Good laid out and even neglecting them, is what

Good professional practice stems from
eight domains created by the Medical Council. The eight domains, patient safety
and quality of patient care, relating to patients, communication and
interpersonal skills, collaboration and teamwork, management (including
self-management), scholarship(knowledge acquired during medical school and in
practice), professionalism, clinical skills describe a physician’s work from
medical school to maintaining professional career and that all physicians
should follow (24). While
practicing, there are the three pillars partnership, practice and performance
to guide physicians to understand professionalism and public of principles and
value that support good healthcare (25).
However, when a physicians do not follow the set of values that are laid out
and even neglecting them, is what causes poor professional performance. In
healthcare, poor professional performance is attributed to professionals who
act in the best of his own interest, acting in a way that compromises patients’
safety, causing them harm and neglecting basic duties as a healthcare
professional – which is to provide basic care for patients with their wellbeing
in mind.  There are many factors that
govern poor professional performance, however, complaints of unacceptable
behaviour and poor communication are more common.

Part of partnership encompasses good
communication between doctors and patients and doctors and colleagues. Doctor
patient communication is also based on trust, with increasing number patient
under the doctor’s care, communication between each patient can decrease and
this will result in an increase of miscommunication and misunderstanding (1). Also, lack of communication
between doctors and staff can result in misinterpretation leading to
misdiagnosis, providing the wrong type of care to patients and in worse-case
scenario – death (2). Hence
effective communication not only plays a part in doctor patient relationship
but also between doctors and staff. Apart from communication, behaviour is also
important in maintaining proper doctor patient or doctor staff relationship.
Medical practitioners who defy the law against proper work behaviour and
compromising the safety of the patient can be reprimanded by the medical
council (12 page 80). Behaviour can
either stem from self or interacting with patients and colleagues. It can be
seen from an individual by his/her friendliness, honesty, helpfulness and
communicative skills (15).
Physicians must know how to manage patients and him/her self. As physicians’
top priority is patient centric care, physicians must display proper self and
work behaviour in order to care for the patient’s safety and effectively treat
the patient. Honesty, competence, confidentiality, patient safety and
commitment are one of the few most important traits of a physician for safe
practice and working efficiently at the same time providing the best patient
care.

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What then constitutes to people working
in the healthcare community to have such poor professional performance? This
stems from physicians and healthcare staff back from when they were still in
school. Studies have shown that students who display unprofessional behaviour
even from medical school tend to carry these aspects when they are practicing (5). Therefore it is important for students
who work in the healthcare sector to perform not only academically but also
work professionally with staffs and patients alike.

Displaying negative self-behaviour can
affect professional performance resulting in team work and communication to
suffer (16). Healthcare staff and
more importantly, physicians, should act in a humble, respectful, polite and in
a civilised manner towards patients and staff alike. This could create trust,
collaboration and shared accountability between staff, colleagues and patients
alike (11 page 1). Improper
behaviour could indirectly result in communication errors due to the lack of
trust between the physician and staff which would undermine good healthcare
delivery to patients (13). Mutual
respect between physicians is also important in effective team work as
respecting other’s talents and knowledge could add valuable input to solving
problems. Without mutual respect, team work and communication would not be able
to function. Being lazy and not proactive is also a cause of concern for
physicians as learning is continuous is medical career. Also having a sense of
team spirit reflects an individual’s ability to contribute and resolve internal
conflicts easily (14). More
importantly, confidence in one’s ability is also a cause of concern as being
egoistic and overconfident can cause medical errors to occur due to the
physician being over self-reliant and not double checking before diagnostics
are made and procedures are done. All these reflect an importance in individual
physicians’ work attitude in order to achieve proper teamwork. One such example
would be at the Rhode Island Hospital, USA, whereby a surgeon – with more than
twenty years of experience in medicine – attended a case of an 86 year old man
with a blood clot to be removed from his brain. The surgeon did not write a
consent form to dictate which side of the head he would operate on. When the
nurse questioned him about the consent form, he simply told the nurse he
remembered which side to operate on. During the operation, the surgeon cut
through to the skull and realized that it was the wrong side, closed the wound
immediately and operated on the correct side. This was a case where the surgeon
was overconfident due to his vast experience and the nurse being too afraid to
step up and confront the surgeon (17).
From this example, we can learn that physicians who are over confident and
arrogant will tend to commit even the simplest mistakes. Studies have shown
that physicians whose confident level range from under confident to
overconfident tend to make lesser mistakes (under confident) to being the most
prone to medical errors (overconfidence). This is due to the fact that under
confident people tend to double check their references to ensure they are
correct (19). Hence arrogance,
egoism and overconfidence can cause professionality to suffer due to the “know
it all” attitude and assuming that one is always correct. Medical
professionals, especially surgery, involves team work, having an unacceptable
behaviour can severely impact the rate of success of the surgery and reflects
badly overall on that individual.

Given the same situation, if my
colleague were to just assume that a particular side of the body were to be
operated on for the surgery and not with any proper consent form being
prepared, I would have stopped and asked him to verify with the nurses and the
registrar. I would also have asked the surgeon to double check on the CT
scan/MRI scan/X-ray to ensure that the correct side of the body is being
operated on. As for his behaviour, I would have advised him that even a
position as a senior surgeon, mistakes will still happen if one is
overconfident and arrogant. To have the correct paper work is also a must, as
consent forms have to be signed and procedures explained to the patient
thoroughly (20). Reviewing the
consent form again prior to surgery can also help the surgeon to clear any
doubts and clarify the areas to be operated on. I would also have advised him
that as a senior surgeon, he would also have told the medical officers and
registrars under him that procedural checks are important, and yet he is not
following them. Therefore, telling him that no matter the seniority and
position, when in doubt just clarify and cross reference to multiple sources
i.e. procedure forms, scan results and colleagues to ensure that the correct
area is being operated on.

Physicians have to be able to relate to
patients as the physician’s primary role is to ensure the safety and care of
patients health. Therefore, physicians must be honest, responsible and
accountable for the patients’ health (21).
As patients consult physician, patients will hold high respect for physicians
and therefore, should display not only proper working attitude but also
personal proper attitude out of work. If physicians commit any wrong doings
during or out of work, this could severely impact the doctor patient
relationship and trust (10 page 9, 10).
Thus the physician’s reputation in the healthcare community could be affected
by improper behaviour. One such unacceptable behaviour of a physician is
dishonesty – profiting off patients to treat their ailments. One such example
would be a senior orthopaedic surgeon, Dr. Mohammed Suhaib Sait, who profited
off unnecessary NHS operations. Dr Sait made an operating profit of £28.7
million in 2016. He profited mostly from keyhole surgery procedures that were
unnecessary or unsuitable to treat his patient’s condition. To name a few
cases, one lady came in for a bunion surgery but did not have bunions. Dr Sait
told the nurse that this was a preventive measure for getting bunions in the
future. Others include taking the patients into operating theatre without
having pre-operative checks done. This severely compromises patient’s safety.
He also carried out arthroscopy on the patient’s knee when the reviewing
surgeon checked the X-ray and said that the patient had obvious arthritis of
the hip and no problems at her knee (22).
From this example we can learn that people are sometimes overtaken by greed and
charge more than they should. As physicians, we should not be influenced by
monetary needs (23 page 39, para 62.1)
and have to take the patient’s safety into consideration. By doing unnecessary
procedures, not only the patient’s safety is compromised, but also the
physician’s reputation and trust between the physician and patient. Physicians
should thus charge a reasonable fees and avoid doing unnecessary procedures
that could compromise patient safety.

Collaboration and teamwork, paired with
communication are what allows physicians to have proper partnership between
colleagues, staff and patients. Communicating and working effectively as a team
allows lesser mistakes to be made by healthcare professionals on a day to day
basis. Miscommunication between physicians and colleagues can hamper proper
healthcare delivery and sometimes cause patient related death. One such
miscommunication would be between a physician and his colleague – handing cases
over from one physician to another. A radiographer who diagnosed a 63 year old
patient with bilateral pneumonia with early signs of congestive heart failure.
The patient was then referred to a pulmonologist, however, lab findings were neither
conveyed to the patient nor the pulmonologist. This is due to the radiologist
assuming that the pulmonologist would access the electronic data to view the
full lab reports on this case. The patient’s symptoms improved over a week,
however, he developed severe chest pain and difficulty breathing due to
pulmonary oedema and ventricular dysfunction. He later passed on in the
hospital’s ICU (6). This case could
be avoided if the radiologist had not assumed that the pulmonologist would have
access the electronic data to confirm the patient’s developing ventricular
dysfunction. As assumptions are not a 100% guaranteed, the radiologist might
have, based on past experience, and assumed that the pulmonologist will view
the case file electronic data (7).
So does that mean that electronic data cannot be trusted? With improving
technologies, integrating different systems from different department could be
a problem. Some large hospitals, lab and outpatient imaging would use different
systems from the speciality or primary care physicians. Therefore, a lack of
accessing data from one physician to another (8). Instead, communication between physicians handing off cases
could be improved by not only from one source of information. The information
should come from multiple sources and cross referenced to ensure that the
information presented from the preceding physician is fully presented to the
succeeding physician and the patient (9).

Communicating with patients is an
important aspect of a physician’s job as history taking can account for more
than 80% of diagnosis alone. This was discussed during the lecture by Prof.
William Henry Smithson on the bio-physco-social model. Physicians must be able
to give patients the information they require and made it simpler for patients
to understand. This allows patients to better understand the treatment that is
available for them and make proper treatment decisions if given a choice. This
in turn, allowing the physician to also provide better treatment for the
patient.

In conclusion, the 8 domains devised by the medical
council and the 3 pillars of professionalism are guidelines for physicians to
follow from medical school to practice. Behaviour and communication are just
part of good professional performance, knowledge, clinical skills and judgement
are also important in making the correct diagnosis and treating the patient
effectively and safely. The basic of medical ethics; autonomy, justice,
beneficence and non-maleficence are also an important part of good professional
practice. Autonomy where communication is involved and beneficence – patient
safety all help to contribute to better healthcare delivery. Also, as quoted by
Hippocratic oath “Into whatever homes I go, I will enter them for the benefit
of the sick, avoiding any voluntary act of impropriety or corruption, including
the seduction of women or men, whether they are free men or slaves” (26) which state that a physician must
be at his best behaviour and not let greed, social status and temptation lure
him/her away from the path of good behaviour.