Misuse of Trust

Chaperones:

Wherever possible, patients should be offered the right to have a chaperone present at the time of examination, especially examinations considered to be intimate, regardless of the gender of the patient and physician. Documentation of the presence or refusal of a chaperone during an examination, as well as the outcome of the examination and ensuing discussion should be made.

Inappropriate relationships:

The trust established during the patient-physician consultation relies on the dignity of that relationship being maintained. Boundaries limiting inappropriate behaviour are put in place to safeguard patients who, at a time of illness, may be particularly vulnerable to their health care provider.

Where a physician is unsure about the appropriateness of their relationship with a patient/patient’s relative, counsel from a senior member of the profession should be sought.

Sexual relationships:

Sexual or improper emotional relationships with patients (current or former), betray the trust of the physician-patient relationship and constitute an abuse of the professional relationship

Good Samaritan Acts

According to the Medical Protection Society (MPS), a medical defence union for physicians:

‘a good Samaritan act is one in which medical assistance is given, free of charge, in a bona fide medical emergency, upon which you may chance, in a personal as opposed to a professional capacity. Examples include roadside accidents and emergencies at public events you attend as a spectator’.

• In an emergency, wherever it arises, a physician must offer his assistance, taking account of his own safety, his competence and the availability of other options of care.


• A physician must, in emergencies, act within the limitations of his experience or qualifications.


• In many emergency situations stopping blood loss, administering pain relief or simply arranging for a transfer to hospital as soon as possible would be sufficient.


• Making a record is always a good option.

Advertising

Notices or signage indicating the location of a physician’s practice should be of a size sufficient to allow identification of the physician. The sign may include the physician‘s name, qualifications, special area of practice, office hours and whether an appointment is necessary.

All claims about competence, experience, quality and outcome of service should be accurate and supportable by suitable certification or evidence of appropriate training.

The promotion of services should not include the offer of any incentives. Similarly advertisements should not include endorsements or testimonials about the physician, their capabilities or the service provided.

A physician is not permitted to use a pseudonym or alias. Registration with the Medical Board of Trinidad and Tobago should be in the physician’s proper name and advertising must occur using this name.

A physician should not use their name to promote a commercial organization.

If a physician is aligned to an organization [medical, pharmaceutical or biomedical] and wishes to speak publicly on an issue related to the organization, the physician is required to declare their alliance and indicate if the views expressed are their own or are representative of the organization.

The professional behaviour of physicians, medical students and other health care professionals impact on the physician–patient relationship, whether the health care professional is in the process of exercising their duty or not. The use of discriminatory language, profanity, evidence of illicit substance use and breach of patient confidentiality in the public domain can lead to sanctions by the Medical Board of Trinidad and Tobago. Physicians must bear this is mind when using social media.

In communications with patients, either orally, written, e-mail or through a website or social media the physician should :

• conduct discussions in a polite, non-offensive manner, ensuring the dignity of the profession is maintained;


• refrain from the promotion of self, services and capabilities in a misleading manner, either directly or indirectly;


• exercise care if sent a social network friend request from a former or current patient as social networking inherently blurs the boundaries between formal and informal relationships . It is advised that the physician should politely refuse and explain the reasons for refusal to the patient.

• If a physician is asked to give evidence or act as a witness in litigation or formal inquiries, he must be honest in all his spoken and written statements. He also must make clear the limits of his knowledge or competence.


• A physician must co-operate fully with any formal inquiry into the treatment of a patient and with any complaints procedure that applies to his work. He must disclose to anyone entitled to ask for it, any information relevant to an investigation into his own or colleague’s conduct, performance or health. In doing so, he must follow the guidance on confidentiality.


• A physician must assist the coroner in an inquest or inquiry into a patient’s death by responding to their enquiries and by offering all relevant information.

A physician’s main obligation is that of their patient’s best interest. There are certain situations however where there is a conflict of interest or dual loyalties exist.

These include:

• Loyalty to public health or society: in cases where conditions are deemed ‘notifiable’, personal information about the patient may be disclosed in order to safe guard the public interest.


• Loyalty to employer: when a physician is employed by a managed health care organisation or insurance company, there is the potential that the physician may limit advising the patient on various investigations or treatments to minimise costs to the employer.


• Loyalty to pharmaceutical or biotechnology and equipment companies: where a physician receives financial incentives or is employed by an organization to promote a product, there is the potential that the physician may prescribe the product because of personal financial gain rather than it be in the patient’s best interests. A similar conflict of interest arises when physicians receive sponsorship for education or research.

Where physicians find themselves in situations of conflict of interest or dual loyalties then they should disclose this information to the patient in their care. Disclosure should be done before starting investigations, treatment or referring the patient.

A physician should not ask for or accept gifts, hospitality or other inducements that may affect or be seen to affect their decision making about patients’ treatment. A physician can however receive small, insubstantial gifts which cannot be regarded as inducement.