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Ethics for All 2019 – Rise to the Challenge

24 October 2019

Ethics for All provides an opportunity for delegates to examine the many ethical challenges you face as clinicians and we have been hosting the event in South Africa for over a decade.

This year’s events were held in Durban, Pretoria and Cape Town, attracting more than 2,000 delegates across the three events. Ethics for All explores the big issues faced by doctors, dentists and healthcare professionals and provides insights on how to tackle ethical challenges with confidence.

Chaired by Dr Graham Howarth, Medical Protection’s head of medical services (Southern Africa), this year’s event explored themes around professionalism and leadership, burnout and the link with medicolegal risk, power outages and the impact on patient safety, and culpable homicide.

Opening the events, Simon Kayll, chief executive of Medical Protection, discussed the concept of mutuality and what it means for members, highlighting our 127 years that we have been working to protect the careers, reputations and security of members around the world.

Mr Kayll discussed our investment in South Africa and confirmed that there is more to come, with key highlights including getting closer to members; investing in more professional staff in-country; and a new MPS Council member from South Africa who has recently been appointed. He confirmed that we are also addressing costs and becoming more financially secure, as well as increasingly using our data to help identify and manage risk.

Professor Jonathan Jansen, Distinguished Professor of Education at the University of Stellenbosch, took the ethical temperature in the room. Professor Jansen, who has a large following on social media, asked his followers in the weeks before the events: “What one thing do you expect from your doctor?”

He received thousands of responses from his followers and, from the responses, he was able to identify several recurring themes. The top ten themes he discussed included:

  1. Care – Treat me as a whole patient; Engage with me as a patient not a body part

     

  2. Respect – Respect me by being on time

     

  3. Integrity – Do not share information about me

     

  4. Listen – Listen to hear not just to prescribe

     

  5. Consultation – Give me a sense of hope … even if only the promise of pain relief

     

  6. Humility – To acknowledge you might not know; to be honest about your limitations

     

  7. Consideration – Do not rush

     

  8. Recognition – Listen to me. Take me seriously. I may know a little something about my condition

     

  9. Connection – Communicate well so that I can understand

     

  10. Honesty – Be honest with me

Burnout

The demand placed on modern clinicians means the possibility of burnout is growing significantly, impacting both the quality of care and potential increase in risk to patients. Burnout is a topic we have covered at the last few Ethics for All conferences and we believe it is an important topic for members and the healthcare profession as whole.

Dr Pallavi Bradshaw, medicolegal consultant and education lead at Medical Protection, explained that evidence strongly suggests the incidence of burnout in doctors is significant and that burnout is linked to medicolegal risk.

This evidence is showing that burnout is prevalent across the world – in the USA and in every country that Medical Protection and Dental Protection have members. Clinicians with burnout are more likely to subjectively rate patient safety lower in their organisations and to admit to having made mistakes or delivered substandard care at work; they are less empathic, less able cognitively and can have a negative impact on colleagues, teams and the organisation.

Medical Protection recently conducted a survey among members to gauge their experience and understanding of burnout. Its findings were discussed in more detail by Dr Bradshaw and more on this will be released by Medical Protection in the near future.

Dr Bradshaw concluded her presentation with some top tips, with the final one from Adrian Plunkett, a neonatologist who has founded an organisation called LfE (Learning from Excellence). He quotes his wife – also a doctor: “Saying thank you or well done might be the simplest quality improvement intervention of all.”

Power outages and patient safety

The next topic was on the issue of power outages and the impact on patient safety. Loadshedding in South Africa is a very real and ongoing issue and Dr Tony Behrman, medical business and medicolegal consultant at Medical Protection, discussed the importance of having a contingency plan in facilities where power outages are likely to occur.

Dr Behrman explained that since January 2019, over 60% of all major incidents reported in a large chain of national hospitals were related to power outages, with 225 incidents reported per month.

He discussed the legal position for South African doctors and dentists around the issues of power outages and plunged the lecture theatres into complete darkness for 30 seconds to demonstrate exactly how dark it would be in a hospital and the impact it would have on patient safety. The 30 seconds felt like a lifetime and delegates were grateful when the lights came back on. Dr Behrman’s top tips includes:

  • Surgical teams who are working in a facility where power outages are likely to occur must have a contingency plan in place.
  • They should confer regularly with the general manager of the facility and carefully consider their advice and explanation of the risks of losing back up power.
  • Should the 16.2 appointee advise not to proceed with further cold cases, this advice should be taken extremely seriously.
  • A doctor who ignores this advice could put a patient’s safety at risk and this could also form the basis of a clinical negligence claim, an inquest and even a possible ensuing criminal charge.

Culpable homicide

The conference concluded with a look at “Culpable homicide – Is the sword of Damocles hanging over our head” and was presented by Dr Izak Loftus, forensic pathologist and histopathologist. Dr Loftus explained that healthcare professionals are aware of the potential consequences of any disciplinary hearing by the HPCSA, or a civil law suit because of alleged medical negligence. However, many healthcare professionals tend to ignore the fact that medical negligence may amount to a criminal offence (culpable homicide or manslaughter) if it contributed to the demise of the patient.

If found guilty of such an offence, a custodial sentence may be handed down; however, until now it has always been a suspended sentence or with the option of a fine, but this has changed. In a recent South African case, a gynaecologist was sentenced to five years’ imprisonment, without suspension or the option of a fine.

Dr Loftus summarised his findings, concluding:

  • If your patient dies, and you are found guilty of negligence, you may be charged with culpable homicide.
  • Your punishment will depend on the severity and circumstances of the offence.
  • If the court finds you were grossly negligent, it may impose a jail sentence as an appropriate sanction.

Medical Protection is proud to provide education and risk management events for doctors, dentists and other healthcare professionals, to help them improve their knowledge and skills and thereby reducing the risk of litigation and complaints. Ethics for All, our annual flagship event for healthcare professionals, brings together local and international speakers from the healthcare profession and beyond, to provide guidance and help doctors, dentists and healthcare professionals to practise safely and ethically. We hope that all delegates enjoyed the events this year and we are seeking feedback from members about what else they want to hear about from Medical Protection.

Videos and slide decks for the presentation will shortly be available on our online learning portal Prism, and members will receive an email alert once these are available.

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