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Good Medical Practice Good Medical Practice Good Practice in Good Practice in Psychiatry Psychiatry Dr. Nikolaos Patelis

Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

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Page 1: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

Good Medical PracticeGood Medical PracticeGood Practice in PsychiatryGood Practice in Psychiatry

Dr. Nikolaos Patelis

Page 2: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

Introduction Introduction

What is Good Medical Practice?

Principles of Good Practice

Good practice in Psychiatry

Page 3: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

What is Good Practice?What is Good Practice?

Discussion (5’)

Page 4: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

Definition of Good PracticeDefinition of Good Practice

Giving a definition and setting universal guidelines is almost impossible as the above are not always acceptable to any practicing doctor, granted that there are as many types of practices as there many types of doctors.

Page 5: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

Definition of Good Practice Definition of Good Practice (2)(2)

A possible definition could be:

“All medical actions and decisions that can be supported scientifically and can be justified whenever there is a question or doubt raised about them, are called…

Good Practice.”

Page 6: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

What are the ingredients to GP?What are the ingredients to GP?

1. Professional integrity2. Communication skills3. Ethical behavior4. Treating patients with dignity5. Being a team player

Page 7: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

Principles of Good PracticePrinciples of Good Practice

Page 8: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

Principles of Good PracticePrinciples of Good Practice

1. The doctor as a person2. The doctor and the practice3. The doctor and the patient4. The doctor as a team player5. The doctor and the employer6. The doctor in solo practice7. The doctor in institutional and public

practice8. The doctor in dilemma

Page 9: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

1. The doctor as a person1. The doctor as a person

1.1.Trust: Be polite and honest Respect patients’ dignity and privacy Respect the right of patients to a second

opinion Be readily accessible to patients and

colleagues when you are on duty Respect the right of patients to decline to take

part in teaching or research and ensure that their refusal does not adversely affect your relationship with them

Page 10: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

1. The doctor as a person1. The doctor as a person

1.2.Communication: Listen to patients and respect their views Use simple language that patients

understand. Protect confidential information. Share

information only if the patient gives consent.

Page 11: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

2. The doctor & the practice2. The doctor & the practice

Recognize the limits of your professional competence Keep clear, accurate, legible and contemporaneous records Prescribe drugs only where you have adequate knowledge of

the patient's health and medical needs Make efficient use of the resources available to you Keep your professional knowledge and skills up to date Make sure that your personal beliefs do not prejudice your

patients care Act quickly to protect patients from risk Avoid abusing your position as a doctor

Page 12: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

3. The doctor & the patient3. The doctor & the patient

The patient who seeks medical help is in an anxious frame of mind. So the patient makes many personal sacrifices. He surrenders his individuality and privacy to the doctor, exposing his innermost secrets and personal problems to the doctor who is a total stranger. The doctor’s only claim to this privilege is his education and training as a compassionate healer.

Be attentive and a good listener Be polite and friendly. Avoid being business-like Be gentle during the examination & when possible always use

a chaperon Be clear and discreet when discussing possible diagnosis Give relevant options for treatment End this relationship based only on professional criteria

Page 13: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

4. The doctor as a team player4. The doctor as a team player

You must treat your colleagues fairly and you must not discriminate between colleagues

You must not make malicious judgment or unfounded criticism of colleagues

Respect skills and contribution of colleagues Be readily accessible to colleagues when you are

on duty Be willing to consult colleagues Make sure that your patients and colleagues

understand your professional status and specialty, your role and responsibilities in the team and who is responsible for each aspect of patients’ care

Page 14: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

5. The doctor & the employer5. The doctor & the employer

The doctor must remember his primary professional responsibility to patients when operating under financial constraints

If the doctor manages finances, he must make sure that the funds are used for the purpose for which they were intended and are kept in a separate account from personal finances

Before taking part in discussions about buying goods or services, the doctor must declare any financial or commercial interest which he or his family might have in the purchase

Page 15: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

6. The doctor in solo practice6. The doctor in solo practice

The doctor in solo practice often has financial obligations, having to bear rentals of facilities, leasing, staff salaries and other expenses. Such a doctor may be vulnerable to demands by patients or by employers.

The doctor should not compromise professional and ethical rules to accommodate unfair demands by such persons for financial rewards or benefits

The doctor must not tout nor canvass for patients, nor lobby with employers or other colleagues

Page 16: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

7. The doctor in public practice7. The doctor in public practice The doctor practicing in an institutional or public facility has to

constantly keep in mind that health resources generally are costly, precious and finite

The fundamentals of patient care by doctors are universal and apply equally whether the doctor is in public or in private practice

In hospitals with wards with classes, the doctor must remember that the class refers to the comfort facilities in the rooms and not to the standard or level of medical care.

Patients newly admitted to the ward should be seen as soon as possible, examined and treatment commenced without delay

Patients need to be attended regularly, and rounds conducted at least once a day, and more frequently in ill patients

Page 17: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

8. The doctor in dilemma8. The doctor in dilemma A patient who complains about his treatment has a right to

expect a response. The doctor has a professional responsibility to deal with complaints constructively and honestly without being prejudiced to the patient’s further treatment

If a patient has suffered serious harm, the doctor should act immediately to put matters right. The patient must receive a proper explanation and the short and long term effects. When appropriate the doctor should offer an apology

If a patient has died, the doctor should explain, to the best of his knowledge, the reasons for, and the circumstances of, the death to the next-of-kin

The doctor must co-operate fully with any formal enquiry.

Page 18: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

Good Practice in PsychiatryGood Practice in Psychiatry

Page 19: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

What are the special characteristics of What are the special characteristics of Good Practice in Psychiatry?Good Practice in Psychiatry?

Discussion (5’)

Page 20: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

Special characteristics of GP in PsychiatrySpecial characteristics of GP in Psychiatry

The psychiatrist should…

Be able to communicate with patients with learning disabilities, drug & alcohol abusers, children, adolescents and families as a whole

Know in detail the legal framework of patient’s consent and disclosure of information (Abarbanel study)

Page 21: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

The Abarbanel StudyThe Abarbanel Study

The study was conducted in Abarbanel Mental Health Center among 113 patients and the article is published in Harefuah Medical Journal by Prof S. Tyano and Dr. R. Finzi.

Conclusion: “Almost two thirds of the patients where unfit to give their informed consent. The patients’ consent to hospitalization was very problematic and probably resulted from their submission to family pressures or from the reason for their hospitalization.”

The problem occurred to disclosure of information, as well. It was the psychiatrist’s decision whether to or not to share information with the patient’s next-to-kin.

Page 22: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

Skills for all psychiatristsSkills for all psychiatrists

Knowledge of the differing presentations of mental health problems in young persons, those with learning disability, older adults and those with physical health problems

Knowledge on substance misuse and its effect on physical and mental health

Skills in the assessment of psychiatric disorder complicated by or associated with substance misuse

Skills in the immediate management of these conditions Sufficient knowledge of management strategies and local

services to access the appropriate care for these conditions Knowledge and skills in these areas will need to be maintained

and updated.

Page 23: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

Good practice within various aspects of Good practice within various aspects of psychiatrypsychiatry

1. Child and adolescent psychiatry2. Psychiatry of learning disability3. Psychiatry of old age4. Psychotherapy5. Rehabilitation psychiatry6. Psychiatry of substance misuse

Page 24: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

1. Child & Adolescent Psychiatry1. Child & Adolescent Psychiatry

having a detailed understanding of the developmental, psychological, behavioral, systemic, physical and social factors in the presentation of child and adolescent mental disorders

being able to engage, communicate and effectively intervene with children, adolescents and adults individually and in families balancing the needs of children and parents in families, and acting in the best interests of children/young people

balancing the maintenance of confidentiality and the need for child protection gaining the child’s consent to assessment and treatment and, where necessary, considering the use of the most appropriate legal orders to assess and/or treat the child/young person

having a detailed knowledge of the relevant legislation relating to children, and being aware of and following local child protection procedures assessing parenting skills and planning for the management and treatment of identified deficits

prescribing with due care, having regard for the age and wishes of the child, parents’ wishes, side-effects and the overall treatment plan.

Page 25: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

2. Psychiatry of learning disability2. Psychiatry of learning disability

treating people with learning disabilities with respect enabling effective and reciprocal communication with people

with communication impairments and with their families and carers

being prepared to advocate on behalf of people with learning disabilities, and encouraging them in self- advocacy

having the specific knowledge and competence required for the assessment and treatment of psychiatric and behavioral problems in people with learning disabilities

understanding the complex interplay between the learning disability, other developmental disorder (such as autistic-spectrum disorders), social disadvantage and adverse experiences, abnormal brain development (including disorders such as epilepsy) and mental illnesses.

Page 26: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

3. Psychiatry of old age3. Psychiatry of old age

an avoidance of stereotyping, regardless of patients’ age or disability

being skilled in the assessment of confusional states and in communicating with patients who have confusional states

recognition that the needs and wishes of patients and their families are not always similar

being cognisant of the interrelationship of biological, psychological and social factors in the etiology, presentation and management of both functional and organic mental illness in old age

understanding how treatments developed for working-age adults may be adapted for an older population

Page 27: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

4. Psychotherapy4. Psychotherapy

paying particular attention to boundaries, time and place, and being sensitive to the psychological implications of transgressing boundaries, e.g. through touch and/or self-revelation

being especially sensitive to issues of confidentiality being aware of the extent and limitations of psychotherapy

training, and staying within the limits of competence respecting the different models operating within both

psychiatry and psychotherapy being well-versed in the evidence base underlying

psychological therapies, and not undertaking treatments for which there is no established clinical or scientific evidence

recognition of the particular psychotherapeutic needs of minority groups (identified by ethnicity, gender, sexual orientation, age and disability)

Page 28: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

5. Rehabilitation psychiatry5. Rehabilitation psychiatry

identifying the biological, social and psychological components that contribute to disability

making assessment of change within the mental, social, cultural and psychological state

assessing and evaluating the social needs of a person with chronic mental illness, and being familiar with the processes that lead to better housing, social support, benefit matters and occupation

Page 29: Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

6. Psychiatry of substance misuse6. Psychiatry of substance misuse

awareness of the need for careful assessment and advocacy for this patient group, who tend to encounter particular forms of stigma

knowledge and awareness of the types and prevalence of legal and illegal drugs, alcohol, prescribed drugs and over-the-counter medications with misuse potential

recognition that substance misuse problems affect all age groups and all sections of society

knowledge and skills to assess those with complex physical problems and substance misuse

knowledge and specific competence to manage complex drug and alcohol dependencies, using pharmacological and psychological approaches in a variety of settings

recognition of the high risk of substance misuse within the medical profession, and competence to treat it