Being a healthcare practitioner starts from the moment of waking up – and the constant reminder that it’s easy for boundaries to blur and professional obligations to slip, write Dr Victoria Cox and Dr Volker Hitzeroth, medico-legal consultants at Medical Protection.
Cox and Hitzeroth write:
Consider this scenario: Dr M is a medical registrar working at a busy regional hospital. During an evening shift, she admits a prominent local businessman, Mr Z, with suspected alcohol‑related liver disease.
The next morning, she hears a nurse telling the reception team that a local celebrity was admitted the evening before. Seeing Dr M walk by, the receptionist asks her who it is and why they were admitted.
Dr M hesitates as these colleagues are not involved in Mr Z’s care, but confirms it is Mr Z and that it looks like advanced, alcohol‑related cirrhosis. Word quickly spreads among staff.
A few days later, Mr Z lodges a formal complaint after hearing that hospital staff were discussing his diagnosis, and Dr M is called for a meeting with her head of unit.
Dr M recognises that she got caught up in the buzz around the prominent patient and should have applied her usual care around confidentiality. Identifying the patient and sharing clinical details with colleagues not directly involved in the patient’s care breaches professional standards and HPCSA ethical rules.
Casual conversations can lead to unintended breaches and erode trust. Professionalism includes being vigilant in informal environments such as staff rooms, reception areas and social gatherings.
Professionalism
‘Professionalism’ might be easy to define in theory, but can become a lot more complicated in practice, and many calls to the Medical Protection advice line are from members seeking advice on how to navigate dilemmas where professional boundaries are at risk of becoming blurred, or have already.
The HPCSA sets out that healthcare practitioners must always regard concern for the best interests or well-being of their patients as their primary professional duty, that they must honour the trust of their patients, and be mindful that they are in a position of power. Most clinicians will be aware of their day-to-day professional obligations to their patients and colleagues and the core principles and values that a regulating body such as the HPCSA require adherence to.
Booklet 2 – Ethical and Professional Rules of the Health Professions Council of South Africa is a set of HPCSA guidelines that sets out the standards of care and behaviour expected of all healthcare practitioners.
Many clinicians will be aware of the key domains where they have a professional obligation to:
• Maintain their knowledge and skills;
• Act with honesty and integrity;
• Treat patients and colleagues fairly; and
• Maintain professional boundaries.
Respect, compassion and ensuring patients and fellow healthcare practitioners’ dignity is also central to the public trust placed in the medical profession.
Most clinicians will never intentionally aim to bring the profession into disrepute or undermine public confidence in it. However, unfortunately, with ever increasing demands on practitioners both in and outside the work environment these boundaries can be easily forgotten, or become blurred, and sadly result in doctors finding themselves at the centre of a regulatory or disciplinary process.
Healthcare practitioners who work independently may find themselves more vulnerable due to a lack of informal safeguards. Having people around you can often help to enforce the importance of clinical and social boundaries. Those working under extreme pressure or in emotionally charged clinical situations may also find it difficult in the heat of the moment to remember their professional responsibilities towards their colleagues or patients.
It is important to remember the significance of role modelling when considering professionalism. How a senior clinician addresses a patient or colleague on a ward round or during a consultation can have a considerable impact on those observing their actions.
While treating patients with respect and without prejudice may seem an obvious example of professionalism, it can be easy to forget that off-the-cuff comments made during a coffee break or on a WhatsApp group could be deemed as unprofessional by a regulating body.
Often it is the actions of a clinician outside the work arena that result in concerns or complaints being raised with the regulator. Emotive reactions to political or social situations on social media, interactions with patients when ‘off duty’, and the seemingly innocent prescribing of medication for a friend or relative are but a few examples that can result in a referral to the HPCSA.
Being a healthcare practitioner, in essence, starts from the moment you wake up in the morning – how you conduct yourself with your friends and family, how you drive to work, your timekeeping and appearance, the relationships you build both in work and socially, and even how you act on holiday.
All of the above are examples of where a clinician’s actions or behaviour in that given circumstance have resulted in a case before the regulator.
It can often appear unfair that the actions of a doctor away from the work environment are still held to account, where in other professions this may not be the case. Conversely, some may see professionalism as a contract that healthcare professionals should always fulfil, with the reward being the trust of their patients and the respect of the general public.
It is important to remember that being professional isn’t about trying to remember or learn the contents of Booklet 2. It is about practitioners familiarising themselves with the key concepts and applying the standards that are relevant to the individual’s knowledge, skills and experience when followed in context.
Rather than focusing on rules and standards, it is important for a practitioner to obtain the skills to be able to take a step back and think through a situation calmly while being able to communicate clearly and professionally.
This can take skill and strength but getting it right can protect both patients and clinicians.
Continued learning
Ongoing learning can help us to recognise those ‘grey’ moments before they become a problem.
Medical Protection members can access the Professionalism course on The Learning Hub at no extra charge, as a benefit of membership. This interactive online course looks at how small, everyday behaviours can affect trust, consent and professional relationships, and why boundary issues often arise unintentionally. It also acknowledges the reality of modern practice – social media, cultural differences, global patient expectations, and working across teams and settings.
Rather than focusing only on rules, the course gives clinicians practical ways to think through difficult situations and communicate clearly and professionally.
Members can access the course any time by logging into The Learning Hub: https://prism.medicalprotection.org/
See more from MedicalBrief archives:
Badmouthing colleagues unethical and risks healthcare reputational damage
Social media complaints and how to deal with them