCollegeofPhysiciansandSurgeonsinCanada.Inaddition,sectionsofthecodewereinformedbyrelevantguidelinesissuedbytheNationalHealthandMedicalResearchCouncilandbyguidelinesdevelopedbyspecialistmedicalcollegesinAustraliaandNewZealand.

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