Good patients with their wellbeing in mind.

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 follow1.
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 healthcare2. However, when physicians
do not follow these 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 misunderstanding3.
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 – death4. 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
council5. 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 skills6.
Physicians must know how to manage patients and him/her self. As physicians’
top priority is patient 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 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 practicing7. 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 suffer8.
Healthcare staff and more importantly, physicians, should act in a humble,
respectful, polite and in a civilised manner towards patients and staff alike.
This creates trust, collaboration and shared accountability between staff,
colleagues and patients9. 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 patients10. 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 in medical career. Also having a sense of
team spirit reflects an individual’s ability to contribute and resolve internal
conflicts easily11. More importantly, overconfident and egoistic is
also a cause of concern it 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. 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, realizing 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 surgeon12. 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 correct13. 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 thoroughly14. 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, no matter the seniority or 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’ health15. 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 trust16. Thus the physician’s
reputation in the healthcare community could be severely affected by improper
behaviour. One such unacceptable behaviour of a physician is dishonesty –
profiting off patients to treat their ailments. One 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 knee17. From this example we can learn that people are sometimes
overcome by greed and charge more than they should. As physicians, we should
not be influenced by monetary needs18 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

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 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.
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 ICU19. 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. Assumptions are not a 100% guaranteed, the radiologist
might have, based on past experience, assumed that the pulmonologist will view
the case file electronic data20. 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 another21. 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 patient22.

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 allows 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”23 which states 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.