Role

Ethical professional

Page last updated 13 September 2022

Milestone: Entry

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.

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

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.

Milestone: Foundation

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.

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.

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.

Milestone: Consolidation

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 when duty of care responsibilities override confidentiality agreements.

Do

  • Manage situations in which duty of care responsibilities override confidentiality agreements in consultations, including:
    • mandatory reporting of communicable diseases (full details of the individual may not be required)
    • recommendation for involuntary admission under the mental health laws for the relevant jurisdiction
    • mandatory reporting of suspected child abuse
    • mandatory reporting of suspected impairment of professional colleagues
    • individuals who have guardians who hold medical power of attorney
    • individuals with occupational injuries being managed under workers compensation.
  • Identify clinical symptoms and signs, including when physical symptoms or signs are not consistent with the history provided, that may raise concerns about:
    • abuse, including neglect
    • family violence
    • risk of suicide (consideration of involuntary admission)
    • risk to others (eg communicable diseases).

Know and do

  • Understand and carry out medico-legal responsibilities, including:
    • fitness to drive
    • requirements for involuntary admission under the mental health laws for the relevant jurisdiction for individuals identified to be at high imminent risk of suicide
    • criteria for mandatory reporting of suspected child abuse relevant in own state or territory
    • criteria for mandatory reporting of family violence (in specific states and territories)
    • understanding occupational health and safety legislative requirements
    • communicable disease notifications and contact tracing.

Know

  • Understand and interpret false positive and false negative rates of diagnostic investigations and the ‘number needed to treat’ statistics.

Do

  • Consider multiple factors (competencies 5.3.1, 5.3.2, 5.3.3, 6.3.4, 8.3.3) when identifying appropriate diagnostic and management options.
  • Communicate the benefits and risks of each diagnostic investigation, procedure and management option to the individual, in clear language appropriate to their level of health literacy and preferred language to support informed consent and shared decision-making.
  • Assess capacity for consent, where relevant, to ensure the individual is able to participate in shared decision-making. Capacity is dependent on the decision being made and is specific to each decision in healthcare settings (incapacity in one area may not mean incapacity for all decisions).

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

  • Use an ‘ethical lens’ in every consultation.
  • Consider a range of ethical issues that may arise in practice; for example:
    • in the care of people with disability (eg conflict between competent medical care, patient autonomy, and inherent concepts of ‘social worth’ and universal human dignity)
    • during antenatal screening and/or in making decisions to continue or terminate pregnancies when there are genetic abnormalities or bodily impairments
    • the need to report a colleague with suspected impairment to the Medical Board of Australia
    • providing care to individuals who decline potentially lifesaving treatment due to religious and/or cultural beliefs
    • being offered gifts by patients.
    • during discussions about sexual wellbeing
    • how individual doctors define ‘troublesome behaviours’
    • decisions about carer/family involvement for patients with limited capacity to provide consent
    • inequity arising from disparity between wait times and services available through the public system compared to private specialist services funded through private health insurance
    • when a patient refuses to inform family members who are at risk when a diagnosis is made (eg communicable disease).

Do

  • Regularly reflect on whether personal values, beliefs, personal biases (including cultural or social bias) or conflicts of interest are impacting delivery of care, either broadly or with specific patients or colleagues.
  • Identify consultations where own values, beliefs, biases or conflicts of interest have impacted the quality of care delivered; for example:
    • experience with heartsink response, where negative perception or experiences of frustration with patients may have impacted ability to identify the contributors to complex presentations and reduced ability to identify a diagnosis, investigate appropriately or initiate management, including referrals
    • being unable to or feeling uncomfortable about providing a specific aspect of care due to a personally held belief
    • awareness of cultural bias in cross-cultural consultations
    • requests for Schedule 8 medications from a relative or colleague.
  • Identify strategies to manage these while maintaining quality and continuity of care.

Do

  • Be aware of the power imbalance between doctor and patient.
  • Set and maintain clear personal and professional boundaries, especially in small communities.
  • Manage transference and countertransference, especially with vulnerable patients.
  • Recognise and manage red flags for the risk of inappropriate interactions where there is a blurring of therapeutic boundaries.
  • Identify situations where it may be appropriate to terminate a therapeutic relationship and to fulfil duty of care responsibilities by communicating this to the individual patient and handing over care to another health professional.

Be

  • Be self-reflective.

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

  • Know the relevant codes and standards of ethical and professional behaviour, including resources that can help health professionals define acceptable conduct and practice in relation to their peers, professional values and ethics, and practising medicine safely (competency 11.3.1).

Do

  • Identify disparities and access support to manage these.

Be

  • Be self-aware.

Do

  • Develop strategies for reflection and self-appraisal (eg seeking advice and support from peers, colleagues or supervisors).
  • Reflect on own values and beliefs, motivations, style of communication, cultural bias and impact of gender on provision of care (eg considering need for gender-concordant clinician for intimate examinations).
  • Develop strategies to recognise and manage personal factors; for example:
    • regular self-reflection on any personal factors that are impacting on the quality of care being delivered (and consider whether a referral to another provider is warranted)
    • addressing potential conflict that may occur if a variety of professional roles are held; for example, when:
      • patients are family members, professional colleagues or close friends
      • patients have another type of professional relationship with the GP (eg accountant, lawyer)
      • a rural GP carries out multiple roles within their community (eg involvement in local sporting clubs, council).
  • Recognise the importance of maintaining therapeutic boundaries to avoid power imbalances (either the GP or the patient being the holder of most power), which may impact how either party behaves (eg GPs feeling pressured to prescribe medications outside of guidelines or to write inappropriate sickness or disability certificates).
  • Demonstrate intellectual humility.

Be

  • Be insightful and committed to continuous improvement.

Know

  • Understand that the health of GPs can be adversely impacted in many ways as a consequence of the type of work they do.
  • Know the importance of having insight into own health needs and ability to prioritise them when required.
  • Recognise potentially risky situations or therapeutic relationships early to minimise risk by engaging support from colleagues, other health professionals or organisations, and implement protective strategies.

Do

  • Optimise physical safety at work to minimise risk of patient-initiated violence by:
    • ensuring awareness of safety systems in the workplace, including location of duress alarms and safe exit routes and action plan, should a situation arise that puts staff or patients at risk
    • developing and maintaining skills in de-escalation techniques
    • being aware of safety issues; for example, ensuring safety during visits outside the practice, avoiding working alone in the clinic, identifying patients who have a history of physical and/or verbal aggression.
  • Manage occupational health risks, including:
    • impacts of stress and fatigue from working with priority population communities (eg Aboriginal and Torres Strait Islander peoples, homeless people, or people who have experienced trauma, are substance dependent or experiencing complex mental health issues)
    • working in remote and regional areas
    • emotionally challenging clinical situations (eg palliative care).
  • Develop strategies to maintain health and wellbeing; for example:
    • accessing professional support
    • seeking support following difficult or confronting situations
    • managing occupational health risks such as stress and fatigue and work-related safety risks (inside and outside the practice).
  • Have own GP to assist in implementing preventive strategies (including access to screening and healthy lifestyle modifications) to ensure physical and psychological wellness and ability to deliver quality care.
  • Manage fatigue. Fatigue management is an important aspect of self-care, particularly for doctors who work in rural and remote areas with onerous on-call responsibilities.
  • Identify any blurring of boundaries in therapeutic relationships. In the event of a physical or psychological impairment that may impact the GP’s wellbeing or ability to manage their professional responsibilities, a robust management plan may need to be developed in collaboration with other health professionals, as appropriate.

Milestone: Fellowship

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

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

  • Understand the resources and support structures that are available to assist in managing significant ethical issues that can occur in general practice (competency 11.3.1). These include:
    • medical defence organisations
    • consulting with experienced colleagues
    • de-identified case discussions in clinic meetings or small group learning contexts
    • practice policy on issues such as acceptance of gifts.

Do

Do

  • Provide support and/or referral for external medical and/or psychological treatment for colleagues in difficulty.
  • Encourage colleagues to have their own GP and to access appropriate support for their physical and mental health.
  • Recognise need to provide support after distressing experiences (competency 11.4.3).
  • Maintain duty of care when colleagues lack insight or have reduced capacity to practice; maintain professional boundaries. For example, avoid prescribing medication for colleagues or providing medical opinions about their health.
  • Identify colleagues who may be in difficulty; for example, experiencing mental health problems, bullying, personality issues (eg narcissistic personality disorder), substance use or physical health problems.
  • Be aware of mandatory reporting responsibilities if a colleague is conducting themselves in a way that meets the notification guidelines, specifically if they may be placing the public at risk (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).

Know

  • Understand that mentoring is typically beneficial for both the mentor and the mentee; understand the skills that are relevant in developing effective mentor–mentee relationships.
  • Recognise that many professionals experience a range of emotional responses following a critical incident, and that informal debriefing or ‘touching base’ is an important part of stress management for health professionals.

Do

  • Avoid blaming any individual.
  • Identify any processes or barriers in the clinical environment that may have contributed to a distressing experience, to inform quality improvement strategies.

Be

  • Be compassionate, respectful and empathic.

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

Do

  • Establish structures to support reflection on own professional performance and ethical conduct compared with peers and colleagues, and identify areas for improvement.
  • Incorporate these into learning plans.

Be

  • Be self-reflective and committed to ongoing learning and personal development.

Know

  • Know the challenges of working in geographic and professional isolation, including working in rural and remote areas, after hours or in solo practice.
  • Recognise the impacts of professional isolation on delivery of safe patient care and perosnal health and wellbeing.

Do

  • Actively plan and implement plans to manage professional isolation, such as through the support of colleagues or other professionals as required, personal wellbeing strategies, and plans to integrate into local communities.

Be

  • Be self-aware and proactive.
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