Professionalism: Honesty, Trust, Disclosure

• Workshop focuses on Professionalism, Honesty, Trust, and Open Disclosure, tailored for MyProfessionalism Year 2 DEM.
• Learners will define honesty, candor, discuss advocacy, learn from public inquiries like the CervicalCheck Scandal, and apply knowledge to clinical scenarios.

Key Insights

• Half-truths are equivalent to whole lies, according to a Yiddish proverb.

Workshop Plan Outline

• Initial Honesty Exercise
• Definition of Honesty, Trust, and Open Disclosure
• Reflection: Understanding What, So What, and Now What followed by Group Work
• Group scenario work focusing on Honesty, Trust, and Open Disclosure
• Discussion on Lessons Learned

The Boy Who Cried Wolf

• The fable illustrates how repeated dishonesty erodes trust, leading to disbelief even when one tells the truth

Honesty Self-Assessment

• The General Trust Scale, developed in 1994 by Yamagashi and Yamagishi, assesses general trust levels
• It rates agreement with statements about the honesty and trustworthiness of people
• Responses are averaged to gauge belief in the honesty and trustworthiness of others

Medical Professionalism at RCSI

• Focuses on values, behaviors, and attitudes promoting professional relationships, public trust, and patient safety
• Patient-centered care and self-care are essential in professional practice

American Board Internal Medicine Foundation's Physician Charter:

• The primacy of patient welfare is achieved by focusing on altruism, trust and patient-interest
• Patient autonomy requires honesty, patient education and empowerment in medical decisions
• Social justice involves considering resource availability and the needs of all patients

Royal College of Physicians (UK) Definition

• Professionalism signifies values, behaviors, and relationships underpinning public trust in doctors
• The six commitments includes integrity, compassion, altruism, continuous improvement, excellence and partnership

Professionalism (IMC)

• At the core of the patient-doctor relationship, therefore is fundamental in patient safety and quality of care
• Based on shared profession-public understanding of principles and values underpinning good care
• It sits on three pillars: partnership, practice and performance

Medical Council of Ireland (IMC)

• Protects the public by ensuring high standards of doctor education, training, conduct, and competence
• Doctors hold a privileged position of trust
• To maintain trust, one must demonstrate professional application of required skills, knowledge, and adherence to high standards.

Good Medical Practice (IMC)

• Ensures patient safety and quality of care by focusing on, professionalism, clinical skills, patient relations, communication, teamwork, management and scholarship.

Professionalism & Trust (IMC)

• Professionals need to maintain doctor-patient boundaries
• Patients will trust medical professional will give care, advice, not personal advantage
• Must not form a sexual or improper relationship with a patient or associate

Professionalism and Communication (IMC)

• Public trust relies on consistent application of professional standards and ethical principles including patient confidentiality, privacy and respect
• Public communications bring significant benefits, however pose risks and ethical challenges
• Public should be able to trust what a doctor says, so one must consider the impact on everyone before speaking

Online Communication (IMC)

• The World Wide Web changed the way people personally and professionally communicate since 1989
• It connects the world, aiding information, share and communicate

Risks of Online Communication for Doctors

• Unprofessionalism
• Misinformation
• Confidentiality
• Privacy

Confidentiality

• Fundamental with general principles and is required in doctor-patient relationships
• Doctor must maintain patient confidentiality for trust
• This duty allows providing appropriate medical care.

Open Disclosure (IMC)

• Open disclosure requires honest compassionate communication with patients, families, or supporters after safety incidents.
• Part of this includes acknowledging what has happened, expressing regret, providing reassurance and preventing recurrence

Raising Concerns (IMC)

• Reporting on patient safety or compromised care in organizations and systems by colleagues, policies and procedures is required
• Concerns not resolved within the organization should raise the issue with the relevant regulatory authority or through the applicable notification or disclosure pathways

Patient-Centred Care

• Giving respectful and individual preferences to patients, needs, values is the foundation for care
• One must patient values guide clinical decisions
• Requires professionalism with good communication and social caring
• This level of care is excellent for the patients

Public Trust (IMC)

• It's the key to good professional practice
• Trust between doctors and patients, colleagues, and the profession and society
• Relies on integrity and honesty of doctors in all areas of their medical practice

Characteristics of Doctor

• Has integrity and honesty
• Respects patients confidentiality and privacy
• Acts in a reliable way and responsible, fairly and without prejudice

Integrity

• Is an unimpaired moral state
• Freedom from moral corruption
• Requires innocence, sinlessness
• “Integrity, is doing the right thing even when no-one is watching”

Accountability

• Means one is generally answering to patients, colleagues, and society
• Professionalism, and it combines integrity
• All are required to ensure trust

Candour and Honesty

• Candour is the quality of being open and honest
• Healthcare requires professional duty and be with a patient, causes/potential, harm or distress
• Doctor must tell the patient when something has gone wrong, apologising, supporting, and explaining the side effects

Advocacy

• Promotes communication, security, representation and human rights, but is not limited to health and service staff
• Requires supporting, their interests and empowering, placing the person at any decision-making

Raising Concerns

• All doctors have ethical obligation
• It is important to inform an authority that patients are being harmed, or could be harmed
• Start with clinical or medical director and escalate further

Protection of Children and Vulnerable

• Need reasonable grounds for possible risk
• Always be aware and comply with guidelines with action
• Reporting in some situations is a justifiable breach

Whistleblowing / Protected Disclosure

• This is ok when health act is being abused and the patients life is in trouble
• You must have a medical reason
• When there is a potential misuse or bad conduct
• Is only destroyed the doctors, and it is for what the doctor raises for

Raising Concerns Policy

• Ok the risk is malpractice and you can act on an concern, some issues are : unsafe, working issues, training, incident, suspicious abuse on a victim .

Entrustable Professional Activities (EPA)

• Professionalism
• Commitment and responsibility can help with ethical
• Respect, privacy and care

Incidents and Events

• There is a circumstance of unnecessary harm
• Can be from user complaints
• Adverse can be from human error

Medical professional are still human!

• In the US, 98000 death per year!
• All people can be reckless and dangerous but it must me safer !

The Michigan heal system

• The model of good, patient safety, can help us get in touch with bad results
• This can help and the data can be fixed

Can i change, do better or be fixed ?

• If a mistake or issue happened let that be the way to perfection !
• To not follow is unforgivable

The stafford hospital

• Issues came u= from long mortality and poor rates
• Is when the doctors are bad and have the right reasons
• The best approach is the statutory of candor

Duty of candor (UK)

• Doctor must use the best
• Understand the issue how its impacted people and patient
• Get feedback from patient and families

Open Door on Check up

• This test had no abnormalities, however she was diagnosed and they review and didn’t tell the other group with different problems that she had that problem
• That can cause so many injuries
• Don’t shut the door

Study

• Can help with preventable actions
• Adverse actions caused the mortality rate and harm

HSE

• The open policy is so important
• Patient should be honesty

Patient incident Safety

(a)The patient should not be harmed again (b Patient would understand what's wrong C) patient safety is all

Process open door policy

• Being with staff
• Communication
• Being empathetic
• Quality and hearing staff

ASSIST

• It’s the process of acknowledgement and being respectful
• Having staff that you can work with communication
• Listening and following directions

Support

• All parties know what could happen so that a member of staff can be able to support

Pending

• That is a bill that would hold the patients to more safety protocols

• That is to tell every doctor to use

It takes self time :

• Is all about that now, what is good, what can we do with that can’t be ok that happens!

• The context what can we do ? how do we go about and follow the right person!

So what

• I have people to help with !

Is this the end of today ?

• This needs to be that way of what do we think in the future that everyone is ok ,

Feedback

• All areas needs to be addressed
• What can we do ? how can we make the person feel or have the team make the client feel/what needs to process that works

Communication

• How can we relate
• What’s important
• And team work

Finally

• Trust but verify that all parties are ok