Practising within your expertise

Care and treatment in an emergency

In an emergency, doctors are expected to offer assistance, whether or not they feel that they are the best person to provide treatment. In these circumstances, a doctor is expected to do what he can in terms of providing first aid or immediately necessary treatment, within the limits of his competence, to ensure that the patient’s condition is stabilised and, at the very least, to prevent others from doing harm.

In an emergency, doctors are expected to offer assistance, whether or not they feel that they are the best person to provide treatment

Case example

Dr Lim, a dermatologist, is walking along a busy street when a cyclist comes out of a side road and is hit by a car. Dr Lim runs over to give first aid. The cyclist is unconscious. Dr Lim prevents the other bystanders from trying to move the patient, checks the cyclist is breathing and asks someone to call for an ambulance. The cyclist’s leg is bent awkwardly, suggestive of a probable fracture. Dr Lim hasn’t done any trauma work since he qualified 20 years ago. He checks distal pulses are present but does not attempt to straighten or otherwise manipulate the fracture, instead waiting for the ambulance crew to take over.

Acting as a professional or expert witness

The duty to act within one’s expertise extends beyond the remit of day-to-day clinical practice and is equally applicable to writing reports and giving evidence in court. As in clinical practice, when giving an opinion in these circumstances, doctors should ensure that they confine themselves to matters within their expertise and that they are prepared to justify their opinion and support it with evidence if called upon to do so. Before accepting instructions to act as an expert, doctors should ensure that they have the appropriate skills and knowledge to fulfil the requirements of the proposed brief.

Case example

Dr Ho, a family physician, is approached by solicitors acting on behalf of relatives of Madam Ng, a former patient with progressive vascular dementia, who recently died. There is a dispute over Madam Ng’s will and Dr Ho is asked to write a report about her testamentary capacity. He provides the report, stating that in his opinion Madam Ng had capacity at the time she made her will.

He is called to give evidence in court, where it becomes evident that Dr Ho did not make a formal assessment of Madam Ng’s capacity when he wrote the report, nor can he recall the elements of the tests he should have applied when assessing testamentary capacity. Dr Ho’s credibility is called into question and, as a result, the relatives’ claim fails. They complain to the Medical Council, who reprimand Dr Ho for acting outside his expertise.

Acting outside one’s own experience and knowledge, even with the best of intentions, is rarely in the patient’s best interests

Finally, one of the basic tenets of medical ethics is primum non nocere (first do no harm), another element of the Hippocratic Oath. Acting outside one’s own experience and knowledge, even with the best of intentions, is rarely in the patient’s best interests. Doctors should know their limitations and, when faced with matters beyond their personal expertise, refer patients to those with the appropriate knowledge and skills. In an emergency or where the patient refuses specialist referral, the doctor should do the best he can for the patient within the limitations of his capability.

Important MPS update

Your specialty: are you paying the right subscription?

There is unsurprisingly no general agreement within the profession about specialty boundaries and the procedures they can do. Nevertheless we expect a member to have been appropriately trained, be competent and work within his/her limitations.

Another difficulty arises when a member from a low risk specialty performs the same procedures that are normally performed and would be reasonably expected to be within a higher risk specialty. Members in such a situation must inform MPS so that we can assess whether in fact it would be appropriate to charge a higher subscription in the interests of fairness to all members since the risk would be that of the other high risk specialty group.

Over the years, MPS has been involved in a number of cases where members have been carrying out procedures for which they are not appropriately indemnified. These doctors often may have been paying a lower rate of subscription to MPS but are carrying out high-risk procedures. MPS would like to remind all members to inform us when the scope of your medical practice changes in any way.

If you did find yourself in the position of asking us for assistance after a complaint has been made, and you have not been paying the appropriate indemnity rate at the time of the incident, it may well call into question if we would be able to assist and ultimately you could be liable for covering the costs of any claims that ensue. If you think you may not be paying the correct subscription rate, please contact us to discuss by emailing wendyh@hkma.org, quoting your MPS membership number.