Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis

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  • Good Medical Practice Good Practice in Psychiatry Dr. Nikolaos Patelis
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  • Introduction What is Good Medical Practice? Principles of Good Practice Good practice in Psychiatry
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  • What is Good Practice? Discussion (5)
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  • Definition 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.
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  • Definition of Good Practice (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.
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  • What are the ingredients to GP? 1. Professional integrity 2. Communication skills 3. Ethical behavior 4. Treating patients with dignity 5. Being a team player
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  • Principles of Good Practice
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  • 1. The doctor as a person 2. The doctor and the practice 3. The doctor and the patient 4. The doctor as a team player 5. The doctor and the employer 6. The doctor in solo practice 7. The doctor in institutional and public practice 8. The doctor in dilemma
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  • 1. 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
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  • 1. 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.
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  • 2. 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
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  • 3. 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 doctors 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
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  • 4. 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
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  • 5. 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
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  • 6. 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
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  • 7. 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
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  • 8. 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 patients 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.
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  • Good Practice in Psychiatry
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  • What are the special characteristics of Good Practice in Psychiatry? Discussion (5)
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  • Special 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 patients consent and disclosure of information (Abarbanel study)
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  • The 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 psychiatrists decision whether to or not to share information with the patients next-to- kin.
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  • Skills 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.
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  • Good practice within various aspects of psychiatry 1. Child and adolescent psychiatry 2. Psychiatry of learning disability 3. Psychiatry of old age 4. Psychotherapy 5. Rehabilitation psychiatry 6. Psychiatry of substance misuse
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  • 1. 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 childs 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.
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  • 2. Psychiatry of learning disabilit