The professional behavior MAM Ibnouf, FRCSEd

Rationale: With development communities tend to have: 1- changes in the Free Market policies, 2- socioeconomic, 3- ethnical, 4- gender and 5- religion diversities. 6- increased interference of the public press, 7- more awareness of cost effective and safe services These have led to great stress and demand for developing new trends toward medical care.

What do you need to know before you join the hospital staff?

OUTLINES 1- The importance of respect 2- How we put this respect into actions: 3- Special emphasis on a- Collaboration b- Honesty c-Evidence for group-work

1- Respect of others 1- You need to know the hospital procedures 2- You need to know what your rights are? 3- You need to know what should you expect? 4- You need step by step help. 5-You need a member of hospital staff to answer your questions and 7- you need to appropriately to answer your patients’ questions. So, You need to respect all hospital staff.

2- Patient rights 1- Right to be treated 2- “ ”” “” “” in privacy 3- “ ”” “” “” to consider their dignity 4- “ ”” “” “” to consider their respect 5- To be protected against abuse 7- “” “” “” “” harm 8- To accept and/or refuse their treatment 9- Not to disclose their secrets

10- Rights of the procedures: e.g. The right drug in the right dose in the right site at the right time Observing these rights will minimize litigations

3- Respect of doctors image 5- You need a guide. 6- You need to know about safety: a- your personal safety b- your patient safety, c- the safety of the environment So, 1- So, You need to respect all hospital staff. 2- Wash your hand to protect yourself, your patient and the environment to be well respected

4- Health advocacy 7- As a junior, you need to have an advocate for you and you yourself through your deeds should be an advocate for your patient as well. 8- You need to have some beside you for support and explaining things. The hospital is a busy place. So, you need to 3- work in a group. The medical practice is not a single person show.

5- Professional behavior self-regulation & lifelong learning 1- Dress tidily, talk kindly (avoid nagging and harsh statements) to be your own advocate to be well respected 2- Be honest, polite and show kindness to others particularly your patients 3- Show empathy for your patients 3- Dedicate yourself to your a- patients b- professional future

6- Professional behavior Show due respect to your colleagues, senior doctors, nurses and other workers in the health profession you are going to work in. Professional behavior Improve your personal image

Unprofessional attitudes: 1-Arrogant 2-greed 3-misperception 4-lack of conscience 5- Impairment 6- Conflict of interest

7- Professional behavior: teamwork Be an active and effective member of your group The team work reduces morbidity and mortality The team members work in an integrated maner

The effective team 1- Clear purpose 2- Good communication 3- Mechanisms for resolving conflicts 4- Has the patient at the centre of its focus 5- Has trust on each other faithful engagement 6- the team coordinate and collaborate to improve patient care enhance patient safety and reduce staff burnout

The effective team The professional collaboration of the integrated work of the teams in the hospital and the primary care system, the consultants, junior doctors, sisters. Physiotherapists, etc leads to: 1- Patient satisfaction when morbidities are reduced 2- Public satisfaction 3- Members satisfaction 4- improves the inter-professional collaboration 5- Better retention of the jobs 6- Justified use of financial resources 7- Fulfillment of the social contract

The evidence So far there is no enough evidence to support that once you have done something to improve the team work the out come improves because of: 1- The complexity of the inter-professional communication and collaboration 2- One of the big challenges is between the professionals who like to work in integrated inter-disciplinary groups and the policy makers who would like to reduce costs of management and money spent in training

Patient safety An emergency case may have a wrong procedure or wrong drug. For this patient patients are encouraged to become part of the health care team

Tips to the patients SPEAK UP 1- Speak up with questions and concerns 2- Pay attention to the care you are receiving 3- Educate yourself 4- Ask a friend or a family member to be your advocate 5- Know what medications you take and why 6- Use a medical facility committed to safety and quality 7- Participate in any and all decisions about your treatment

The SPEAK UP campaign Every one has a role in improving the patient condition and safety but the patient involvement in in the health care team according to the centres of Medicare and Medicaid

Apologizing effectively If something went wrong: The patient and his guardian may feel worried What do patients and his guardian want? Patients want to know what is going on What is the right thing to do?

The right thing is to: 1- be honest and tell him and/or his guardian what happened 2- Explain why it happened 3- Apologize for that 4- Tell them what is the next step to be done

Avoid 1- blaming the others (doctors or nurses) 2- Tell the truth and 3- Tell him you will find out why it happened and you will feed him back 4- tell him what is the next step to be done

What is the consequence of apologizing 1- most likely the patient will respect your honesty and will withstand for the next step of management 2- even if he complain the compensation will be much less than when you dismiss your responsibility 3- this is because it is known that medical errors are un- intentional and also it is believed that people who go to medical schools are: a- intelligent, b- hard working, and c- the community needs their service d- they are just helpers in healing

Honesty Honesty of professions: Annual Gall Pull updates Americans views: Nurses 83% Grade school teachers 74% Pharmacists 71% Military officers 65% Medical doctors 64% Layers 15% Congressmen 9% Car salesmen 5% Lobbyist 5% USA Today /Gall Poll Nov-Dec 2007

In conclusion Professionalism: Aspiration towards altruism, accountability, excellence, duty, service, honour, Integrity (honesty), compassion, self-effacement (self-judgment) and self- sacrifice.

Bioethics The 4 principles of bioethics: Nonmaeficence Autonomy: individuals make their own decisions Nonmaleficence: Avoid causing harm Justice: Benefits and risks should be fairly distributed Beneficence: take actions to help others

Do and don’t do 1- Be professionally compassionate and keep a distance for the patient to understand that you are this kind doctor Avoid to become a friend, he may give you something to influence your decision 2- Do pleasant with parents first then with kids. Avoid giving children incentives. This may act as the wrong massage.

Do and don’t do Usually medical staff sustain a lot of stress, and may easily triggered to become angry. Develop a habit to speak politely Never act in a rude, offence unprofessional manner

Management of disruptive behaviour Such incidence may not be passes as isolated incidence Should be managed as follows: 1- Systematically 2- Collegially 3- Effectively the result you will be saving a good doctor for a bright future

Management Provide periodic feed back Measure performance against expectations Set measures for communication and performance and expectations Appoint excellent physicians