Professional responsibility

As the UK GMC10 states, a doctor must always be prepared to justify their actions. Many of the professional codes stress the importance of behaving in a proper manner so as not to bring the profession into disrespect. For example, the German code12 requires that doctors will preserve the honour and noble tradition of the medical profession to the best of their ability, exercise their profession scrupulously and with dignity and also protect the freedom and reputation of the medical profession. The UK medical code10 is more explicit about the requirement to identify and report unprofessional behaviour by acting quickly to protect patients from risk where there is good reason to believe that Òyou or a colleague may not be fit to practiseÓ. Similarly in Ireland, where risk to a patient exists in relation to a colleagueÕs conduct or competence, doctors should express their concern to the colleague concerned in the first instance, followed by local systems and then if necessary reporting to the Medical Council. In Norway11, if a doctor has concerns about a fellow worker e.g. that they are ill or misusing drugs, they are also told to first raise this directly with their colleague. Care should be taken especially with medical students and junior doctors. If this does not solve the matter, the Norwegian doctors11 should take the matter up with the administratorÕs superior or the health authority. An onus is also placed on doctors to take care of their own health and seek help if it is needed.

The relationship with colleagues is important when defining what it means to be a professional, in terms of teamwork, training, and maintaining professional standards. UK nurses must co-operate with others in the team. German doctors12 must pay respect to their teachers and colleagues. UK doctors10 should work with colleagues in the ways that best serve patientsÕ interests. The Irish guide14 suggests that doctors should give professional support to each other and that denigration of a colleague is never in the interests of patients and should be avoided. In Norway11, doctors are also warned to be careful when criticising colleagues especially in front of patients and others, but they are also reminded that they must always have the patientÕs best interests at heart.

Self regulation is an important criterion for the definition of a profession. The Irish guide14 to ethical conduct and behaviour defines misconduct in terms of what other colleagues expect. Thus misconduct is considered to be:

Ò(a) Conduct which doctors of experience, competence and good repute consider disgraceful or dishonourable; and /or

(b) Conduct connected with his or her profession in which the doctor concerned has seriously fallen short by omission or commission of the standards of conduct expected among doctors.Ó

Another characteristic of a profession is the maintenance of Òprofessional knowledge and competenceÓ. 15 The Polish code states that ÒIt comes within duties of each physician to constantly supplement and improve his/her professional knowledge and skills as well as to share own experience and skills with other fellow-physicians.Ó 13 Similarly in Norway11, doctors are instructed to maintain their knowledge and seek to improve it. Public health specialists would share concerns about professional standards in terms of training and maintaining professional competency.

The PHLS Principles18 refer to the main sills, processes and activity used by public health professionals such as seeking Òthe information needed to implement effective policies and

programsÓ(P5) and engaging Òin collaborations and affiliationsÓ (P12). Acting in Òa timely mannerÓ (P7) on this information, and maintaining professional competence (P11) are also required, which are competencies that would be expected within any professional code of ethics.

The PHLS guidance notes19 for principle 11 suggest that the criteria for professional competence would have to be specified by individual professions, such as epidemiology and health education. As with the various professional codes of conducts for clinicians, professional competence is key if a public health professional is to do their role, but also to effectively work with other stakeholders, including those within the general public. However, as various professional bodies have discovered, designing a system to facilitate and monitor these competences can be complex and is often bureaucratic.

2.10 Trust

The German code12 also refers to the importance of maintaining and enhancing confidence between physicians and patients. This issue is also prominent in the UK, where doctors10 are required to Òbe trustworthyÓ. The UK nursing code15 is explicit about the link between acting as a responsible professional and trust: ÒPatients must be able to trust doctors with their lives and well-being. To justify that trust, we as a profession have a duty to maintain a good standard of practice and care. avoid abusing your position as a doctor.Ó In Ireland, it is recognised that Òthe position of trust and privilege held by doctors in the community is founded not only on technical knowledge and skill, but also on high standards of personal and professional behaviour at all times.Ó

Maintaining trust is a recurrent theme throughout the PHLS guidelines.18 For example, the accompanying text for P12 specifically refers to conflicts of interests undermining public trust. As with doctors and nurses, public health professionals must also be trustworthy, although the degree of dependence of an individual patientÕs life, let alone that of a healthy member of the general public, on the actions of a public health professional is of course less. There should be trust in a public health professional to protect and promote the well-being of the population as a whole. However, this trust has been eroded by various public health scares and scandals, e.g. Bovine Spongiform Encephalopathy(BSE)/ new variant Creutzfeldt- Jakob Disease (CJD), and the combined measles, mumps and rubella (MMR) vaccination. Public health professionals will have personal beliefs too, as with clinical decision making, these will always be there at a sub-conscious level, but as far as is practicable should not prejudice decision making.

Requirements to treat people with respect and consideration for dignity, privacy etc would apply at a population level too. Of course, respect for dignity and integrity does not mean that a public health professional must do everything that an individual or even what the majority of a population may want, just that their interests should be considered along with the interests of other individuals and groups in the population. All data and information should be respected as confidential, but as at an individual patient level, there may be circumstances when public interest requires that confidentiality should be broken. In such circumstances care must be taken to restrict the breach of confidence to ensure that there really is a genuine public interest requirement and that only the minimum amount of information is disclosed to appropriate third parties, who are also aware of their obligations.