THIS year, the UK National Health Service will introduce a “duty of candour’, a new contractual requirement on health care providers to “tell their patients if their safety has been compromised, apologise, and ensure that lessons are learned to prevent them from being repeated”.
It reminds me of the errant schoolboy being marched up to the front door of the neighbour’s house to apologise for the broken window.
The UK’s new requirement does not enjoy universal support. Respondents to the NHS consultation process were 50% for and 48.4% against the proposal. Nevertheless, it is going ahead.
Interesting times ahead in the NHS … yet again.
Australia does not need to follow suit. We have safeguards, checks and balances, and new quality and reporting agencies aplenty.
Even before the advent of our new agencies, we have institutionalised morbidity and mortality audits, perinatal and infant mortality checking, root cause analyses for adverse events and near misses, together with a medical indemnity insurance industry that has encouraged us to be open and clear with our patients.
Offering a sincere expression of regret for an adverse outcome and providing a clear explanation is not an admission of liability.
Why should we legislate for common sense?
The doctor–patient relationship is unique. It is built on honesty and trust. It is our job — our calling — as doctors to provide the best possible care for our patients throughout their lives. We provide that care and advice based on our special skills and knowledge.
If there are adverse events, we recognise them, take responsibility for them, and seek to rectify them — in concert with the patient — and put in place mechanisms to avoid recurrence of such events.
To this end, I think we are well ahead of the UK and the NHS.
The Medical Board of Australia produced Good medical practice: a code of conduct for doctors in Australia. The AMA had a hand in its publication, and it encapsulates the views of the profession in many areas.
Formally adopted in 2010, the code describes what is expected of all doctors registered to practise medicine in Australia. It sets out the principles that characterise good medical practice and makes explicit the standards of ethical and professional conduct expected of doctors by their professional peers and the community.
The Medical Board code states clearly that, in the event of adverse events, doctors should explain to the patient as promptly and fully as possible what has happened and the anticipated short- and long-term consequences.
The code also states that doctors should acknowledge the patient’s right to complain and work with patients to resolve the issue, where possible.
Importantly, the code calls on doctors to provide a prompt, open and constructive response, including an explanation, and, if appropriate, an apology.
It is also a companion piece to the AMA’s code of ethics.
The AMA’s code says that doctors must first consider the wellbeing of the patient, treat your patient with compassion and respect, and approach health care as collaboration between doctor and patient.
This is at the core of medical practice in Australia. We have an intrinsic duty of candour, and more.
It will be interesting to observe how our colleagues in the UK respond to being obliged by law to do what they surely do naturally and instinctively.
Dr Steve Hambleton is the federal president of the AMA.
Posted 18 February 2013