The College of Medicine statement on professionalism (2005)
There are several documents that delineate the expectations of society, the profession and the college with respect to the ethics and professionalism of medical doctors. Three such documents are replicated below.
Note that breaches of professionalism that are egregious and/or refractory to correction may, in themselves and at the discretion of the Undergraduate Medical Education Committee, constitute sufficient grounds for removal from the program, regardless of performance in other aspects of the curriculum.
“Not everything that can be measured is important, and not everything that is important can be measured.” (Albert Einstein)
The College of Medicine statement on professionalism (2005)
We, as teachers, learners and educational support personnel of the College of Medicine, University of Saskatchewan have a responsibility to ourselves as individuals, to each other, and to patients and society as a whole, to understand and exhibit the highest standards of personal, interpersonal, and public professionalism.
- As individuals, we commit to demonstrating the personal characteristics necessary for moral function within the medical profession and the university community, and as representatives of these occupations within society as a whole. Such characteristics will include but are not limited to humility, respect for others, and self-care.
- As caregivers, colleagues and coworkers, we will demonstrate professional interpersonal behaviour in all settings, guided by the values of integrity, accountability, and responsibility.
- As medical professionals, learners, and educational support personnel interacting in the public domain, we will strive to fulfill all reasonable health-related societal expectations, demonstrating at all times compassion, reliability, honesty, respect, and an appropriate level of competence. We will seek to promote the public good and understand the principles of good stewardship. We will adhere to the Codes of Ethics of our professions and occupations.
We consider these to be important standards describing the expectations we have of ourselves and of each other, and will treat any significant divergence as a serious threat to the mission and values of the College of Medicine.
MD Program, College of Medicine specifications of professional conduct
- Honesty / Integrity
- earns the respect of others
- puts truth before personal advantage; e.g., would not alter clinical records or misrepresent other’s work as their own (see also http://www.usask.ca/university_council/reports/09-27-99.shtml)
- records and reports accurately on activities
- Responsibility / Reliability
- is dependable and fulfills commitments; e.g., reliably completes assigned duties and meets deadlines
- is punctual and is not late or absent without justification
- shows a caring attitude; e.g., as evidenced by feedback from patients/relatives/staff/peers
- strives to understand the needs of others, and attempts to meet the physical and emotional needs of patients, as appropriate
- recognizes own abilities and limitations; admits and handles errors and criticism appropriately
- recognizes and declares conflicts of interest
- maintains professional standards and performs procedures according to ability
- balances personal and professional life, and recognizes the need to work safe hours
- recognizes the need for appropriate care of physical and mental health, and seeks help where necessary
- recognizes that use of alcohol or drugs may impair performance and takes appropriate action where necessary
- Doctor / Patient Relationship
- respects the patient’s privacy and dignity and maintains patient confidentiality
- protects the patient’s rights and avoids emotional, sexual, physical or financial exploitation
- behaves equitably towards all, irrespective of gender, age, culture, gender, age, culture, social and economic status, sexual preferences, beliefs, contribution to society, illness-related behaviours or the illness itself
- shows respect for beliefs, rights, roles, responsibilities, abilities and cultural values of others
- shows sensitivity in all interactions with patients and is not aggressive, hostile, derogatory or demeaning
- respects the personal and professional integrity and roles of other health professionals
- respects and co-operates with peers, patients, staff and other members of the community
- Relating to Others
- resolves conflict constructively
- observes agreed behaviour in electronic communication (see University of Saskatchewan Electronic Mail Policy – http://www.usask.ca/university_secretary/policies/operations/4_42.php?heading=menuPolicies)
- uses appropriate language in all written and verbal communication
- willingly participates and contributes in group community activities
- facilitates the learning of others and does not inhibit their efforts
- teaches others who are at earlier stages of learning
*Adapted with permission from the School of Medicine, University of Queensland (see Parker, Malcolm (2006), ‘Assessing professionalism: theory and practice’, Medical Teacher, 28:5, 399 – 403).
The complete College of Medicine breach of professional policy and related documents can be found at: http://www.medicine.usask.ca/education/undergrad/professionalism
The Canadian Medical Association Code of Ethics
(Updated 2004) http://www.cma.ca/index.cfm/ci_id/2419/la_id/1.htm
This Code has been prepared by the Canadian Medical Association as an ethical guide for Canadian physicians, including residents, and medical students. Its focus is the core activities of medicine –such as health promotion, advocacy, disease prevention, diagnosis, treatment, rehabilitation, palliation, education and research. It is based on the fundamental principles and values of medical ethics, especially compassion, beneficence, nonmalfeasance, respect for persons, justice and accountability. The Code, together with CMA policies on specific topics, constitutes a compilation of guidelines that can provide a common ethical framework for Canadian physicians. Physicians should be aware of the legal and regulatory requirements that govern medical practice in their jurisdictions. Physicians may experience tension between different ethical principles, between ethical and legal or regulatory requirements, or between their own ethical convictions and the demands of other parties. Training in ethical analysis and decision-making during undergraduate, postgraduate and continuing medical education is recommended for physicians to develop their knowledge, skills and attitudes needed to deal with these conflicts. Consultation with colleagues, regulatory authorities, ethicists, ethics committees or others who have relevant expertise is also recommended.
- Consider first the well-being of the patient.
- Treat all patients with respect; do not exploit them for personal advantage.
- Provide for appropriate care for your patient, including physical comfort and spiritual and psychosocial support even when cure is no longer possible.
- Practice the art and science of medicine competently and without impairment.
- Engage in lifelong learning to maintain and improve your professional knowledge, skills and attitudes.
- Recognize your limitations and the competence of others and when indicated, recommend that additional opinions and services be sought.
- Resist any influence or interference that could undermine your professional integrity.
- Contribute to the development of the medical profession, whether through clinical practice, research, teaching, administration or advocating on behalf of the profession or the public.
- Refuse to participate in or support practices that violate basic human rights.
- Promote and maintain your own health and well-being.
Responsibilities to the Patient
- Recognize and disclose conflicts of interest that arise in the course of your professional duties and activities, and resolve them in the best interest of patients.
- Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants.
- Do not exploit patients for personal advantage.
- Take all reasonable steps to prevent harm to patients; should harm occur, disclose it to the patient.
- Recognize your limitations and, when indicated, recommend or seek additional opinions and services.
- In determining professional fees to patients for non-insured services, consider both the nature of the service provided and the ability of the patient to pay, and be prepared to discuss the fee with the patient.
Initiating and Dissolving a Patient-Physician Relationship
- In providing medical service, do not discriminate against any patient on such grounds as age, gender, marital status, medical condition, national or ethnic origin, physical or mental disability, political affiliation, race, religion, sexual orientation, or socioeconomic status. This does not abrogate the physician’s right to refuse to accept a patient for legitimate reasons.
- Provide whatever appropriate assistance you can to any person with an urgent need for medical care.
- Having accepted professional responsibility for a patient, continue to provide services until they are no longer required or wanted; until another suitable physician has assumed responsibility for the patient; or until the patient has been given reasonable notice that you intend to terminate the relationship.
- Limit treatment of yourself or members of your immediate family to minor or emergency services and only when another physician is not readily available; there should be no fee for such treatment.
Communication, Decision Making and Consent
- Provide your patients with the information they need to make informed decisions about their medical care, and answer their questions to the best of your ability.
- Make every reasonable effort to communicate with your patients in such a way that information exchanged is understood.
- Recommend only those diagnostic and therapeutic services that you consider to be beneficial to your patient or to others. If a service is recommended for the benefit of others, as for example in matters of public health, inform your patient of this fact and proceed only with explicit informed consent or where required by law.
- Respect the right of a competent patient to accept or reject any medical care recommended.
- Recognize the need to balance the developing competency of minors and the role of families in medical decision-making. Respect the autonomy of those minors who are authorized to consent to treatment.
- Respect your patient's reasonable request for a second opinion from a physician of the patient's choice.
- Ascertain wherever possible and recognize your patient's wishes about the initiation, continuation or cessation of life-sustaining treatment.
- Respect the intentions of an incompetent patient as they were expressed (e.g., through a valid advance directive or proxy designation) before the patient became incompetent.
- When the intentions of an incompetent patient are unknown and when no formal mechanism for making treatment decisions is in place, render such treatment as you believe to be in accordance with the patient's values or, if these are unknown, the patient's best interests.
- Be considerate of the patient's family and significant others and cooperate with them in the patient's interest
Privacy and Confidentiality
- Protect the personal health information of your patients.
- Provide information reasonable in the circumstances to patients about the reasons for the collection, use and disclosure of their personal health information.
- Be aware of your patient’s rights with respect to the collection, use, disclosure and access to their personal health information; ensure that such information is recorded accurately.
- Avoid public discussions or comments about patients that could reasonably be seen as revealing confidential or identifying information.
- Disclose your patients' personal health information to third parties only with their consent, or as provided for by law, such as when the maintenance of confidentiality would result in a significant risk of substantial harm to others or, in the case of incompetent patients, to the patients themselves. In such cases take all reasonable steps to inform the patients that the usual requirements for confidentiality will be breached.
- When acting on behalf of a third party, take reasonable steps to ensure that the patient understands the nature and extent of your responsibility to the third party.
- Upon a patient’s request, provide the patient or a third party with a copy of his or her medical record, unless there is a compelling reason to believe that information contained in the record will result in substantial harm to the patient or others.
- Ensure that any research in which you participate is evaluated both scientifically and ethically and is approved by a research ethics board that meets current standards of practice.
- Inform the potential research subject, or proxy, about the purpose of the study, its source of funding, the nature and relative probability of harms and benefits, and the nature of your participation including any compensation.
- Before proceeding with the study, obtain the informed consent of the subject, or proxy, and advise prospective subjects that they have the right to decline or withdraw from the study at any time, without prejudice to their ongoing care.
Responsibilities to Society
- Recognize that community, society and the environment are important factors in the health of individual patients.
- Recognize the profession's responsibility to society in matters relating to public health, health education, environmental protection, legislation affecting the health or well-being of the community and the need for testimony at judicial proceedings.
- Recognize the responsibility of physicians to promote equitable access to health care resources.
- Use health care resources prudently.
- Recognize a responsibility to give generally held opinions of the profession when interpreting scientific knowledge to the public; when presenting an opinion that is contrary to the generally held opinion of the profession, so indicate.
Responsibilities to the Profession
- Recognize that the self-regulation of the profession is a privilege and that each physician has a continuing responsibility to merit this privilege and to support its institutions.
- Be willing to teach and learn from medical students, residents, other colleagues and other health professionals.
- Avoid impugning the reputation of colleagues for personal motives; however, report to the appropriate authority any unprofessional conduct by colleagues.
- Be willing to participate in peer review of other physicians and to undergo review by your peers. Enter into associations, contracts and agreements only if you can maintain your professional integrity and safeguard the interests of your patients.
- Avoid promoting, as a member of the medical profession, any service (except your own) or product for personal gain.
- Do not keep secret from colleagues the diagnostic or therapeutic agents and procedures that you employ.
- Collaborate with other physicians and health professionals in the care of patients and the functioning and improvement of health services. Treat your colleagues with dignity and as persons worthy of respect.
Responsibilities to Oneself
- Seek help from colleagues and appropriately qualified professionals for personal problems that might adversely affect your service to patients, society or the profession.
- Protect and enhance your own health and wellbeing by identifying those stress factors in your professional and personal lives that can be managed by developing and practicing appropriate coping strategies.
Students' Oath of Commitment
(As declared by students during their White Coat Ceremony at the beginning of Phase A)
As I begin my training as a physician at the University of Saskatchewan, College of Medicine I pledge the following:
I promise to earn the trust and respect of my teachers and to return them in kind, for only through mutual trust and respect can we learn the skills required of a physician.
I will accept responsibility for those medical duties that I feel prepared for; I will hold back when I am not prepared; and I will seek the experience that I need to prepare myself.
I will strive to preserve the dignity, the humanity and the privacy of all my patients, and through my openness and kindness I will seek to earn their trust in turn.
I will treat my patients and my colleagues as my fellow beings and never discriminate against them for their differences; and I will ask that they do the same for me.
I will value the knowledge, and the wisdom of the physicians who have preceded me; I will add to this legacy what I am able, and I will pass it on to those who come after me.
As my skills and my knowledge grow so too will my awareness of my limitations and my errors; I will strive to recognize and understand my weaknesses; And I promise never to put an end to my studying and learning that I might improve myself every day of my practice, in all the years to come.
(Modified from the University of Kansas School of Medicine Oath of Commitment.)