First professional AETCOM questions

1. Enumerate and describe professional qualities of a physician

2. Roles of a physician
3. Duties of a doctor
4. Respect and follow correct procedure when handling cadavers and other
biological tissues
5. Importance of empathy in a doctor
6. Communication skills, breaking bad news
7. Describe and discuss the commitment to life long learning as an important
part of physicians growth
8. Patients’ rights

1.Professional Qualities Of A Physician

Professionalism is an important component of medicine’s contract with society. Not

only do we need to make good decisions for our patients based on the evidence in
the literature, but we need to apply those decisions in a way that is professional and
ultimately helps our patient. Certain behaviors early in medical education do
correlate with unprofessional behavior during a physician’s career. We need to be
vigilant in looking for those behaviors and let our students and trainees know why
we’re so concerned about them. Physicians are likely to improve in professionalism
with training and experience.

The professionalism charter defined three fundamental principles of professionalism:

• The primacy of patient welfare: This principle focuses on altruism, trust, and
patient interest.

• Patient autonomy. This principle incorporates honesty with patients and the need to
educate and empower patients to make appropriate medical decisions

• Social justice. This principle addresses physicians’ societal contract and distributive
justice—that is, considering the available resources and the needs of all patients
while taking care of an individual patient.

Linking professionalism values to specific behaviors

Responsibility • Follows through on tasks

• Arrives on time
Maturity • Accepts blame for failure
• Doesn’t make inappropriate demands
• Is not abusive and critical in times of
stress
Communication skills • Listens well
 • Is not hostile, derogatory, sarcastic
• Is not loud or disruptive
Respect • Maintains patient confidentiality
• Is patient
• Is sensitive to physical/emotional
needs
• Is not biased/discriminatory

Demonstrate respect, compassion, and integrity; a responsiveness to the needs of

patients and society that supersedes self-interest; accountability to patients, society,
and the profession; and a commitment to excellence and on-going professional
development • Demonstrate a commitment to ethical principles pertaining to
provision or withholding of clinical care, confidentiality of patient information,
informed consent, and business practices • Demonstrate sensitivity and
responsiveness to patients’ culture, age, gender, and disabilities

Professional responsibilities:

• Commitment to professional competence

• Commitment to honesty with patients
• Commitment to patient confidentiality
• Commitment to maintaining appropriate relations with patients
• Commitment to improving quality of care
• Commitment to improving access to care
• Commitment to a just distribution of finite resources
• Commitment to scientific knowledge
• Commitment to maintaining trust by managing conflicts of interest
• Commitment to professional responsibilities

2.Indian medical graduate- Roles of a doctor in healthcare & society

1. Clinician - Who understands and provides preventive, promotive, curative,

palliative, and holistic care with compassion
2. Leader and member of the health-care team and system Ability to take
everyone along to deliver the outcome in time bound manner more efficiently
and effectively with capabilities to collect, analyze, synthesize, and
communicate health data appropriately
3. Communicato-r With patients, their families, colleagues, community and
political leaders to influence by providing evidence-based interventions
 4. Lifelong learner -With a commitment to the continuous improvement of skills
and knowledge as per the change in medical technologies and
epidemiological shift
5. Professional -Who is committed to excellence, ethical, responsive and
accountable to patients, community, and the profession
Role of a doctor in healthcare

Doctors are required to be not only competent clinicians but also good
managers of health promotive and preventive programmes, effective hospital
administrators, competent trainers and qualified researchers. They must not
only work within the hospital but also support the health personnel and
activities of the entire district, and in particular the community primary health
care workers. However, as it is now, they are graduates of traditional medical
schools, whose educational programmes do not equip them adequately for
their emerging new roles in rural hospitals. Reorientation of the existing health
system, including its health personnel, is needed. The critical factor in such a
process is the development of appropriate attitudes at all levels of health
services. This is a difficult but challenging task, as it involves long established
medical institutions which hold firmly to old traditions and values.

3.Duties of a doctor

1. A physician shall uphold the dignity and honor of his/her profession.

The prime object of the medical profession is to render service to humanity; reward
or financial gain is a subordinate consideration

2. Maintaining Good Medical Practice

The principal objective of the medical profession is to render service to humanity with
full respect for the dignity of profession and man. Physicians should improve
knowledge and skills and should make these available to patients and colleagues.

Membership in medical society – physician should affiliate with associations and

societies and involve in the active functioning of these bodies.

A physician should participate in professional as part of continuing medical education

programs for at least 30 h every 5 years organized by reputed professional academic
bodies.

3. Maintenance of Medical Records

Every physician should maintain medical records of his/her patients for 3 years from
the date of commencement of the treatment in a standard pro forma.
 Efforts shall be made to computerize medical records for quick retrieval.

4. Display of Registration Numbers

Every physician shall display the registration number accorded to him/her by the
State Medical Council/Medical Council of India in his/her clinic and all his/her
prescriptions, certificates, money receipts given to his/her patients.

Every physician should prescribe drugs with generic names and should ensure that
there are rational prescription and use of drugs.[1]

5. Exposure of Unethical Conduct

A physician should expose without fear or favor, incompetent or corrupt, dishonest or

unethical conduct on the part of members of the profession.[5]

6. Payment of Professional Services

The personal financial interests of a physician should not conflict with the medical
interests of the patients. A physician should announce his/her fees before rendering
his/her service and not after the treatment is underway.

7. Evasion of Legal Restrictions

The physician shall observe the laws of the country in regulating the practice of
medicine. He should cooperate with observance and enforcement of sanitary laws
and regulations in the interest of public health.[1]

8. Medicolegal Cases

Attending doctor can decide further investigations required by the law enforcing
agencies in accordance with the prevailing law of the land, but the treating doctor
decides the admissibility of the case

Compulsory duties

1. Notification of births and deaths

2. Notification of notifiable diseases to the appropriate authorities

3. Reporting of cases of poisoning

4. Reporting of suspected causes of death

5. Reporting of cases covered under the privileged communication

6. Responding to call for emergency, military services.

 Voluntary duties

1. To treat and to continue to treat and maintain the professional secrets of the patients

2. To obtain consent of the patients for medical examination

3. To obtain informed consent before any procedure

4. To issue medical certificate, fitness certificate, death certificate, vaccination

certificate, or certificate of disabilities

5. to conduct postmortem examination as per the requirement and request from

appropriate authority

6. To inspect prisons

7. To attend cases of accidents and medical emergencies

8. To conduct medicolegal examinations.

4.Respect and follow correct procedure when handling cadavers and other
biological tissues

Cadaveric dissection helps students to understand structural organization and also

to grasp the three dimensional anatomy and concept of innumerable variations
Through dissection, students are able to get the feel of the human tissues and
structures of the human body

When every individual has autonomous control over the disposition of his or her own
body, few great humans or their relatives donate their bodies to medical institutes for
educational purpose and remain alive in our process of learning anatomy. These
cadavers are silent mentors and first teachers of medical students. The main ethical
concern of cadaver dissection lies in respecting human life. The dissection of a body
must be carried out in a respectful manner to show continued reverence towards the
deceased person until the very end. This would serve as an initial step towards
showing respect and empathy to patients in their future careers.

5.Empathy in a doctor

Empathy as “the act of correctly acknowledging the emotional state of another

without experiencing that state oneself.” It goes without saying that physicians
cannot fully experience the suffering of each patient.

Empathy is an emotional experience between an observer and a subject in which the

observer, based on visual and auditory cues, identifies and transiently experiences
the subject's emotional state . In order to be perceived as empathic, the observer
must convey this understanding to the subject. During the initial phase of the
process, the observer must not only identify but also understand the basis of the
subject's feelings. For example, a physician may encounter a patient who appears
depressed, expresses feelings of sadness and informs the physician that a close
relative has recently passed away. This may cause the physician to recall
subconsciously his emotional state patients want to be understood and treated with
respect by their doctors. They want to have the context of their lives and their
concerns taken into consideration when they are given treatment options. This is
what patients value. The doctor’s ability to develop an understanding and take into
consideration what is important to the patient (that is, their beliefs, hopes, desires,
and possibilities) seems to be an essential element to the provision of this type of
care. We call this ability empathy.

Empathy differs from sympathy, as empathy attempts to help the other person and is
based on an understanding of the patient’s perceived needs and not simply on the
doctor’s response to those needs.

Sympathy is a pity-based response, where the doctor tries to relieve distress when
witnessing a patient’s suffering Sympathy is seldom helpful, as it does not address
the real issues or empower the patient to find relevant solutions. Sympathy stems
from lack of a clear distinction between the self and the other, or emotional contagion
and over-identification with the patient. It leads to burnout, as the doctor assumes
responsibility for ending the patient’s suffering, which is not only burdensome but
also disrespectful and disempowering for the patient.

6.Communication Skills In A Doctor

The doctor must have the ability to communicate to patients in a patient, respectful,
non threatening, non judgemental and empathetic way.

Communication skills involve both style and content. Attentive listening skills,
empathy, and use of open-ended questions are some examples of skillful
communication. Improved doctor-patient communication tends to increase patient
involvement and adherence to recommended therapy; influence patient satisfaction,
adherence, and health care utilization; and improve quality of care and health
outcomes.

Breaking bad news to patients is a complex and challenging communication task in

the practice of medicine. Relationship building is especially important in breaking bad
news. Important factors include understanding patients' perspectives, sharing
information, and patients' knowledge and expectations.

Miscommunication has serious implications, as it may hinder patients'

understanding, expectations of treatment, or involvement in treatment planning.
 In addition, miscommunication decreases patient satisfaction with medical care,
level of hopefulness, and subsequent psychological adjustment.

Successful information exchange ensures that concerns are elicited and explored
and that explanations of treatment options are balanced and understood to allow for
shared decision making

In addition to minimizing avoidance behavior, which prevents patients from

expressing opinions, effective doctor-patient communication should involve
productive conversation, which involves understanding of both parties' perspectives,
by shifting from a perspective that is rigidly certain of one's belief to a more
exploratory approach that strives to understand the situation from another
perspective
patients often regard their doctors as one of their most important sources of
psychological support. Empathy is one of the most powerful ways of providing this
support to reduce patients' feelings of isolation and validating their feelings or
thoughts as normal and to be expected.

Doctors with better communication and interpersonal skills are able to detect
problems earlier, can prevent medical crises and expensive intervention, and provide
better support to their patients. This may lead to higher-quality outcomes and better
satisfaction, lower costs of care, greater patient understanding of health issues, and
better adherence to the treatment process. Effective doctor-patient communication
can be a source of motivation, incentive, reassurance, and support. Patients want
doctors who can skillfully diagnose and treat their sicknesses as well as
communicate with them effectively

7. DOCTOR AS A LIFE LONG LEARNER

To stay up-to-date with new evidence and guidelines that are continuously being
developed, health professionals must engage in ongoing professional development.
lifelong learning Is a core competency in health professions

The most essential characteristics of a lifelong learner are reflection, questioning,

enjoying learning, understanding the dynamic nature of knowledge, and engaging in
learning by actively seeking learning opportunities.

lifelong learning as an attribute involving a set of self-initiated activities and

information-seeking skills with sustained motivation to learn and the ability to
recognize one’s own learning needs. As such, lifelong learning has been recognized
as an indicator of professionalism, competence, and critical competent of continuing
professional development

Four Key Concepts Of The Lifelong Learning:

• self-initiated activities (behavioural aspect)

• information-seeking skills (capabilities)
• sustained motivation to learn (motivation)
• and ability to identify one’s own learning needs (cognition).

8. Patients’ rights

Patient differ in different jurisdictions globally and often depend on prevalent socio-
cultural norms.. There are separate bills, charters and hospital documents regarding
patients’ rights available in different settings.

The Universal Declaration of Human Rights in 1948 described the rights of a patient
emphasizing on fundamental dignity and equality.

Right to access medical care- Patients have a right to receive treatment

irrespective of their type of primary and associated illnesses, socioeconomic status,
age, gender, sexual orientation, religion, caste, cultural preferences, linguistic and
geographical origins or political affiliations. All hospitals both in the government and
in the private sector are duty bound to provide basic Emergency Medical Care to
injured persons irrespective of paying capacity.

Right to information Every patient has a right to adequate relevant information

about the nature, cause of illness, provisional / confirmed diagnosis, proposed
investigations, risks, benefits, expected treatment outcomes and possible
complications to enable them to make informed decisions, and involve them in the
care planning and delivery process and it shall be explained at their level of
understanding in language known to them.

Right to records and reports --Patient’s or their authorized individuals have the
right to access the original copy of their all medical records during period of
admission, preferably within 24 hours and after discharge, within 72 hours)and
request to receive a copy of their clinical records.

Right to confidentiality, human dignity and privacy-- All patients have a right to
privacy and medical information of the patient given to a health care provider shall
not be divulged to others unless the patient gives his consent to disclose such
information to other. Female patients have the right to presence of another female
person during physical examination by a male practitioner.
Right to second opinion: Patient has the right to a seek a second opinion on
medical condition form a doctor or hospital of his/her choice.

Right to safety and quality care according to standards-- Patients have a right to
safety and security in the hospital premises. They have a right to be provided with
care in an environment having requisite cleanliness, infection control measures, safe
drinking water and sanitation facilities.

Right to proper referral and transfer & continuity of care A patient has the right
to continuity of care and the patient and caregivers have the right to be informed by
the hospital about any continuing health care requirements following discharge from
the hospital.

Right to informed consent Every patient has a right that informed consent must be
sought prior to invasive investigation/surgery which carries certain risks. The patient
or their family shall be explained about risks, benefits, and alternatives of a given
procedure or intervention to enable them to make an informed decision about their
care.

Right to redress Patient has the right to give feedback, make comments, or lodge
complaints about the health care they are receiving or had received from a doctor or
hospital and all complaints must be given a registration number and there should be
a robust tracking and tracing mechanism to ascertain the status of the complaint
resolution.