Milestone

Entry

Last updated 13 September 2022
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Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

10. Maintain legal and duty of care responsibilities

Know

  • Understand that patients have a right to access competent, compassionate care, and to be fully informed about their healthcare.
  • Be familiar with potential obstacles to duty of care that may arise in complex situations where the GP has a duty of care to a number of parties. Seek help if there is a lack of confidence in the appropriate course of action.

Do

  • Act on patient cues.
  • Respect patient–doctor boundaries.
  • Maintain confidentiality.
  • Recognise professional limitations in oneself and colleagues.
  • Ensure appropriate reporting and follow-up.
  • Undertake advocacy as appropriate.
  • Respect a patient’s culture and values and consider how these affect the therapeutic relationship.
  • Identify who needs to be prioritised in duty of care responsibilities and:
    • seek help to make this decision, if needed
    • document decisions
    • consider notifying the appropriate medical defence organisation
    • seek help and debrief with trusted senior colleagues.

Be

Be respectful of patient autonomy and the person’s right to make decisions about their health and medical care.

Do

  • Ensure all relevant information for a patient is incorporated into the clinical notes.
  • Ensure accuracy of clinical notes, especially in consultations where mandatory reporting may be necessary, legal documentation is being completed, or where there is a forensic component in which clinical notes may be used as evidence in court.
  • Accurately record clinical information, including:
    • patient demographics
    • cultural status, including Aboriginal and Torres Strait Islander status and migration history
    • preferred language
    • medical information
    • current medication
    • family history
    • social and occupational history
    • lifestyle risk factors
    • health screening status
    • presenting problems, risk factors and management plans, including plan for follow-up
    • consent obtained.
  • Obtain informed consent prior to sharing information with external parties, including family members and/or carers, except for situations in which this is not possible; for example, where mandatory reporting legislation takes precedence or when an individual is incapacitated and unable to make or communicate decisions about their medical care.
  • Understand appropriate use of health information systems to uphold patient privacy and confidentiality and optimise the quality of continuity of care and communication.
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

11. Demonstrate professional and ethical conduct

Know

Be

  • Be non-judgemental, ethical, trustworthy, respectful and compassionate.
  • Be reflective and demonstrate intellectual humility.
  • Have integrity.

Know

  • Know that ethical issues may arise when there is an apparent contradiction between the doctor’s personal values and beliefs and their professional code or that of broader society. Examples may include:
    • antenatal screening and/or the decision of an individual to terminate pregnancy for genetic abnormalities or malformations
    • provision of care to individuals about sexual wellbeing, particularly individuals who identify as LGBTIQ+
    • decisions about degree of family and/or carer involvement for individuals where there are concerns about capacity to consent
    • situations in which a patient refuses to inform family members who may be at risk when a diagnosis is made of a communicable disease
    • issues regarding inequitable access to care due to social determinants.

Do

  • Identify ethical issues and dilemmas that arise in consultations and seek help appropriately to manage these.
  • Reflect on own values and belief systems, and how these may impact on patient care.
  • Consider multiple perspectives and available options to facilitate a decision.
  • Resolve issues in a timely way in line with professional codes of conduct by seeking formal or informal guidance.
  • Document decision-making.
  • Refer patients to other professionals to provide clinically appropriate care if unable to provide the care requested because of personally held beliefs or values.

Be

Be non-judgemental, empathic and understanding.

Know

  • Know the importance of health professionals having structures to manage their own wellbeing.
  • Know the importance of health professionals having insight into the potential impacts of significant health issues, stress, burnout, compassion fatigue and vicarious trauma on their capacity to provide care.
  • Identify local and online resources to assist doctors who may be experiencing difficulties; for example, the Doctors’ Health Network, medical defence organisations and employee assistance programs.

Do

  • Practise self-reflection and self care and provide support to colleagues.

Know

  • Be aware of mandatory reporting responsibilities and act on these, if necessary, in circumstances where a colleague is conducting themselves in a way that meets the notification guidelines (eg practising while intoxicated, engaging in sexual misconduct, placing patients at risk due to an impairment, practising in a way that is a significant departure from professional standards).

Do

  • Identify peers in the workplace who would benefit from support and/or experience.
  • Identify peers who may be experiencing difficulties for personal and/or professional reasons; for example:
    • after critical incidents or challenging patient encounters
    • individuals experiencing mental health issues, bullying or substance use
    • individuals demonstrating signs of fatigue, burnout, vicarious trauma or compassion fatigue.
  • Identify peers who may have a lack of insight into the impact their physical or psychological health issues or personality traits have on their ability to practise safely.
  • Support peers who may be experiencing difficulties by:
    • suggesting they undertake debriefing and/or professional counselling
    • encouraging them to contact their medical defence organisation in the event of a critical incident that may have legal consequences.
  • Understand limits of professional relationships (eg not prescribing for or providing medical care to peers but recommending appropriate independent medical care).

Be

Be empathic, compassionate and professional.

Know

  • Understand the potential consequences of unclear boundaries in therapeutic relationships; for example, unreasonable patient expectations that may put the patient at risk or raise the possibility of legal action.

Know and do

  • Identify and manage red flags for the risk of potential blurring of therapeutic boundaries in consultations, including:
    • feeling uncomfortable about seeing a particular patient
    • requests from patients for dishonest or unethical behaviour by the doctor (eg supplying medications that are not clinically indicated, providing incorrect information on legal documentation, taking part in an intimate relationship)
    • situations where the doctor may be providing a level of care that is outside their normal practice.
  • Understand and recognise transference and countertransference and manage appropriately, including:
    • communicating with the patient about clear therapeutic boundaries
    • referring appropriately if boundaries are not able to be maintained.
  • Seek out advice from colleagues in situations where there are concerns about therapeutic boundaries being compromised.

Be

  • Be self-reflective and professional
Open all sections

Instructions

Expand each role using the menu on the left to reveal its capabilities. Clicking on each capability on the left will show the associated competencies on the right hand side. These can then be expanded to provide more detail on the required knowledge, skills and attributes.

Compare competencies of the roles at different milestones

12. Use self-reflection to deliver quality care and to enhance and maintain self-care practices

Know

  • Acknowledge that maintaining personal health and wellbeing helps to ensure sustainable, safe delivery of care.

Do

  • Recognise and prioritise own health needs and seek appropriate help and support when required.
  • Identify potentially risky situations or therapeutic relationships early to minimise risk; seek appropriate support and implement protective strategies.
  • Optimise own and others’ physical safety at work and follow safety procedures.
  • Find own GP for independent medical advice and preventive care.
  • Seek professional help in the event of a physical or psychological illness that may impact ability to manage professional responsibilities.
  • Understand the impact of fatigue on wellbeing, particularly for doctors who regularly do shift work, work with vulnerable communities (eg people with complex chronic disease, including mental illness; people who have experienced trauma or who have had refugee-like experiences; people at end of life; people with substance dependence), and/or work in rural and remote areas with on-call responsibilities.
  • Reflect regularly on own workload and wellbeing and recognise signs of vicarious trauma and fatigue, including compassion fatigue.
  • Develop a self-care plan that includes strategies such as regular exercise, healthy diet, stress management and maintaining social connections.

Be

  • Be motivated to make self-care a priority and to create structures for healthy lifestyle choices.

Know

  • Recognise that doctors often put aside their own emotional responses to deal with the situation at hand.

Do

  • Recognise signs of stress, anxiety, sleep disturbance, vicarious trauma, compassion fatigue and burnout in response to traumatic or confronting situations, and access support through formal or informal debriefing with colleagues.
  • Identify situations that may be challenging, including:
    • critical incidents
    • near misses
    • emotionally challenging patient encounters (eg patients who are verbally or physically aggressive, have experienced trauma, have self-harmed or attempted suicide, and situations where there are legal concerns, such as child protection or family violence)
    • where Transference or countertransference may have occurred.
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