Professionalism in practice

IT almost goes without saying that doctors must behave in a professional manner. But ask any random group of clinicians what “being professional” means and you will likely receive a wide range of opinions. Views can be influenced by many factors, such as the point they are at in their career, their specialty, whether or not they have an educational or training role, and whether they work as an independent contractor or are employed.

In the 20 years I’ve worked at MDDUS I have noticed a considerable evolution in the expectations of doctors (in both their professional and personal lives), regulators and patients.

Some of this is related to societal change. Patients nowadays have access to far more information, while a shift to more autonomous decision-making means they are more likely to challenge doctors.

Also at play are eroding levels of self-regulation, brought about by factors such as the introduction of extended clinical teams and tighter organisational/budgetary controls. Closer government direction or rationing also creates a dilemma for doctors who try to provide the best patient care while managing finite resources.

Even in the most difficult circumstances, NHS Health Education England’s expectation is that: “Professionalism is how a doctor should look and behave even when faced with challenges, such as insufficient time with patients.”

Acceleration of the IT infrastructure, use of artificial intelligence and remote monitoring tools are changing the way that doctors practise with the potential for less (visible) continuity and greater distance between patient and doctor. Social media also plays a greater part in doctors’ personal and professional lives – whether they actively engage or not. If you have a publicly accessible personal social media profile, I’d be surprised if you have never been approached in this way by a patient.

In their work with Oxford University in 2018, the Royal College of Physicians (RCP) London concluded: “What is clear, is that the constant evolution of medicine requires a revision of our understanding of professionalism, so that it is not undermined by intercurrent events. With the changes in the way healthcare is delivered, and doctors are perceived, we need to update what we understand by the term professionalism.”

All of this means doctors must regularly review the way in which they practise ‘professionalism’, not only to stay up to date with the latest regulatory guidance, but also to remain in tune with the prevailing expectations of society. This is all in a context where, according to the GMC, “many doctors feel that the current environment is the most challenging of their careers”.

Exploring professionalism

In our RCP-accredited online member courses on professionalism, we explore these challenges in three parts:

• the responsibilities of a doctor when things go wrong
• the expectations set out on personal conduct
• maintaining professional boundaries with patients and colleagues.

Firstly, as professionals, doctors have a duty to raise concerns about patient care, even if this may be difficult. This may relate to a clinical task/responsibility and perhaps also to a colleague’s mental/physical health or behaviour. Doing the right thing is not always easy.

In the event of a patient safety incident, a doctor’s professional duty of candour requires that responsibility is accepted, lessons are learned and that patients are informed/supported. As a hospital doctor, particularly in the event of more serious incidents, you will likely have to engage fully to support your employer in meeting contractual or organisational requirements in relation to the statutory duty of candour. In these circumstances, it is important to seek advice from MDDUS to mitigate any personal or regulatory risk.

Secondly, doctors must not forget their professional duties relating to personal conduct. There are instances outside the workplace where doctors are required to self-report to the GMC in line with paragraph 75 of the regulator's core guidance Good medical practice. It states that you must tell the GMC without delay if, anywhere in the world:

a. you have accepted a caution from the police or been criticised by an official inquiry

b. you have been charged with or found guilty of a criminal offence

c. another professional body has made a finding against your registration as a result of fitness to practise procedures.

There are pitfalls for doctors in relation to personal or professional use of social media, maintaining patient boundaries, and also when discussing personal beliefs.

Other sources of complaint relate to patients feeling uncomfortable during intimate examinations, while accepting patient gifts is also fraught with difficulty.

Leader’s role

For those reading this in a leadership role, you have an additional responsibility to create conditions within which doctors and other members of the team are supported to behave professionally. In my experience, barriers to professional behaviour include:

• professional isolation
• challenging team and organisational cultures, leading to diminished resilience
• fear of raising concerns
• a discomfort about reflective practice.

By offering access to online courses on these topics for members we can remove another of the biggest barriers to meeting regulatory professional standards: lack of awareness.

If you would like further advice or guidance on any medico-legal or ethical issues arising from your clinical practice, contact our advisory team on advice@mddus.com

Liz Price is senior risk adviser at MDDUS