As an organisation that has been working for South African doctors for 65 years, and which supports more than 31 000 members in the country, Medical Protection has insight into areas of medico-legal risk that many might not think about.
Dr Yash Naidoo, case manager at Medical Protection, offers some timely advice on how inter-professional criticism can negatively affect your relationship with patients and even increase your risk of complaints.
"After two years of working from home, the working world is slowly starting to return to the office. With that comes the commute, and for many, like me, the car radio. I tune in to one of Johannesburg’s popular breakfast shows during my drive, and pay little attention to the chat segments between songs.
One morning, however, there was something different on the radio. The host – a well-known celebrity – said something that immediately pricked my ears: 'I have a bone to pick with every single dentist in the country.' Oh no, I thought. What have we done?
I was a dentist before becoming a practising lawyer. Those two professions are relevant in the context of this article. I no longer practise either profession, but instead my current role gives me the privilege of assisting doctors, dentists and other healthcare professionals when they find themselves in trouble with their regulator, among other things.
Back to the radio show. It turns out that what had happened to the host was that she had consulted a new dentist and was pleasantly surprised to hear his positive comments about the dental work done by the previous dentist. 'Every other dentist I’ve gone to… the first thing they rush to do… is to trash the dentist you went to before,' the radio host proclaimed. Her colleagues in the background at the studio could be heard concurring. They all agreed that the practice of making disparaging comments about colleagues, in a particular profession or industry, annoyed them.
They then opened their phone lines to the public, asking people to call in and say which professions they believed were notorious for a lack of collegiality – specifically, which professionals don’t compliment their colleagues. Dentists featured prominently. Lawyers too.
Inter-professional animosity was highlighted by a caller – between physiotherapists and chiropractors. Doctors were also mentioned – by more than one caller. One pointed a finger at GPs, while another was very specific in describing what she perceived to be a spat between ophthalmologists and optometrists. When questioned on which of the two professions she fell under, her reply was that she was neither, but that she had first-hand experience of disparaging remarks made by each professional about the other, when she was required to take her child to consult both.
Even sangomas (traditional healers or diviners) were not spared. The radio host summed it up perfectly: “It actually doesn’t serve the patient.”
For me, this segment provided a fascinating insight into public sentiment and perceptions about various professions. Particularly the healthcare professions. And it reminded me about a specific rule of the HPCSA, and why the rule is so important.
You can listen to it here.
The HPCSA rule
The HPCSA’s ethical rule 12 says that “(a) practitioner shall not cast reflections on the probity, professional reputation or skill of another person registered under the (Health Professions) Act or any other Health Act”.
Let’s break that rule down and focus on some of the less straightforward terms.
“Shall” is archaic legalese. Put simply, it means “must”. “Cast reflections” essentially means to look back on something; in this context in a negative light. “Probity” is the quality of having strong moral principles, honesty, decency. The remainder of the rule needs no further dissection.
To put it simply, as healthcare practitioners registered with the HPCSA, we must not badmouth our colleagues.
Why does the rule exist?
That question is understandable. Does the HPCSA simply want us to sugarcoat our views and heap praise on our colleagues for the sake of it? No – the rule clearly does not say that. But what is its purpose?
The reason will perhaps become clearer, when viewed in the context of the HPCSA’s general ethical guidelines for healthcare professions.
The HPCSA says the primary professional duty of a healthcare practitioner should be concern for the patient’s best interests and well-being. To fulfill this duty, they must, among other things, honour the trust of their patients and be mindful that they are in a position of power over their patients and should avoid abusing this position.
The preamble to the general ethical guidelines starts with the first sentence: “Good clinical practice is based on a trust relationship between patients and healthcare professionals.”
With this background, it should be clearer why the rule in question exists. It is there to ensure the reputation of the profession is upheld. And not for the sake of the professions, but for the sake of the patient. If the profession is brought into disrepute, then the public will lose faith in its professionals, which in turn leads to a breakdown in trust and inevitably, compromised clinical practice.
We are human
I appreciate that it is not always easy to keep tight-lipped. A slip of the tongue can happen, even innocently as an observation in passing. Or a thought out aloud. But we must remember the rule, the reason for it, and then ask ourselves – is the comment I am about to make going to benefit the patient in any way? If the answer is no, then it should not be said.
Reporting unprofessional, illegal or unethical conduct
With that said, it is not the case that you should always remain silent. That is where the HPCSA’s rule 25 comes in. It says you must report any unprofessional, illegal or unethical conduct on the part of another colleague, to the HPCSA. The circumstances under which this rule would be applicable are beyond the scope of this article, but it is mentioned here merely as a reminder that there are conflicting duties and rules in professional practice, and when faced with such conflicts, careful consideration is required before acting.
Conclusion
The healthcare profession is a noble profession. We have a duty to uphold its reputation. The reputation of the profession is important for the public’s trust in the profession. Without trust, clinical practice is compromised. And the best interests of the patient fall by the wayside.
A negative comment about a colleague, said to a patient, can create a negative perception of the profession as a whole. Before making a comment about a colleague, ask yourself if it will benefit the patient in any way. If not, don’t say it. And if you find yourself in a professional or ethical dilemma, remember to contact Medical Protection to request assistance.
Medical Protection is celebrating 15 years of our flagship Ethics For All conference in South Africa. Our speakers will address the latest developments in the medical and healthcare fields, including the rise of human factors and the learnings from aviation; social media and the ethical relationship with patients; wellbeing and care; and top claims in report writing among other topics. The Medical Conference is on Thursday 20 October, you can find out more or register here:
www.medicalprotection.org/southafrica/events-e-learning/events/ethics-for-all
See more MPS columns from MedicalBrief archives:
Understanding why and how to manage patients’ expectations
How to manage frustration from working in resource-constrained institutions
The need for medico-legal reform: A welcome chance to speak up