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CODE OF CONDUCT & OTHER SUNDARY ISSUES. BY DR. B. A. ADIGUN Ag .P. S. OYO STATE HOSPITALS MANAGEMENT BOARD. & CHAIRMAN MDCN MONITORING COMMI TEE (OYO STATE CHAPTER). PREAMBLE CODE OF CONDUCT i.e. (MEDICAL ETHICS) OBJECTIVES OF CODE OF CONDUCT HYPOCRATIC OATH ALLEGIANCE TO PROFESSIONS

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Code of conduct other sundary issues

CODE OF CONDUCT&OTHER SUNDARY ISSUES.

BY

DR. B. A. ADIGUN

Ag .P. S. OYO STATE HOSPITALS MANAGEMENT BOARD.

&

CHAIRMAN MDCN MONITORING COMMI TEE (OYO STATE CHAPTER)


Code of conduct other sundary issues

  • PREAMBLE

  • CODE OF CONDUCT i.e. (MEDICAL ETHICS)

  • OBJECTIVES OF CODE OF CONDUCT

  • HYPOCRATIC OATH

  • ALLEGIANCE TO PROFESSIONS

  • MEDICAL & DENTAL COUNCIL OF NIGERIA.

  • MEDICAL (professional) NEGLIGENCE.

  • CRIMINAL NEGLIGENCE.

  • MALPRACTICES.

  • SUNDARY ISSUES.


Preamble

PREAMBLE

  • MEDICAL profession has been and still remain One of the UNIVERSALLY acclaimed LEARNED and NOBLE professions of the world.

  • Originally there were three primary learned professions a) The physician.

    b) The lawyer.

    c) The priest.


Preamble contd

PREAMBLE contd.

  • The word “Ethics” is derived from Greek word “ethos “ which means Customs and Habits i.e. something in conformity with moral, norms or standard of professional conduct. It is a science of knowledge which deal with the nature and grounds of Moral obligations, distinguishing what is right from what is wrong.


Preamble contd1

PREAMBLE contd.

The code of conduct serves asguiding standardsfor the relationship of medical and dental practitioners on one hand,

a) with the profession,

b) their colleagues,

c) their patients,

d) members of allied professions

e) and the public on the other.


Objectives of code of conduct

Objectives of code of Conduct

  • a) to enable Medical &Dental practitioners in Nigeria to maintain correct attitude universally expected of physicians.

    b) to meet the standard set by Medical & Dental Council of Nigeria with regards to Ethics and Quality of professional practice.

    c) to ensure that Medical & Dental practitioners perform their duties in a manner that earns the trust of Patients and the respect of the society for the profession.

    d) to let the Public know what to expect from Medical practitioners.

    e) to serve as standard to be used by disciplinary organs of MDCN to determine professional conduct.


Hippocratic oath

Hippocratic Oath.

  • Newly qualified medical doctors & dental surgeons shall be formally INDUCTED into the professions respectively at a ceremony during which the Hippocratic (Physicians) Oath shall be administered to them and shall obtain from these grandaunts, a pledge to obey ALL the rules and Regulations which guide medical and dental practices in Nigeria i.e. (Oath of Allegiance to the Profession).


Hippocratic oath contd

Hippocratic Oath contd.

  • The Hippocratic Oath.

    I SOLEMNLY PLEDGE,

    a) To consecrate my life to service of humanity:

    b) I will give to my teachers the respect and gratitude which is their due:

    c) I will practice my profession with conscience and dignity:

    d) The health of my patient will be my first consideration:

    e) I will respect the secrets that are confided in me, even after the death of the patient:


Hippocratic oath contd1

Hippocratic Oath contd.

f) I will MAINTAIN by all means in my power, the honor and the noble traditions of the medical profession.

g) My colleagues shall be my sisters and brothers:

h) I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to influence between my DUTY and my patient:


Hippocratic oath contd2

Hippocratic Oath contd.

i) I will maintain the utmost respect for human life:

j) I will not use my medical knowledge to violate human rights and civil liberties, even under threat:

k) I make these solemn declarations freely and upon my honor.


Allegiance to the corporate body of the profession

Allegiance to the Corporate Body of the Profession.

Mandatory allegiance exist between a doctor or dentist and the corporate body of the profession i.e.

  • The Nigerian Medical Association.

  • Medical and Dental Council of Nigeria which is a regulatory arm statutorily set up by LAW to enhance the standard of service provided to the public and equally protecting the profession from unnecessary encroachment by QUACKS.


Medical dental council of nigeria mdcn

MEDICAL & DENTAL COUNCIL OF NIGERIA (MDCN).

Medical and Dental Practitioners Act, Cap 221 Laws of the Federation of Nigeria 2004. gives the much needed legal backing to the Authority of the council (i.e.MDCN.) over all medical practitioners and dental surgeons in Nigeria.


Functions of m d c n

FUNCTIONS OF M.D.C.N

a)Determining (and reviewing from time to time) the level of knowledge and skill that must be attained to become members of medical or dental profession.

b) Maintain a register of persons entitled to practice as members of medical or dental profession.

c) Reviewing the code of conduct from time to time as considered desirable.

d) Make rules for professional conduct.


Functions of m d c n cont

FUNCTIONS OF M.D.C.N. cont.

f) EMPOWERED to establish

i) Medical and Dental Practitioners Investigating Panel.

ii) Medical and Dental Practitioner Disciplinary Tribunal.

iii) Committee on Practitioner’s Health.


Who is a medical practitioner or dental surgeon

Who is a Medical Practitioner or Dental Surgeon

Persons who have

i)under gone the course of training based on curriculum for Medical and Dental education which is approved by Medical and Dental Council of Nigeria and have OBTAINED certificates approved OR recognized by the Council.

ii) have been registered with the Council.

iii) licensed by M.&D.C.N.


Registration of medical and dental practitioners

REGISTRATION OF MEDICAL AND DENTAL PRACTITIONERS

Medical & Dental Practitioners Act CAP 221 1990, .

A person shall not hold an appointment or practise as a medical practitioner or dental surgeon UNLESS he\she is registered with the M&DCN.

“ It is the act of REGISTRATION and not the medical qualification that confers on the practitioner the LEGAL RIGHT to practice medicine or dentistry in Nigeria”.

This emphasizes the importance of registration with Nigerian Medical Council before engaging in any form of medical practice.


Registration of medical and dental practitioners contd

REGISTRATION OF MEDICAL AND DENTAL PRACTITIONERS Contd.

a) Provisional Registration:

- for internship.

- registration lapses when signed off.

- internship must be completed within TWO years of graduation.

  • Full Registration:

    - is obtainable after satisfactory completion of internship

    -confers legal right to practice on his own, but he\she must recognise limitations.

    c) Registration as a Specialist:

    - have acquire specialist training from National Postgraduate Medical College .

    - validly sign off interns.

    d) Limited or Temporary Registration: specific period of validity.


Practising fees licensing

PRACTISING FEES \LICENSING

Medical & Dental Practitioners Act CAP 221 1990.

NO registered medical practitioner or dental surgeon shall practise in any year UNLESS he\she has paid to the Council in respect of that that year the appropriate practising fee.

The regulation of the Council expect ALL practitioners to pay their practising fee for the ensuing year before the 31st December of the preceding year in other to remain currently licensed on the first day of the New Year.

Practising Fee

  • 0 – 10 years N6,000:00

    b) >10 years N10,000:00


Practising fees licensing contd

PRACTISING FEES \LICENSING Contd.

Medical practitioner or Dental surgeon who practises without paying the prescribed fee shall be Guilty of an offence and shall be liable on conviction:

- first offender shall be fined twice the prescribed fee

-second offender , to a fine not less than TEN times the prescribed practising fee.

Keeping such medical\dental practitioner in employment of any person or institution makes such employer guilty of a punishable offence.

LATE payment of the practising fee attract a surcharge determined by Council from time to time.


Medical professional negligience

MEDICAL (professional) NEGLIGIENCE

  • The basic RULE is that negligence consist of DOING something which a reasonable medical practitioner would not have done in that situation or OMITTING to do something which a reasonable medical practitioner would have done in that situation.


Medical professional negligence

MEDICAL (professional) NEGLIGENCE ……..

This means the failure on the part of a medical and dental practitioners to exercise reasonable degree of skill and care in the treatment of a patient resulting in arm or damage to the patient.

Characteristics of NEGLIGENCE; for a medical practitioner or dental surgeon to be negligent he\she must

a) Owe a duty of care to another person i.e. patient.

  • He\she must have committed a breach of that duty of care.

    c) The patient must have suffered damage(s) as a result of the breach of duty of care.


Medical professional negligence contd

MEDICAL (professional)NEGLIGENCE Contd.

Breaches of duty committed by doctors include:

  • Failure to give ATS or tetanus toxoid to a road traffic crash victim and the patient later develops Tetanus.

  • If a doctor fails to attend to a patient when called to see a patient.

  • If a doctor fails to make a diagnosis (manifestation of incompetence in patient assessment) e.g. if analgesic is given to patient who came to hospital with acute abdominal pain and sent home.

  • If patient collapse and die after an injection of penicillin, or develop injection abscesses


Medical professional negligence contd1

MEDICAL (professional) NEGLIGENCE Contd.

v) Failure to obtain inform consent before proceeding on any surgical procedure.

vi)Failure to refer or transfer a patient in good time when such referral was necessary.

vii)Failure to advise, or proffering wrong advice, to a patient on the risk involved in a particular operation or course of treatment especially if the treatment involves loss of an organ, function or deformity.


Medical professional negligence contd2

MEDICAL (professional) NEGLIGENCE Contd.

viii) In instances where the legal axiom RES IPSA LOQUITOR (the fact speaks for itself) is applied.

  • In such cases the doctor have done something that is palpably wrong and he \ she is in court to plead for mercy e.g.

    a) operating on wrong patient.

    b) amputating wrong limb.

    c) leaving swabs and surgical instruments in the abdomen of patient.


Medical negligence contd

MEDICAL NEGLIGENCE Contd.

WHO MAY SUE

Every person of full age of 18 years can sue provided he\she is

i) someone to whom duty of care is owed.

ii) someone who by statutes is conferred such right e.g. where death occur as a result the negligence.

iii) minor (not yet 18years) having a cause of action can sue through his parent or guardian.


Medical professional negligence contd3

MEDICAL (professional) NEGLIGENCE Contd.

Proof of Negligence.

Except in cases of res ipsa loquitur (the thing speaks for itself), the patient (plaintiff) must be able to proof that

- the injury or harm was actually caused by the breach of care and it is not traceable to any remote cause(s).

-the facts proved must point to the defendant as being the negligent party.

9


Medical professional negligence contd4

MEDICAL (professional) NEGLIGENCE Contd.

Recurrent Professional Negligence: refer to practitioner appearing before Disciplinary Tribunal for the second time and is found guilty.

Gross Professional Negligence; extent of negligence resulted in permanent disability or death of the patient, and the practitioner found guilty is liable to:

  • Suspension for a period of SIX months: or

  • Having his\her name STRUCK of the medical or dental register, as the case may be.


Criminal negligence

CRIMINAL NEGLIGENCE.

There must be evidence of Reckless Disregard for the Life and Safety of the patient.

“Section 303 of the criminal code of Nigeria”: imposes the duty on any person who performs surgical or medical treatment on any other person, to have reasonable Skill and to use reasonable Care in doing so.

The “state “ prosecutes the doctor and doctor is charged for Manslaughter depending on the circumstances of the case.

Unlike in civil negligence


Criminal negligence contd

CRIMINAL NEGLIGENCE Contd

The LAW demands that it should be “proved beyond reasonable doubt, that the Doctor’s action constitute a deliberate or reckless disregard for the patient’s life and safety.”

  • R. v Bateman (1952). He was found guilty of criminal negligence and convicted for Manslaughter.

  • R. v Akerele. Dr Akerele was acquitted by the Privy Council in England.


Malpractices

MALPRACTICES

The practice of medicine and dentistry shall be conducted according to standards ( set by Medical and Dental Council of Nigeria), by methods adjudged acceptable, by registered medical and dental practitioners.

Any medical or dental practitioner who is found by statutory procedure, to have failed to meet the professionally accepted standards, methods or decorum, shall be guilty of MALPRACTICE.

Practitioners should learn not to take cases he\she cannot effectively handle in terms of;

  • Skills.

  • Facilities.


Malpractices contd

MALPRACTICES Contd.

Other forms of malpractices include:

  • Issuing sick certificate retrospectively .

  • Issuing sick certificate beyond the duration of illness and period of convalescence.

  • Issuing false sick or death certificate.

  • Deceit of patient to extort money.

  • Aiding unprofessional practice of medicine and dentistry i.e.. unauthorised practice of medicine or dentistry by any person, agency or corporate body.


Malpractices contd1

MALPRACTICES Contd.

  • Association with Chemists, Opticians , Dental Technologists, Optometrists, Non-Medically qualified persons and insurance agents by means of commission arrangement etc.

  • Association with Midwives or Nurses operating maternities or Nursing homes.


Sundary issues

SUNDARY ISSUES.

CONVIDENTIALITY.

A medical practitioner or dental surgeon shall preserve absolute secrecy on all he\she knows about his patient even after the death of the patient. Adherence to this ethical issues of confidentiality embraces:

  • Protection of patient’s medical records.

  • Maintenance of confidentiality in the process of further consultation.

  • Discretionary breach of confidentiality to protect the patient or the community from imminent dangers.

  • Release of information only following the granting of informed consent by the patient.

  • Breach of medical confidentiality in a law court upon being directed by the presiding judge.


Sundary issues contd

SUNDARY ISSUES Contd,

Self-Advertisement:

Physician should refrain from self-advertisement because it could become a source of danger to the public. It may precipitate unwholesome rivalry among practitioners.

  • a registered practitioner who breaches this code of ethics would be found guilty of Infamous conduct in a professional respect if proved.

  • Signboards and Signposts of not more than120cm by 90cmwhich shall bear only the name of Hospital and or clinic is permisible


Alcohol and drugs

ALCOHOL and DRUGS

Conviction for alcohol or drug related offences is a discreditable action to the profession and a clear danger to patients. Practitioners may be adjudged guilty of infamous conduct on the following grounds:

  • If convicted by any court for drug-related offences.

  • If found to be on drugs or under the influence of drugs.

  • If there is evidence that he was under the influence of alcohol or drugs while attending to patients.

  • If the practitioner indulges in the abuse of dangerous drugs or abuse of privileges conferred on medical and dental practitioners by the Dangerous Drugs Act and Regulations.


Euthanasia

EUTHANASIA

Runs contrary to one of the cardinal principle of the Physician’s Oath. A doctor should not terminate life whether the patient is in a sound health or terminally ill. A practitioner shall be adjudged to be in breach of the ethical code of practice if found to have encouraged or participated in any of the following acts:

  • Termination of a patient’s life by the administration of drugs, even at the request of patient.

  • Prescribing or supplying drugs with the explicit intension of enabling the patient to end his\her life.


Code of conduct other sundary issues

  • Termination of a patient’s life through the administration of drugs with or without the patient’s explicit request thinking same to be in the interest of the patient.

    FITNESS TO PRACTICE.

    Like any member of the society, medical practitioners and dental surgeons are prone to various ailments and undesirable habits. This ailments and habits may impair the productivity, judgment and alertness of the practitioners and render them unreliable. The council regard the following as conditions which could render a practitioner UNSAFE and constitute obstacles to fitness to practice medicine or dentistry:


Fittness to practice contd

FITTNESS TO PRACTICE Contd.

  • A practitioner suffering from Senile Dementia.

  • A practitioner suffering from physical or mental conditions which can imperil his patients, embarrass his professional colleagues and indeed jeopardize his own career and professional position.

  • A practitioner who has become addicted to drugs and might or indeed does commit offences against the Dangerous Drug Act and Regulations.

  • A practitioner addicted to alcohol who might not be or is not in the right frame of mind.


Procedure to determine fitness to practice

PROCEDURE TO DETERMINE FITNESS TO PRACTICE

Most times problems are encountered with the methodology of determining fitness to practice. Misgivings of any is eliminated by setting up Ad-hoc Committee on Practitioner’s Health comprising of the following members whom shall not be less than Fifteen (15) years post registration.

  • Physician

  • A psychiatrist

  • A dentist

  • A community Health\Occupational Physician.

  • One (1) other non-medical member.


Code of conduct other sundary issues

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