When in contact with patients, the student bears the same responsibilities as does the doctor in regard to professional conduct. An understanding that the ethical and legal obligations involved in the doctor-patient relationship will be observed is implicit in all clinical work. The `ground rules' which govern the professional conduct of doctors are of great antiquity and can be traced to what is usually called the Hippocratic Oath which had its beginnings in the school of medicine founded by Hippocrates in the fifth century BC. A modern version of this oath was adopted at the First Assembly of the World Medical Association held in Geneva in 1948 and was subsequently amended at meetings in Sydney in 1968 and in Venice in 1983. The World Medical Association version of the Hippocratic Oath now reads as follows:
`At the time of being admitted as a Member of the Medical Profession, I solemnly pledge myself to consecrate my life to the service of humanity. I will give to my teachers the respect and gratitude which is their due. I will practise my profession with conscience and dignity.
The health of my patient will be my first consideration. I will respect the secrets which are confided in me even after the patient has died; I will maintain by all the means in my power the honour and the noble traditions of the medical profession; my colleagues will be my brothers.
I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patients; I will maintain the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity.
I make these promises solemnly, freely and upon my honour.'
Professional ethical codes are not immutable and slowly change with time as the morals and structure of a society change. New moral and ethical issues arising from modern biotechnological advances were among the subjects debated by the World Medical Association at its meeting in Venice during October 1983 and the assembly changed the sentence in its version of the oath which then read
`I will maintain the utmost respect for human life from the time of conception ...' to read: `I will maintain the utmost respect for human life from its beginning ...'
The Australian Medical Association has paraphrased the ethical requirements of both the Hippocratic Oath and the Declaration of Geneva as follows:
(a) to live a pure and moral life and to pay due respect to his teachers, to share a knowledge of medicine with the rest of the profession and to have no secret remedies or processes;
(b) to do no man any harm by the misapplication or criminal application of a knowledge of medicine;
(c) to undertake only such things as are within the competence of the individual practitioner;
(d) to keep secret anything learned as the outcome of professional relationship with a patient which should not be divulged;
(e) to avoid abuse of the doctor-patient relationship.
The `Code of Ethics' of the Australian Medical Association is reproduced in full as Appendix II of the second edition (1991) of the textbook Ethics, legal medicine and forensic pathology by V D Plueckhahn and S M Cordner.
On the presumption that students have embarked upon the MB BS degree with the intention of practising as a doctor, it is important to be alerted to the role of the Medical Practitioners Board of Victoria and, well ahead of time, to the legislation which pertains to medical registration in Victoria. The prime purpose of the Medical Practice Act is to protect the public. The Act stipulates that the board is to refuse to register as doctors persons:
Students are reminded that they are ethically and legally obliged to maintain the confidential nature of any knowledge they obtain about patients. It is fundamental to proper doctor-patient relationships that patients know that they may disclose intimate things to treating doctors and that the doctors in turn will observe strict confidentiality about such personal matters. Patients must not be afraid to seek the advice of doctors and the doctors in turn must be free to ask patients whatever questions they consider are necessary for proper diagnosis and treatment. Strict medical confidentiality, once inviolate, has been substantially eroded in modern medical practice by various statutory enactments at both State and Federal levels. For example, medical records may be seized by court order and communications by patients to doctors are not generally protected from disclosure to courts of law. Statute law also lays down circumstances under which information gained in doctor-patient relationships must be disclosed. Included are the reporting of `notifiable diseases,' the notification of venereal disease, provisions related to the consumption of alcohol and road-traffic accidents, the reporting of births, and the stating of the causes of death in death certificates. Such legal responsibilities of modern doctors have considerably dented the Hippocratic requirement for the doctor to `preserve absolute secrecy on all he knows about his patient because of the confidence entrusted in him.'
Students in their third, fourth, fifth and sixth years, and for some aspects of the education provided in earlier years of the course, are required to undergo clinical teaching in hospitals or clinics associated with the university. Normally students are under the control of clinical teachers which affords some protection to them in the event of them incurring liability towards any patient with whom they may have come into contact. In certain circumstances, however, this indemnity is not provided and students should make themselves aware of their responsibilities towards patients during these years of training. In cases where a student may incur personal liability without indemnification, the Medical Defence Association of Victoria and the Medical Indemnity Protection Society will provide a service to them.
During contact with patients, students will realise the need to develop sensitivity to patients' varying personalities and needs. Learn to listen patiently, not only to what patients are saying but also to what they are not saying, perhaps because they are afraid or embarrassed. Courtesy, kindness and sympathetic understanding are just as important in the care of the sick as are the technical skills which you will also be learning to acquire.
Students must conduct themselves in a manner which is acceptable to patients and which does not undermine their confidence or endanger their health. A neat appearance and a quiet and sympathetic demeanour inspires the patients' confidence and will be helpful in your work.
Do not practise medicine before you are qualified to do so, and then only in professional surroundings. Your friends and acquaintances - and the inevitable party pest - may try to induce you to practise medicine casually or on social occasions. It is dangerous to give medical advice without taking a complete history and doing an adequate examination, and very foolish to do so in most circumstances unless you are legally qualified. A thoughtless or ill-informed word of reassurance may lead someone to postpone seeking medical advice properly and lead to tragedy. Learn to rebuff these advances courteously.
The total care of the patient is a team effort requiring not only doctors but nurses and various health-supporting personnel, for example physiotherapists, dieticians, occupational therapists. Hospital chaplains and spiritual advisers also contribute to the care of patients, especially in certain circumstances such as the care of the dying patient. Students are urged to learn as much as they can from, and cooperate with, these various members of the team.
Plueckhahn V D and Cordner S M Ethics, legal medicine and forensic pathology MUP, 1991
In order to meet health requirements for working in the wards of affiliated teaching hospitals and for protection of other students and themselves, students in the MB BS course need to comply with certain precautionary procedures. These consist of confidential tests for immune status (including blood tests and skin tests), receiving vaccines and having X-rays where the evidence indicates these are appropriate and there are not specific contraindications in individual cases.
This policy is in accord with the National Health and Medical Research Council advice that educational institutions training students in health sciences should ensure that such students are protected as far as possible by vaccination against risks of infection.
The faculty recommends that all students accept responsibility for having up-to-date immunisations before commencing the medical course. Immunisations recommended are diphtheria, tetanus, polio, measles, mumps, rubella, tuberculosis and hepatitis B.
Prospective students should note that on enrolment, students are provided with detailed written information and, as appropriate, counselling about the effect that HIV or hepatitis B infection may have on the ability of health care workers to practice their profession. In addition, arrangements will be made by the faculty for every student to have a personal consultation, early in the first year, with an infectious diseases physician. At this time, a check for each student's immunity to diseases such as tuberculosis will be conducted and students will be offered personal advice and counselling about infectious diseases and their personal health.
| Published by Monash University, Clayton, Victoria
3168 Copyright © Monash University 1996 - All Rights Reserved - Caution Authorised by the Academic Registrar December 1996 |