Milestone

Foundation

Last updated 13 September 2022
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

10. Maintain legal and duty of care responsibilities

Do

  • Recognise the overarching duty of care responsibilities that doctors carry in every therapeutic relationship, and identify when there is a conflict between duty to the individual patient and to the general public or specific other individuals. Consider the best approach to manage this, and seek help from senior colleagues, if needed.
  • In situations where there are questions over duty of care:
    • document the reasons for decisions
    • consider notifying the appropriate medical defence organisation
    • access other resources to understand your responsibilities and/or seek help from and debrief with trusted senior colleagues.
  • Identify the types of complex situations that may arise in which the GP has a duty of care to several parties involved in a situation (including to the general community). Examples may include:
    • situations where contact tracing is required for communicable diseases, particularly STIs where the patient wishes to remain anonymous
    • identifying and managing expectations of workplace stakeholders (eg modifying patient management to suit employer culture for individuals with occupational injuries – especially relevant for elite athletes)
    • mandatory reporting to government child protection services, where the alleged perpetrator and child are both patients of the doctor
    • situations where an individual with impaired capacity to provide consent and their carer are both patients of the doctor and there is a conflict in decision-making regarding management
    • during review for fitness to drive, where the doctor is aware that the patient is demonstrating diminished capacity to drive, but would be severely impacted by having their driver licence revoked
    • involuntary admission certification for individuals who are putting themselves or others at risk due to experiencing severe mental health issues
    • provision of care to both people who are experiencing family violence and the person who is perpetrating the violence.

Do

  • Identify clinical presentations, symptoms and signs, including when they are not consistent with the history provided, which may raise concerns about:
    • child abuse, including neglect
    • family violence
    • risk of suicide
    • risk to others (eg communicable diseases).
  • Identify clinical presentations where there are medico-legal responsibilities, including mandatory reporting or notification, to consider:
    • certifiable and reportable deaths
    • assessment of fitness to drive
    • assessment of work capacity, including fitness certificates and sick and carer certificates
    • injuries sustained from alleged assaults where documentation may be used in court proceedings and medical reports requested for criminal proceedings (eg injuries resulting from alleged family violence, child abuse or other types of violence)
    • assessment for involuntary admission under the mental health laws for the relevant jurisdiction for individuals identified to be at high imminent risk of suicide or harm to others
    • assessment of capacity to provide informed consent/testamentary capacity
    • mandatory reporting of suspected child abuse
    • occupational health and safety legislative requirements (eg needle-stick injuries, handling of bodily fluids, infection guidelines)
    • voluntary assisted dying
    • advance care directives
    • prescribing drugs of dependence.
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

Do

  • Recognise potential threats to effective therapeutic relationships, including:
    • drug-seeking behaviour
    • inappropriate behaviour by a patient toward self or practice staff (eg aggressive behaviour or sexual advances)
    • ‘splitting’ of health professionals in the patient’s healthcare team (where individuals may consciously or subconsciously create conflict between members of the care team by providing different versions of their history – this commonly occurs with individuals with borderline personality disorder)
    • situations where the wishes of the patient may not be well understood (eg individuals with severe cognitive impairment or intellectual disability, or who are floridly psychotic)
    • patients who present seeking analgesics but are unwilling to be properly assessed
    • transference and countertransference.
  • Document concerns clearly in clinical notes.
  • Communicate clearly to the patient about doctor’s role and therapeutic boundaries.
  • Ensure that duty of care responsibilities are maintained.
  • Access support from colleagues to manage these if uncertain.
  • Consider terminating the therapeutic relationship if boundaries are not able to be maintained. In this situation, it is important for doctors to consider their duty of care to refer the individual to another doctor to enable continuity of care. While strategies used to achieve this referral will vary according to the situation, it is important to communicate this with empathy and respect. Recognition of transference and countertransference is important to ensure that appropriate boundaries are maintained.
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

  • Recognise that following a critical incident or other challenging clinical situation, health professionals may experience stress reactions, including feelings of guilt and fear of litigation or disciplinary action.
  • Identify situations in which you may need to access support; for example:
    • following a critical incident (eg failed resuscitation)
    • where there is a blurring of boundaries in therapeutic relationships
    • navigating complex ethical issues
    • a missed diagnosis leading to a poor clinical outcome
    • a communication problem or difficult interaction with a patient or family member (eg an individual presents as aggressive and/or with unreasonable expectations)
    • when a situation causes a doctor to feel inadequate, unsupported or confronted.
  • Recognise that support from colleagues can be beneficial and may entail debriefing, exploring emotional responses or assessing whether there is anything to be learned from the experience.
  • Identify colleagues who can provide mentoring and support.
PROVIDE FEEDBACK