Good medical practice

Domain 2: Patients, partnership and communication

Introduction

The approach and attitude of a medical practitioner can have a lasting impact on a patient. Treating patients with kindness, compassion and respect can profoundly shape their experience of care. 

Good medical professionals recognise that patients are individuals with diverse needs, and don’t make assumptions about the options or outcomes a patient will prefer. They listen to patients and work in partnership with them. They do their best to make sure all patients receive good care and treatment that will support them to live as well as possible, whatever their illness or disability.

Treating patients fairly and respecting their rights

16

You must recognise and respect every patient’s dignity and right to privacy.

17

If relevant to your practice, you must follow our more detailed guidance on Intimate examinations and chaperones

18

You must recognise a patient’s right to choose whether to accept your advice, and respect their right to seek a second opinion.

19

You must treat patients fairly. You must not discriminate against them or allow your personal views to affect your relationship with them, or the treatment you provide or arrange. You must not refuse or delay treatment because you believe that a patient’s actions or choices contributed to their condition. 

20

You must give priority to patients based on their clinical need if these decisions are within your power. If inadequate resources, policies, or systems prevent you from doing this – and patient safety or dignity may be seriously compromised as a result – you must follow the guidance in paragraph 75.

21

If you have a conscientious objection to a particular procedure, you must make sure that the way you manage this doesn’t act as a barrier to a patient’s access to appropriate care to meet their needs. You must follow the guidance in paragraph 87 and our more detailed guidance on Personal beliefs and medical practice

22

You must treat information about patients as confidential, including after a patient has died. You must follow our more detailed guidance on Confidentiality: good practice in handling patient information.

Treating patients with kindness courtesy and respect

23

You must treat patients with kindness, courtesy and respect. This doesn’t mean agreeing to every request (see paragraph 7d) or withholding relevant information that may be upsetting or unwelcome (see paragraph 28). It means:  

  1. communicating sensitively and considerately, particularly when you’re sharing potentially distressing issues about the patient’s prognosis and care
  2. listening to patients, recognising their knowledge and experience of their health, and acknowledging their concerns
  3. trying not to make assumptions about what a patient will consider significant or the importance they will attach to different outcomes 
  4. being willing to explain your reasons for the options you offer (and the options you don’t) and any recommendations you make
  5. recognising that patients may be vulnerable, even if they don’t seem it
  6. being alert to signs of pain or distress, and taking steps to alleviate pain and distress whether or not a cure may be possible.

Supporting patients to make decisions about treatment and care

24

All patients have the right to be involved in decisions about their treatment and care, and be supported to make informed decisions if they are able to. You must start from the presumption that all adult patients have capacity to make decisions about their treatment and care. 

25

You must be satisfied that you have consent or other valid authority before examining or treating patients, or involving patients or volunteers in teaching or research. More detail about this is given in our guidance on Decision making and consent which you must follow. If relevant to your practice, you must also follow our guidance on Making and using visual and audio recordings of patients.

26

You must be aware of your legal and ethical duties relating to consent and capacity. This means you must:

  1. be aware of the relevant law on capacity and mental health
  2. have regard to relevant codes of practice 
  3. follow our guidance on Decision making and consent.
27

When treating patients coming to the end of their lives, you must follow our more detailed guidance on Treatment and care towards the end of life: good practice in decision making.

Sharing information with patients

28

The exchange of information between medical professionals and patients is central to good decision making. You must give patients the information they want or need in a way they can understand. This includes information about:

  1. their condition(s), likely progression, and any uncertainties about diagnosis and prognosis 
  2. the options for treating or managing the condition(s), including the option to take no action
  3. the potential benefits, risks of harm, uncertainties about, and likelihood of success for each option.
29

You must listen to patients and encourage an open dialogue about their health, asking questions to allow them to express what matters to them, and responding honestly to their questions.

30

You must make sure that the information you give patients is clear, accurate and up to date, and based on the best available evidence. 

31

You should check patients’ understanding of the information they’ve been given, and do your best to make sure they have the time and support they need to make informed decisions if they are able to.

32

You must take steps to meet patients’ language and communication needs, so you can support them to engage in meaningful dialogue and make informed decisions about their care. The steps you take should be proportionate to the circumstances, including the patient’s needs and the seriousness of their condition(s), the urgency of the situation and the availability of resources. 

33

You must consider and respond to the needs of patients with impairments or disabilities. Not all impairments and disabilities are easy to identify so you should ask patients what support they need, and offer reasonable adjustments that are proportionate to the circumstances.

34

You must treat each patient as an individual. You must not rely on assumptions about the treatment options or outcomes a patient will prefer, or the factors they will consider significant.

35

If patients are asked to agree to be involved in teaching or research, you must share any information they’ll need to make a decision and you must follow the guidance in paragraph 85 and our more detailed guidance on Good practice in research

36

You must be open and honest with patients about any interests you have that may affect (or could be seen to affect) the way you propose, provide or prescribe treatments, or refer patients. You must follow our more detailed guidance on Financial and commercial arrangements and conflicts of interest.

Communicating with those close to a patient

37

You must be considerate and compassionate to those close to a patient and be sensitive and responsive in giving them support and information. You must follow our more detailed guidance on Confidentiality: good practice in handling patient information.

Caring for the whole patient

38

You must support patients in caring for themselves and empower them to improve and maintain their health. This may include:

  1. helping them to access information and support to manage their health successfully 
  2. supporting them to make decisions that improve their health and wellbeing.
39

You should ask patients about any other care or treatment they are receiving – including over-the-counter medications – and check that any care or treatment you propose, provide or prescribe is compatible. 

40

If a patient is taking multiple medications, you should discuss the importance of regular reviews to check that the medications continue to meet the patient’s needs and are optimised for them. You should consider the overall impact of the patient’s treatments, and whether the benefits outweigh any risk of harm. 

Safeguarding children and adults who are at risk of harm

41

You must consider the needs and welfare of people (adults, children and young people) who may be vulnerable, and offer them help if you think their rights are being abused or denied. You must follow our more detailed guidance on Protecting children and young people and 0-18 years: guidance for all doctors

42

You must act promptly2  on any concerns you have about a patient – or someone close to them – who may be at risk of abuse or neglect, or is being abused or neglected.

2

See our ethical hub advice on adult safeguarding.

Advice on adult safeguarding

This ethical hub topic explores: The underlying principles which define adult safeguarding. The different types of abuse. What you should do when an adult who appears to be at risk refuses help.

Helping in emergencies

43

You must offer help in an emergency, taking account of your own safety, your competence, and the availability of other options for care.

Making sure patients who pose a risk of harm to others can access appropriate care

44

Patients must not be denied care because their condition puts others at risk. If a patient poses a risk to your health or safety, you should take all available steps to minimise the risk before either providing treatment yourself, or making alternative arrangements for the patient to access care to meet their needs.

Being open if things go wrong

45

You must be open and honest with patients if things go wrong. If a patient under your care has suffered harm or distress, you must follow our guidance on Openness and honesty when things go wrong: the professional duty of candour, and you should:

  1. put matters right, if possible
  2. apologise (apologising does not, of itself, mean that you are admitting legal liability for what’s happened)
  3. explain fully and promptly what has happened and the likely short-term and long-term effects
  4. report the incident in line with your organisation’s policy so it can be reviewed or investigated as appropriate – and lessons can be learnt and patients protected from harm in the future. 
46

You must respond promptly, fully and honestly to complaints. You must not allow a patient’s complaint to adversely affect the care or treatment you provide or arrange. 

47

You should only end a professional relationship with a patient when the breakdown of trust between you and the patient means you can’t continue to provide good clinical care to them. You must follow our more detailed guidance on Ending your professional relationship with a patient.