PCM - Lecture 6 PDF

Level 1 - Semester 1 PCM LECTURE (6) PHYSICIAN DUTIES AND RIGHTS DR ZIAD MAHANA  ‫‪PCM‬‬ ‫‪LECTURE - 3‬‬ ‫‪0‬‬...

Level 1 - Semester 1 PCM LECTURE (6) PHYSICIAN DUTIES AND RIGHTS DR ZIAD MAHANA  ‫‪PCM‬‬ ‫‪LECTURE - 3‬‬ ‫‪0‬‬ ‫‪Doctor's‬‬ ‫‪Duties‬‬ ‫❖ يجب على كل طبيب قبل مزاولته المهنة أن يؤدى القسم التالي أمام نقيب األطباء أو من ينوب عنه‪:‬‬ ‫))اقسم باهلل العظيم أن أراقب هللا في مهنتي‪ ،‬وأن أصـــون حـيــاة اإلنسان في كافة أدوارها فى كل الظروف‬ ‫واألحوال باذال وسعى في استنقاذها من الهالك والمرض واأللم والقلق‪ ،‬وأن احفظ للناس كرامتهم واستر‬ ‫عورتهم واكتم سرهم‪ ،‬وان أكون على الدوام من وسائل رحمة هللا باذال رعايتي الطبية للقريب والبعيد‪،‬‬ ‫للصالح والخاطئ والصديق ‪،‬والعدو‪ ،‬وان أثابر على طلب العلم أسخره لنفع اإلنسان ال آلذاه‪ ،‬وان أوقر من‬ ‫علمني واعلـم مــن يصغرني‪ ،‬وأكون أخا لكل زميل فى المهنة الطبية متعاونين على البر والتقوى‪ ،‬وان‬ ‫تكون حياتى مصداق إيمـانـي فــي ســـرى وعالنيتي نقية مما يشينها تجاه هللا ورسله والمؤمنين‪ ،‬وهللا على‬ ‫ما أقول شهيد((‬ ‫‪1) Permission to practice the profession‬‬ ‫‪‬‬ ‫‪Obtain‬‬ ‫‪2) The registration number from SMC (State Medical Council) represented in‬‬ ‫‪Egyptian medical syndicate in Egypt.‬‬ ‫‪ The registration number in:‬‬ ‫‪‬‬ ‫‪Display‬‬ ‫& ‪▪ His clinic‬‬ ‫‪▪ All his prescriptions - certificates - money receipts given to his patients‬‬ ‫‪Dr. Ziad Mahana‬‬ ‫‪1‬‬  PCM LECTURE - 6 ▪ Births and deaths 1) NOTIFICATION OF ▪ Notifiable diseases to the appropriate authorities COMPULSORY ▪ Cases of poisoning DUTIES 2) REPORTING OF ▪ Suspected causes of death ▪ Cases covered under the privileged communication 3) RESPONDING TO ▪ Call for emergency & military services ▪ And to continue to treat & 1) TREAT ▪ Maintain the professional secrets of the patients ▪ Consent of the patients for medical examination 2) OBTAIN ▪ Informed consent before any procedure ▪ Medical ▪ Fitness 3) ISSUE ▪ Death Certificates VOLUNTARY ▪ Vaccination DUTIES ▪ Disabilities ▪ Postmortem examination as per the requirement and 4) CONDUCT request from appropriate authority ▪ Medico-legal examination ▪ Cases of accidents 5) ATTEND ▪ Medical emergencies 6) INSPECT PRISONS Dr. Ziad Mahana 2  PCM LECTURE - 6  WHEN? → It begins the moment the physician-patient relationship is established… IN THERAPEUTIC RELATIONSHIP Starts when the physician agrees to treat the patient The Physician has to comply with the directive of the party IN FORMAL RELATIONSHIP demanding such examination.  DUTIES OF A PHYSICIAN TOWARDS PATIENTS INCLUDE... ① ▪ Exercise reasonable degree of skills and knowledge (competent) ② ▪ Attendance and examination ③ ▪ Prescribe proper, suitable, and approved medicines. ④ ▪ Control and warn ⑤ ▪ Instructions ⑥ ▪ Sufficient information ⑦ ▪ Third parties ⑧ ▪ Consent ⑨ ▪ Investigations ⑩ ▪ Emergency cases ⑪ ▪ Operations ⑫ ▪ Professional secrecy/confidentiality - Maintaining the medical records ⑬ ▪ Prognosis Dr. Ziad Mahana 3  PCM LECTURE - 6 ❶  He owes this duty even when the patient is treated free of charge.  He should not guarantee cure or an assured improvement. ❷  ACCORDING TO THE SITUATION: IF THE DOCTOR IS CALLED BY POLICE TO ATTEND A CASE OF THE DOCTOR AGREES TO ATTEND A PATIENT ROADSIDE ACCIDENT DOCTOR – PATIENT RELATIONSHIP Established Not stablished ROLE OF DOCTOR IN THIS SITUATION He is under an obligation to attend to the case May give first aid & advice “As long it requires attention” ❸  He is RESPONSIBLE for any temporal or permanent damage caused by wrong prescription.  Physicians should prescribe drugs with generic names. ❹  Doctor should WARN patients of the side-effects of prescribed drug  Otherwise it can be considered as PART OF NEGLIGENCE. ❺  DOCTOR SHOULD GIVE FULL INSTRUCTIONS: ① His patients. FOR WHOM ② or their attendants. Especially children & mentally disabled need this arrangement of care ① Use of medicines (Quantities & Timings) REGARDING ② Diet. Dr. Ziad Mahana 4  PCM LECTURE - 6 ❻  The physician should: 1) Provide the patient with sufficient information about his medical condition 2) Give the patient the opportunity to discuss the benefits, risks, and costs of appropriate treatment alternatives.  The patient or his relatives (AFTER PATIENT PERMISSION) should have such knowledge of the patient's condition as well as the prognosis. ❼  If a patient suffers from an infectious disease...  The doctor should warn both patient & the third parties “who are close to the patient” ❽ OBTAINED FROM ▪ A mentally sound Adult. WHOM? ▪ Aged: > 18 years in Egypt ▪ Patient must be told of all the relevant facts: BEFORE OBTAINING - in non-medical terms. Then obtain consent THE CONSENT - in a language the patient understands. ORAL CONSENT WRITTEN INFORMED CONSENT ▪ Sufficient for ▪ Needed for TYPES ① Medical examination. ① Interventions. ② Non-invasive investigations. ② Operations.  A patient who has decision making capacity may accept or refuse any recommended medical intervention. Dr. Ziad Mahana 5  PCM LECTURE - 6 ❾  The doctor should advise investigations recommended by guidelines according to each case... ① For proper diagnosis. IMPORTANCE ② & To know the progress. ⎚ Biopsy, X-rays, etc… EXAMPLES Wrong interpretation of X-ray is liable to be held as NEGLIGENT ❿  In such cases, a doctor is OBLIGED to give medical aid & to save life of the EMERGENCY CASES patient.  If the physician discontinues patient treatment for any reason the patient has IN NON-EMERGENT the right to obtain sufficient notice & reasonable assistance in making CASES alternative arrangements for care. ⓫ ⎚ Doctor should BEFORE THE ① Explain the nature & extent of operation. OPERATION ② Take written informed consent of patient. ⎚ Doctor should ① Take proper care to avoid mistakes. DURING THE **Examples of these mistakes OPERATION - Operating on the wrong patient or on wrong limb - Leave any instrument or swab inside a body cavity. ② Seek for the assistance of qualified & experienced anesthetists. Dr. Ziad Mahana 6  PCM LECTURE - 6 ⓬  The doctor is OBLIGED to maintain the patient secrets & related information as well as records Who is mentally intact & aged >18 years When to release them? ▪ Not release them without the patient consent even to the patient family. ▪ EXCEPT in certain conditions e.g., ‫األمثلة إضافة للفهم‬ THE PATIENT ⎚ In children & disabled. FOR SAKE OF THE COMMUNITY ⎚ In infectious disease & criminal cases. THE PHYSICIAN HIMSELF ⎚ When he accused by malpractice. Maintaining the medical records RETENTION  The physician should maintain the medical records of his indoor patient GUIDELINES period of 3 years from the date of commencement of the treatment.  WHEN? → Done On request. ACCESS TO THIS  BY WHOM? → Either by the patients① or legal authorities② RECORDS The same should be issued within a period of 72 hours. ⓭  The patient or his relatives patient's should have such knowledge condition as will serve the best interests of the patient and the family. Dr. Ziad Mahana 7  PCM LECTURE - 6  The patient has the right to obtain a 2nd opinion or choose someone else to provide a consultation or service.  Consultation for the patient’s benefit is of foremost importance.  Unnecessary consultations should be avoided. Attending physician vs consultant THE ROLE OF ATTENDING PHYSICIAN ‫الطبيب ال ُمعالِج‬ THE ROLE OF CONSULTANT ⎚ REGARDING THE TREATMENT AFTER CONSULTATION  Any treatment variations after consultations:  Could only prescribe ▪ He should be informed by them. ▪ In case of emergency. ▪ & He is responsible for prescribing them. ▪ Or as an expert when called for. ⎚ WHEN PATIENTS REFERRED TO SPECIALISTS BY THE ATTENDING PHYSICIAN  Should give the specialist a case summary of the  Should communicate his opinion in patient. writing to the attending physician. Consultation is advised with a specialist in the following conditions: ① In case of emergency. ② If the patient requests consultation. ③ In cases where diagnosis remains obscure. ④ In connection with organ transplantation. ⑤ When treatment or operation involves risk of life. ⑥ When an operation involves mutilation or destruction of an unborn child.  To take decision about termination of pregnancy case in therapeutic abortion for saving mother life, after 12 weeks and up to 20 weeks of pregnancy. Dr. Ziad Mahana 8  PCM LECTURE - 6 ❶ No insincerity, rivalry, or envy. ❷ All due respect should be observed towards the physician in-charge of the case  No statement or remark be made → which would impair the confidence the patient has reposed in him. ❸ Consultant not to take charge: As consultant should normally not take charge of the case. ❹ Appointment of substitute:  A physician should accept to attend another physician's patients during his temporary absence from his practice. Dr. Ziad Mahana 9  PCM LECTURE - 6 0 Doctor's rights 1) The workplace environment rights: WORK ENVIRONMENT OF ❶ Should be Safe – Healthy – Supportive. THE PHYSICIANS  Which allows doctors to: ① Voice their opinions. ❷ FREEDOM OF EXPRESSION ② & to join or form professional organizations - unions - networks PROFESSIONAL  Which enables doctors to: Maintain and improve their ❸ DEVELOPMENT AND EDUCATION knowledge & skills.  Which guarantees that doctors: LEGAL PROTECTION AND ❹ ① Have access to legal advice. REPRESENTATION ② Have assistance in case of complaints. 2) The physicians have right to refuse: ① To perform certain procedures or treatments that violate their moral, religious, or ethical beliefs. ② To accept patients unless it is an emergency or a humanitarian situation. 3) The physicians’ economic rights & advertisement rights: ❶ FAIR REMUNERATION  Which ensures that physicians are paid adequately. SET THEIR OWN FEES  As long as they are Reasonable① - Transparent② - Consistent③ ❷ FOR THEIR SERVICES with the standards of their profession.  Include information in their advertisement about their: ▪ Qualifications. ▪ Fees. ❸ ADVERTISEMENT ▪ Experience. ▪ Location. ▪ Services. ▪ Contact details. Dr. Ziad Mahana 10  PCM LECTURE - 6 4) Patients’ duties towards his physician: ① Helping health care workers in:  To be truthful & to give all required history information to their health care DIAGNOSIS providers. TREATMENT  To cooperate with agreed-on treatment plans. FOLLOW UP  Follow the instructions of their health care providers. TEACHING  To accept care from medical students, residents, & other trainees… PROCESS  Under appropriate effective supervision in educational health institutes. ② To be aware of behavior that unreasonably places the health of others at risk as infection control instructions. ③ To report illegal or unethical behavior by health care professionals to the appropriate authorities. Dr. Ziad Mahana 11