1. Dr Liz Meyer Medical Legal Consultant Medical Protection Society in South Africa Dr Liz Meyer Medical Legal Consultant Medical Protection Society in South Africa HOW TO AVOID GETTING INTO TROUBLE 8 October 2008 PROFESSIONALISM:

2. PROFESSIONAL: WORTHY OF A PROFESSIONAL PERSON, SKILFUL OR COMPETENT.

3. THE HEART OF MEDICINE The relationship a healthcare professional establishes with a patient during a clinical encounter

4. THE IDEAL RELATIONSHIP Empathy “I could be you” Control “A person not merely a patient” Trust Communication Patient expectations

5. PROFESSIONAL MEDICAL PRACTICE Make the care of your patient your first concern

7. Treat patients as individuals, respect their dignity and do not discriminate

8. Patients are people who need you!

9. WORK IN PARTNERSHIP WITH PATIENTS: Listen to them Give them information in a way they can understand Respect their rights to reach decisions with you

10. The times they are a’ changing: Shift from “doctor knows best” to patients’ rights, autonomy and expectations Reduced clinical freedom: MHC, Protocols

11. The Death of Paternalism in UK medicine

12. PROVIDE A GOOD STANDARD OF PRACTICE AND CARE Keep knowledge and skill up to date

13. Recognise and work within the limits of your competence

14. Seek APPROPRIATE help early

15. MANSLAUGHTER There have been a series of these cases in SA many related to giving wrong drug/wrong patient/wrong dose. Pleading inexperience does not protect you in law. “there can be no excuse for a medical man, even though just setting out on his career … if he does not know the dose or the uses …” S v Mkwetshana 1965 If he doesn’t know he must consult There have been a series of these cases in SA many related to giving wrong drug/wrong patient/wrong dose. Pleading inexperience does not protect you in law. “there can be no excuse for a medical man, even though just setting out on his career … if he does not know the dose or the uses …” S v Mkwetshana 1965 If he doesn’t know he must consult

16. MANSLAUGHTER Failure to call specialist “I’m not a monkey” Says doctor to husband who was urging him to call a specialist….. The patient exsanguinated, retained placenta The Dr was convicted and sentenced to 2 years (suspended on appeal) S v Nel 1988 Failure to call specialist “I’m not a monkey” Says doctor to husband who was urging him to call a specialist….. The patient exsanguinated, retained placenta The Dr was convicted and sentenced to 2 years (suspended on appeal) S v Nel 1988

17. What is a good doctor?

18. By marrying the applied scientist & the medical humanist

19. BE HONEST AND OPEN AND ACT WITH INTEGRITY

20. If you put your integrity on the line, you’re …

21. Act without delay if you have good reason that patients may be at risk.

22. Rodney Ledward & Richard Neale Disgraced Gynaecologists (UK)

23. “Fastest gynaecologist” in the SE. 7 Hyst / am Pressurized patients into private treatment & into unnecessary operations Removed ovaries without discussion or consent Surgical incompetence, eg:hyst, cut both ureters & repaired without urologist, perforated bladder, post op bleeding, ordered tests & left, but uncontactable 198 Claims for damages, dozens already settled Rodney Ledward

24. ‘The profession has got rid of a first class consultant, I say that with no conceit whatsoever, looking in the mirror, feet on…’ ‘I have no regrets. I’m a perfectly capable gynaecologist…I’ve done a first class job & had my errors like everyone else’ ‘Mr Ledward is conceited, deluded….and breathtakingly arrogant. I Bogle, Chairman BMA

25. Ask for help early & follow professional advice

26. Never abuse your patients’ trust in you or the public’s trust in the profession

27. Make sure your examinations are appropriate

28. Beware of personal body contact

29. Don’t bury your head in the sand! CALL the MPS