Good Medical Practice (NZ)
Good Medical Practice (NZ)
Good Medical Practice (NZ)
MEDICAL
PRACTICE
Medical Council of New Zealand, December 2016
employer, or report your concerns to the Registrar of the Medical Telephone 0800 11 22 33 or email
2
enquiries@privacy.org.nz.
For more information, refer to
www.privacy.org.nz
Professionalism
Patients trust their doctors with their health and wellbeing, and
sometimes their lives. To justify your patients’ trust, follow the
principles outlined below and the duties outlined in the rest of
this document.
Respecting patients
Aim to establish a relationship of trust with each of your patients.
Be aware of cultural diversity, and function effectively and
respectfully when working with and treating people of different
cultural backgrounds.
Treat patients as individuals and respect their dignity by:
■■ treating them with respect
■■ respecting their right to confidentiality and privacy.
about their right to see another doctor. You must be satisfied the United Nations Convention
on Persons with Disabilities. This
that the patient has sufficient information to enable them to
convention is intended to protect
exercise that right. the rights and dignity of persons
with disabilities. The convention
21. Do not express your personal beliefs to your patients in ways includes provisions to ensure that
that exploit their vulnerability or that are likely to cause persons with disabilities receive
care appropriate to their needs,
them distress. and at the same standard as others.
Code.
Treating information as confidential17
Rule 10 (1)(d) of the Health
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22. Treat all information about patients as confidential and Information Privacy Code, allows
you to disclose information about
sensitive18. a patient in a limited range of
circumstances, including when
“disclosure [is] necessary to prevent
or lessen a serious and imminent
threat to public health or public
safety or the life and health of an
Supplementary guidance – individual.”
Sharing information in public
When sharing information in any public forum (including,
for example, chatting in a hospital cafeteria or posting to a
social networking site), do not disclose information about
yourself that might undermine your relationship with patients.
Similarly, do not disclose information that might identify and
cause distress to colleagues, patients or their families.
Supplementary guidance –
Sharing information with parents, caregivers
or next of kin
When working with patients under 16 years, you should
determine their competence to understand their condition
and make decisions about their treatment. If they are
competent, they are entitled to confidentiality. In the absence
of a concern that the young person is at risk of harm, you
should only share information with parents and caregivers
with the patient’s consent.
When working with adult patients who have an intellectual
disability or communication difficulties you should make a
judgement as to whether you are acting in the patient’s best
interests by sharing information with family or caregivers.
Whenever possible you should seek the permission of the
vulnerable adult to share information about their condition
and treatment with others.
When an adult patient has died, advise the patient’s partner
or next of kin, unless you know that the patient would have
objected. When a patient under 16 has died, explain to the
parents or caregivers to the best of your knowledge why and
how the patient died.
20
As outlined in the Privacy Act and
the Health Information Privacy Code.
21
As outlined in s.151 of the Crimes
Act 1961.
■■ y ou have determined that he or she has an adequate See the Council’s statement on
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consider and discuss the information with you; and and Disability Services Consumers’
Rights go to http://www.hdc.org.
■■ the patient has made an informed choice; and nz/the-act--code/the-code-of-rights
Advance directives
35. An advance directive is a formal document that clearly
and specifically outlines or describes the patient’s wishes.
Advance directives have legal standing in the Code of Health
and Disability Services Consumers’ Rights. There may be
exceptional circumstances in which it may not be appropriate
to comply with the wishes outlined in an advance directive28,
however you must always respect and consider those wishes.
If a patient has an advance directive that is relevant to their
care you should, where possible, confirm that it is consistent
with their current views before providing treatment.
Support persons
36. Patients have the right to have one or more support
persons of their choice present29, except where safety
may be compromised or another patient’s rights For example, where the patient
28
for example by arousing ill-founded fear for their future This right is outlined in Right 8 of
29
health or by fostering unrealistic expectations. The the Health and Disability Services
Consumers’ Rights.
information must conform to the requirements of the
Council’s Statement on advertising, the Fair Trading Act See the Council’s Statement on
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Management
43. You must always strive to work with managers and
administrators in a constructive manner to create and sustain
an environment that upholds good medical practice. If you are
working in a managerial or leadership role you should adhere
to the guidance contained in the Council’s statement on
Responsibilities of doctors in management and governance.
Being accessible
44. Be readily accessible when you are on duty. Depending on Colleagues are those you work
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the situation, this may mean you are accessible to patients, with, including doctors and other
health professionals.
or it may mean that you are accessible to colleagues or a
triage service. For more information, refer
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Medical certification.
hospitality that may affect, or be perceived to have the
capacity to affect, the way you prescribe for, treat or refer See also the Council’s statement
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patients. The same applies to offering such inducements. on Doctors and health related
commercial organisations.
■■ d
o not exploit patients’ vulnerability or lack of medical
knowledge when making charges for treatment or services
■■ d
o not encourage patients to give, lend or bequeath
money or gifts that will benefit you
■■ d
o not put pressure on patients or their families to
make donations to other people or organisations
■■ d
o not put inappropriate pressure on patients to accept
private treatment.
Conflicts of interest38
58. If you have a conflict of interest, you must be open about
the conflict, declaring your interest. You should also be
prepared to exclude yourself from related decision making.
that procedures are in place for raising and responding to on Responsibilities of doctors in
concerns. management and governance.
Raising concerns about patient safety40
62. Protect patients from risk of harm posed by a colleague’s
conduct, performance or health.
63. If a colleague behaves in a manner which is inappropriate
or unprofessional you should speak to them and raise your
concerns in a constructive manner.
64. If your colleague does not respond to your concerns and
continues to act inappropriately or unprofessionally, raise
your concerns with a manager, appropriate senior colleague
or the relevant external authority. Your comments about
colleagues must be made honestly and in good faith. If you
are not sure how to raise your concerns, ask an experienced
colleague for advice.
65. If a colleague is concerned about the conduct, competence
or health of another practitioner, or about a problem in the
workplace, you should treat their concerns with respect
and support them in taking action to address the concerns
and in notifying the relevant authorities. You may need to
provide less experienced colleagues with additional support
to ensure that they have the confidence to raise concerns.
66. If you have reasonable grounds to believe that patients are,
or may be, at risk of harm for any reason, do your best to
find out the facts. Then you should follow your employer’s
procedures or policies, or tell an appropriate person or
organisation straight away. Do not delay taking action because
you yourself are not in a position to put the matter right.
67. Under the Health Practitioners Competence Assurance Act
2003 you must tell the Council if you have reason to believe
that a doctor’s ill-health is adversely affecting patient care.
68. You should also tell the Council about:
■■ c oncerns you have that another doctor is not fit to practise
or is not providing an appropriate standard of care
■■ b
ehaviour by another doctor that risks causing harm
to patients.
69. If a colleague raises concerns about your practice, you
should respond constructively.
Your health
71. You should register with an independent general practitioner
so that you have access to objective medical care. You
should not treat yourself41.
72. Protect your patients, your colleagues and yourself by:
■■ f ollowing standard precautions and infection control
practices
■■ undergoing appropriate screening
■■ b
eing immunised against common serious
communicable diseases where vaccines are available.
73. You must tell the Council’s Health Committee if you have
a condition that may affect your practice, judgement or
performance. The Committee will help you decide how to
change your practice if needed. You should not rely on your
own assessment of the risk you may pose to patients42.
74. If you think you have a condition that you could pass on to
patients, you must consult a suitably qualified colleague. Ask
for and follow their advice about investigations, treatment
and changes to your practice that they consider necessary.
Supporting colleagues
78. You should support colleagues who have problems with
performance, conduct or health.
Accepting the
obligation to
maintain and
improve standards
Principles
Act in accordance with relevant standards.
Keep your professional knowledge and skills up to date
Recognise, and work within, the limits of your competence.
e committed to autonomous maintenance and improvement
B
in your clinical standards.
emonstrate reflectiveness, personal awareness, the ability to
D
seek and respond constructively to feedback and the willingness
to share your knowledge and to learn from others.
ccept a responsibility for maintaining the standards of the
A
profession.
on Continuing professional
development and recertification
Keeping up to date
83. Keep your knowledge and skills up to date throughout your
working life:
■■ f amiliarise yourself with relevant guidelines and
developments that affect your work
■■ t ake part regularly in professional development
activities that maintain and further develop your
competence and performance
■■ a dhere to and keep up to date with all laws and codes
of practice relevant to your work.
Definitions
Clinical practice and non-clinical practice
Fitness to practise
Practice of medicine
Administrative practice
Non-treating doctors performing medical assessments of patients
for third parties
Raising concerns about a colleague
Responsibilities of doctors in management and governance
Safe practice in an environment of resource limitation
General subjects
Advertising
Complementary and alternative medicine
Cosmetic procedures
Disclosure of harm following an adverse event
A doctor’s duty to help in a medical emergency
Ending a doctor-patient relationship
Good prescribing practice
Information, choice of treatment and informed consent
The maintenance and retention of patient records
Medical certification For the most recent versions of the
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statements, go to www.mcnz.org.nz
Doctors and health related commercial organisations under the heading News and
Publications. New and updated
Use of the internet and electronic communication statements are sent to all doctors
with the Council’s newsletter.
Telehealth
When another person is present during a consultation
Sexual boundaries in the doctor-patient relationship, a resource
for doctors
Health
HRANZ Joint guidelines for registered health care workers on
transmissible major viral infections
Providing care to yourself and those close to you
Cultural competence
Best practices when providing care to Māori patients and their
whānau
Cultural competence