In recent years there has been increasing publicity about errors and malpractice of doctors, both hospital doctors and general practitioners (GPs). Although the medical profession in the UK is usually self- regulated, there have been fears that unless the GMC responds to growing public fears, then self regulation of doctors may not be sustainable for too much longer.
The GMC holds the medical register, which list those doctors (this includes surgeons) who are qualified to practice in the UK, and the specialist register, which gives details of doctors’ specialist training (doctors must be included in this to hold consultant posts in the NHS).
Good Medical Practice, released in booklets, by the GMC in 1995 under the general heading of Duties of a Doctor signaled a revolution in the regulation of British medical practice through setting out “the standards of competence, care and conduct set by the GMC”; in effect, a benchmark of best quality medical care, against which the performance of a doctor can be judged. Medical doctors will be expected to work within the ethical regulatory framework of ‘Good Medical Practice’.
GMC guidance has developed over many years in response to a range of factors including advances in medical technology, changes in legislation and a progressive shift in societal norms towards a greater emphasis on individual autonomy. In its revision of ‘Good Medical Practice’ (GMP) in 2006 the GMC noted that the main cultural change since its previous publication in 1995 was ‘an increased expectation of patients and public involvement in both individual and organisational decisions in health care’ (GMC invitation to tender 2008). The guidance was therefore revised to focus on a doctor’s obligation to work in partnership with patients.
The General Medical Council (GMC) holds the central registers of doctors’ qualifications. The medical register shows who is properly qualified to practice medicine. The specialist register shows doctors who have completed specialist training, including surgical training. Doctors must be included in this to hold consultant posts in the NHS.
Many NHS hospitals also have Patient Advice and Liaison Services (PALS), which can offer advice on what to do if you want to make a complaint. Some areas also have Community Health Councils, which can advise how to make a complaint. The regulatory body for doctors, The General Medical Council (GMC), deals with professional complaints concerning medical doctors and surgeons.
A 2009 study by the University of Warwick on titled – Non UK qualified doctors and Good Medical Practice: The experience of working within a different professional – the findings were quite shocking: “Many Non UK qualified doctors find a distinct difference in the ethical framework in which health care is practiced in the UK compared to their country of qualification. The main contrast is in the model of doctor patient relationship. The emphasis on individual autonomy and patients’ rights in the UK and the degree to which this is articulated and regulated in formal legal, ethical and institutional policies. The concepts of individual autonomy, duty of confidentiality, and informed consent to treatment are recognised as important by all doctors but the level of importance given to them in the UK was a surprise to many Non UK qualified doctors.”
The GMC, in addition to setting and monitoring professional standards, has a role in educating and supporting doctors to ensure that they understand and incorporate the principles of GMP into their working lives.
As a doctor registered with the GMC, you should provide a good level of care to your patients.
“All doctors who work in the UK are required to be registered with the General Medical Council (GMC) and to comply with the standards of good practice set out in the core GMC guidance ‘Good Medical Practice’ (GMP). These professional standards are the benchmark against which decisions about a doctor’s fitness to practice are taken. A lack of awareness or understanding of these standards on the part of a doctor may have adverse consequences for the doctor (he or she may lose their registration) but it may also mean that patients receive care that is below the standard that they can and should expect.”
It is your responsibility to be aware of the GMC’s Doctors’ Rule Book. Good medical practice is essential reading for every doctor, and awareness of good medical practice, agreement with Duties of a Doctor, is vital to your chances of success at interview. It will give you the answer to every ethical question they throw at you.
“It is health that is real wealth and not pieces of gold and silver.” Gandhi
“The health of a society is truly measured by the quality of its concern and care for the health of its members… The right of every individual to adequate health care flows from the sanctity of human life and that dignity belongs to all human beings… We believe that health is a fundamental human right which has as its prerequisites social justice and equality and that it should be equally available and accessible to all.”
The duties of a doctor are a series of 14 statements set around 7 broad values. Ultimately, you should recognise that you are personally accountable for your practice, and you must be always prepared to justify your decisions and actions.
Extract taken from Good Medical Practice: The Duties of a doctor by the GMC puts this in a lucid manner as:
“Patients must be able to trust doctors with their lives and wellbeing. To justify that trust, we as a profession have a duty to maintain a good standard of practice and care and to show respect for human life.
In particular as a doctor you must:
- Make the care of your patient your ﬁrst concern
- Treat every patient politely and considerately
- Respect patients’ dignity and privacy
- Listen to patients and respect their views
- Give patients information in a way they can understand
- Respect the rights of patients to be fully involved in decisions about their care
- Keep your professional knowledge and skills up to date
- Recognise the limits of your professional competence
- Make sure that your personal beliefs do not prejudice your patients’ care
- Respect and protect confidential information
- Be honest and trustworthy
- Act quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be ﬁt to practice
- Avoid abusing your position as a doctor
- Work with colleagues in ways that best serve patients’ interests
In all these matters you must never discriminate unfairly against your patients or colleagues. And you must always be prepared to justify your actions to them.”
Many doctors working in the UK are aware of Good Medical Practice and the performance procedures, and are in broad sympathy with Duties of a Doctor.
As we go through the statements, think about difficult scenarios you might have encountered or they might throw at you.
- How would you respond?
- How could you demonstrate you would take responsibility for your actions?
- Do you admit it when you made a mistake or do you try to hide it?
- Do you offer an apology?
You do not have to admit guilt to say that you are sorry to the patient that has been upset, or felt ignored, or has to wait a long time.
Come up with new phrases which sound genuine coming out of your mouth and clearly get across your personal accountability.
Some examples might be:
- Being a doctor on duty, I would have to …
- It is my responsibility to …
- I would feel compelled to …
Play around with some phrases that you might use to bring out your justifications for any of your decisions or actions.
Some examples are:
- I would do this so that …
- In order to ….
- So that …
- With the aim of …
Patients are always your first concern. If you are faced with any type of ethical problems dealing with a patient, the spinal reflex has to come out with a phrase such as:
My first duty is to my patient. I would first see to the needs of my patients. Obviously, the patients’ safety will be my prime concern.
You could never be criticized for dealing with your patients first. However, you should also follow that up with some practical suggestions, detailing what you would do to ensure that patients are looked after properly.
This is where the vast majority of your competitors would fall down. Medical school applicants have often learnt to rattle off the phrases “I would assess and stabilize the airway, breathing and circulation.” But when the interviewer follows up with the question, “Well, in which ways would you assess the airway”, they appear flummoxed.
Think creatively about what practical things you would do if faced with the situation given to exercise your duty of care to your patient.
So, for a drunken doctor exercising your duty of care might involve:
- Removing the doctor from the clinical area
- Providing or arranging cover for that doctor’s clinical duties for that day
- Reviewing every clinical decision or action made by that doctor that day and
- May be, if necessary, offering the patients a brief explanation and an honest apology
For a situation in which you had a disagreement with a nurse over the treatment of a patient,
- Your first duty of care will be to your patient.
- To exercise that you would ensure that the patient was clinically stable enough for a discussion to take place.
- If a time a critical decision had to be made, then as the senior clinician on duty you would execute your decision in good faith, being fully prepared to justify your actions.
You have a duty to promote health as well as treat sickness of your patients and the general public alike. Be aware of health promotion messages such as:
- Stopping smoking
- Safe sex
- Sensible drinking
- Healthy diet
- Breast feeding
- Depression awareness
Ensure that you will be able to speak for 20 or 30 seconds on any health promotion advice you would be expected to deliver when interviewed or in the post that you are applying for. This will certainly provide icing on a cake type of answers but it might even provide the basis for your answer if asked:
- How would you deal with a parent who did not want their child vaccinated?
- What would you say to a lady who wanted gastric banding?
- Should we offer angioplasty to smokers?
Honesty, openness and integrity should be values that you should back on when faced with a dilemma. These are useful words to describe yourself or your actions.
Think through a few phrases for yourself such as:
- I will do what I felt to be right.
- The honest thing to do is …
- My policy is to be straight forward and honest.
If faced with a situation where a patient is being put at a risk, you have to describe what you would do now to prevent that occurring.
- Be careful not to suggest your beliefs might lead to patients or colleagues being discriminated again.
- You might not like the idea that a smoker is at the top of a lung transplant list. But you must be careful to defend your view on clinical grounds alone.
- You may share a certain view about rapists but you are not allowed to refuse to treat patients because of that view.
Obviously, you should not say anything in the interview which might suggest you were coercing a patient to take a certain drug or go to a certain health institution by unjustly using your position as their doctor.
Demonstrate that you can work in partnership with patients both in a role play exercise as well as in an interview setting. You need to be able to demonstrate that you will actively listen to patients and then respond to their concerns and preferences.
Make sure that you can give patients the information they want in a way they can understand.
Think about your performance in a role play:
- What information would you want to give somebody about a drug that you are prescribing?
- Doses, times, before or after meals,
- How are they going to take the medication – under the tongue, with water, with milk, using an inhaler or viral injection
- How could you explain these clearly to them?
- What side-effects should they look for?
- What should they do if they experience a side-effect?
- What should they do if they miss a dose?
You might want to think about these types of issues. Subscribers to the site would find this similarly guiding your thinking on a range of issues, both to enhance your self-awareness and an important delivery to produce your most persuasive sales speeches. You need to show them things that involve patients in clinical decisions that affect them.
How much you show your ability to support your patients to self manage?
- Treating your patients as individuals and respecting their dignity are two values that are easy to get across in some of your answer.
Consider constructing a few phrases that could be delivered naturally and convey that you treat patients politely and considerately, and you respect your patients’ rights to confidentiality.
Think about phrases that you might use in a role play exercise as well as in an interview. When nervous, some of your competitors might throw away easy marks by not considering these phrases:
For a role play, exercise you might say things like,
- Good morning, Sir. How can I help you today? (Oh Gosh, that must have been awful for you)
- Anything that you tell me will not go beyond these four walls (without discussing it first)?
For an interview, consider phrases such as:
I would invite them to sit down with me in a quiet room. I would listen carefully to what was troubling the angry relative. Although I would never disclose patients’ names to my wife, I do find it helps me to unwise generally if I tell her about what I learnt that day.
Another of your duties is to provide a good standard of medical practice and clinical care. You need to discover ways to display that you keep your professional knowledge and skills up to date. Never be worried about using statements that suggest you willingly recognize and work within the limits of your competence.
- Think about how you can describe your work with colleagues and the ways patients may be better served.