Appendix 1
Good Medical
Practice
Consultation draft
Medical Council of New Zealand, August 2012
Index
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Section
Index
Reading this document
Consultation process
Inside cover
About Good Medical Practice
How Good Medical Practice applies to you
Professionalism
Domains of competence
Caring for patients
Providing good clinical care
Safe practice in an environment of resource limitation
Keeping records
Prescribing drugs or treatment
Providing care to yourself and those close to you
Treating people in emergencies
Treating patients who present a risk of harm
Treating patients who present a risk of violence
Respecting patients
Establishing and maintaining trust
Cultural competence
Personal beliefs and the patient
Involving relatives, carers and patients
End of life care
Euthanasia
Dealing with adverse outcomes
Reporting of alleged abuse
Ending a professional relationship
Working in partnership with patients and colleagues
Assessing patients’ needs and priorities
Supporting self-care
Information, choice of treatment and consent
Informed consent in specific situations
Use of interpreters
Advance directives
Support people
Advertising
Working with colleagues
Management
Being accessible
Going off duty
Shift handover
Arranging a locum
Treating information as confidential
Sharing information in public
Sharing information with parents or caregivers
Sharing information with colleagues
Continuity of care
Transferring patients
Referring patients
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Delegating patient care to a colleague
Prescribing and administering of medicines by other practitioners
Planning for transfer of care
Mentoring, teaching, appraising and assessing doctors and students
Supervision for newly registered doctors
Acting ethically
Integrity in professional practice
Sexual and emotional boundaries
Writing reports, giving evidence and signing documents
Providing objective assessments of performance
Writing references and reports
Financial and commercial dealings
Conflicts of interest
Accepting the obligation to maintain and improve standards
Applying your knowledge and experience to practice
Research
Maintaining and improving your professional performance
Keeping up to date
Openness and investigatory or legal processes
Giving evidence
Raising concerns about patient safety
Concerns about premises, equipment, resources, policies and systems
Your health
Disclosing concerns to the Council
Being open about concerns and restrictions on your practice
Supporting colleagues
Related documents
Standards set by the Council
Standards set by other agencies
Additional consultation questions
3
Reading this document
Comments contained in coloured boxes like this one are not intended to be included in the final version
of Good Medical Practice, but are intended to guide you as you read through our draft. They offer a
commentary on the changes made, and provide you with space to add your comments.
The rest of the document outlines the wording that the Medical Council of New Zealand (the Council)
proposes to use in its revised edition of Good Medical Practice. Where changes to wording used in the
previous edition has been proposed, new text has been written in bold, and deletions have been struck
through like this.
The Council is proposing that Good Medical Practice should focus only on core, high level standards.
Where more specific advice is needed, the Council proposes to either address these matters through a
separate statement1 or – following the Nursing Council’s lead – through a text box included within the
resource. For example, the section on Providing care to yourself and those close to you (paragraph 10
on page 14) only outlines the key principles that should be involved in such circumstances, and readers
are referred to the Council’s statement on the same subject for more advice. Where a separate
statement does not exist, we have proposed including any necessary specific advice within a box set into
the main text. For example, under the heading Treating patients who present a risk of harm (paragraph
12 on page 15) we propose including a text box providing Supplementary advice – Treating patients who
present a risk of violence.
Consultation process
Please send your comments to Michael Thorn, the Council’s senior policy adviser and researcher by
12 October 2012. You can either complete the questions on the covering consultation paper, or the
questions contained in this Appendix and send it to Michael at mthorn@mcnz.org.nz or post it to:
Michael Thorn
Senior policy adviser and researcher
Medical Council of New Zealand
PO Box 11-649
Wellington 6011
Please also feel free to send Michael any other comments or suggestions you have about Good Medical
Practice.
Your comments and submissions will be circulated to members and staff of the Council for
consideration. We also intend publishing a summary and analysis of the responses received (with any
details which might identify individual submitters removed).
1
Council statements are intended to outline the duties of doctors in specific situations. You can view and
download Council’s statements at http://www.mcnz.org.nz/news-and-publications/statements-standards-fordoctors/
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Inside cover
A number of minor changes are recommended for this section. These changes are primarily aimed at
aligning the language with that used in the rest of the resource, and more accurately stating the role of
the Council.
Patients are entitled to good doctors. Good doctors make the care of patients
their first concern; they are competent, keep their knowledge and skills up to
date, establish and maintain good relationships with patients and colleagues, are
honest and trustworthy and act with integrity ethically.
The primary principal purpose of the Medical Council of New Zealand is to promote and protect public
health and safety by providing mechanisms to ensure doctors are competent and fit to practise.
The Council has the following key functions:
 registering doctors
 setting standards
 recertifying and promoting lifelong learning for doctors
 reviewing practising doctors if there is a concern about performance, professional conduct or health
 accrediting training institutions – including medical schools, colleges of medicine and hospitals.
Do you agree with these statements and the changes proposed by the Council? Do you think any other
changes should be made?
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About Good Medical Practice
A number of changes have been proposed for this section. The intention of these changes is to clarify
the legal framework in which Good Medical Practice sits, and to outline how it can and should be used.
We have drawn on resources published by the Nursing Council, the Dental Council and the Pharmacy
Council in making these changes.
Under section 118 of the Health Practitioners Competence Assurance Act 2003 (HPCAA), the Council is
responsible for setting standards of clinical competence, cultural competence and ethical conduct for
doctors. Under section 118(i) of the Health Practitioners Competence Assurance Act 2003, it is a
function of the Medical Council to set standards of clinical competence, cultural competence and
ethical conduct for doctors. Under Right 4 of the Code of Health and Disability Service Consumers’
Rights patients also have “the right to have services provided that comply with legal, professional,
ethical and other relevant standards.” The Council has developed Good Medical Practice to be the
foundation document for these standards.
The Council sets standards through discussion with the profession and the public. The standards
detailed in Good Medical Practice, and in other Council statements, are those which the public and the
profession expect a competent doctor to meet and have been developed through discussion with the
public and the profession. Where relevant, Good Medical Practice also provides guidance to assist
doctors understand, and comply with, the requirements of legislation.
Good Medical Practice is not intended to be exhaustive. There may be obligations or situations that
are not expressly provided for. In such circumstances, a doctor’s first priority should always be the
care of his or her patient.
Good Medical Practice is addressed to doctors, but is also intended to let the public know what they can
expect from doctors.
How Good Medical Practice applies to you
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

For medical students, Good Medical Practice identifies the basic duties of a good doctor and
serves as a source of education and reflection.
For doctors, Good Medical Practice serves as a basis for you to monitor your own conduct and
that of your colleagues. The Health Practitioners Disciplinary Tribunal, the Council’s Professional
Conduct Committees and the Health and Disability Commissioner may use Good Medical Practice as
a standard by which to measure your professional conduct.
For patients, Good Medical Practice provides guidance for assessing the minimum ethical and
clinical conduct expected of doctors.
The Council expects all doctors registered with the Council to be competent. It is the responsibility of
competent doctors to be familiar with Medical Practice and to follow the guidance it contains.
The directives outlined in Good Medical Practice are usually duties and must be followed. However,
we recognise that not all duties will apply in all situations, and that there are sometimes factors
outside a doctor’s control that affect whether or how he or she can comply with some standards.
Throughout this resource we have used the term “you should” (rather than a more directive term
such as “you must”) to indicate where this is the case.
6
If you believe that a doctor is not meeting standards outlined in Good Medical Practice, you should
draw that matter to the attention of the Registrar of the Medical Council or the Office of the Health
and Disability Commissioner.
Do you agree with these statements and the suggested changes? Are there any other changes you
would like the Council to make?
7
Foreword Professionalism
Council feels that this section should be given greater prominence. It outlines most of the key principles
that should underpin good medical practice. To bolster this section, we are proposing to rename it and
to include a number of additional principles intended to broaden the scope of the section and ensure
that it outlines all of the principles that a good doctor should adhere to. We also propose to structure
the rest of the resource around the principles and sub-headings used in this section, and to quote the
relevant principles at the start of each chapter.
Establishing a relationship of trust with your patients
Doctors must Establish a relationship of trust with each of their your patients.
Patients trust their doctors with their health and wellbeing, and sometimes their lives. To justify your
patients’ trust, follow the principles outlined below and the duties outlined in the rest of this document.
Caring for patients
Make the care of patients your first concern.
Protect and promote the health of patients and the public.
Work with colleagues in ways that serve patients’ interests
Provide a good standard of care and practice by:
 keeping your professional knowledge and skills up to date
 recognising, and working within, the limits of your competence
 working with colleagues in ways that best serve patients’ interests.
Respecting patients
Treat patients as individuals and respect their dignity by:
 treating them politely and considerately
 respecting their right to confidentiality and privacy.
Working in partnership with patients and colleagues
Work in partnership with patients by:
 listening to them and responding to their concerns and preferences
 giving them the information they want or need in a way they can understand
 respecting their right to reach decisions with you about their treatment and care
 supporting them in caring for themselves to improve and maintain their health.
Be aware of cultural diversity, and function effectively and respectfully when working with and
treating people of different cultural backgrounds.
Maintain the trust of colleagues, and treat them politely and considerately.
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Acting with integrity ethically
Act ethically and in accordance with relevant standards.
Be honest and open when working with patients; act with integrity by:
 acting without delay to prevent risk to patients
 acting without delay if you have good reason to believe that a colleague may be putting patients at
risk
 never discriminating unfairly against patients or colleagues
 never abusing your patients’ trust in you or the public’s trust of the profession.
Accepting the obligation to maintain and improve standards
Keep your professional knowledge and skills up to date
Recognise, and work within, the limits of your competence.
Be committed to autonomous maintenance and improvement in your clinical standards.
Demonstrate reflectiveness, personal awareness, the ability to seek and respond constructively to
feedback and the willingness to share your knowledge and to learn from others.
Accept a responsibility for maintaining the standards of the profession.
Work cooperatively with, and be honest and open in your dealings with, managers, employers, the
Medical Council, and other authorities.
Remember that you are personally accountable for your professional practice – you must always be
prepared to justify your decisions and actions.
Do you agree with the principles outlined here, and the suggested changes? Are there any other
changes you would like the Council to make? Are there any additional principles that should be
incorporated?
9
Domains of competence
It is suggested that the current domains of competence be replaced with the principles outlined in the
foreword on Professionalism, and that these principles be used to provide a framework for the rest of
the document.
1. The Council public and the profession expects doctors to be competent in the following areas:
 medical care
 communication
 collaboration
 scholarship
 professionalism
 caring for patients
 respecting patients
 working in partnership with patients and colleagues
 acting ethically
 accepting the obligation to maintain and improve standards
In the sections that follow, we outline the requirements of each of these domains of competence areas.
Do you agree with the suggested changes? Are there any other changes you would like the Council to
make?
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Medical care Caring for patients
Principles
Make the care of patients your first concern.
Protect and promote the health of patients and the public.
Work with colleagues in ways that best serve patients’ interests.
Providing good clinical care – a definition
We suggest making a number of changes to this section. In particular, a number of duties that were
included in this section have been deleted. We feel that some of these have already been captured in
other parts of the resource (for example, those that relate to keeping colleagues informed), while others
appear to be important points that should apply more broadly than just in relation to “clinical” care.
The latter points have been included under the heading Accepting the obligation to maintain and
improve standards.
2. Good clinical care includesWhen you assess, diagnose or treat patients you must provide a good
standard of clinical care. This includes:
 adequately assessing the patient’s condition, taking account of the patient’s history and his or her
views, and examining the patient as appropriate2
 providinging or arranginging investigations or treatment when needed
 takinging suitable and prompt action when needed, and referringring the patient to another
practitioner when this is in the patient’s best interests.
3. In providing care you are expected to3:
 recognise and work within the limits of your competence
 provide effective treatments based on the best available evidence
 consult and take advice from colleagues when appropriate
 keep colleagues well informed when sharing the care of patients
 be readily accessible when you are on duty. Depending on the situation, this may mean you are
accessible to patients, or it may mean that you are accessible to colleagues or a triage service
 make good use of the resources available to you
 take steps to alleviate pain and distress whether or not a cure is possible.
 respect the patient’s right to seek a second opinion.
Do you agree with the standards outlined in this section, and the suggested changes? Are there any
other changes you would like the Council to make?
2
See the Council’s statement on Non-treating doctors performing medical assessments of patients for third parties,
which outlines the specific requirements for non-treating doctors performing medical assessments for other
parties.
3
See the Council’s statement on Use of the internet and electronic communication for information about providing
services electronically or from a distance.
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Safe practice in an environment of resource limitation
It is proposed to include a new section here. This section outlines (and also expands on) an existing
duty, which was previously included under the heading Providing good clinical care. This paragraph has
been shifted, because the principles it outlines appear relevant to all aspects of a doctor’s work (and not
just when providing clinical care). The wording has also been changed to better reflect the standards
outlined in the Council’s statement on Safe practice in an environment of resource limitation.
4. Doctors have a responsibility to the community foster the proper use of resources – in particular by
making efforts to use resources efficiently, consistent with good patient care. Strive to use resources
efficiently, consistent with good patient care, and balance your duty of care to each patient with your
duty of care to the population4.
Do you agree with the standard outlined in this section? Are there any other changes you would like the
Council to make to this section?
Keeping records5
We propose to replace the term “relevant clinical findings” in the below paragraph with the broader
term “relevant clinical information”. It could be argued that “relevant clinical findings” might only refer
to a very discrete set of information about any conclusions drawn – rather than the broader base of
clinical information that informed those conclusions, and which might also inform future decisions. It
could also be argued that the current term fails to capture information elicited from the patient about
their own health and which might help inform the decision-making process.
The Health Practitioners Disciplinary Tribunal made some comments that might help inform your
thinking about what doctors should include in a patient record6. In decision 201/Med08/96P the
Tribunal stated that:

“Notes are the only record of a patient’s consultation with the doctor (other than sometimes faulty
recollection) and there is no doubt that the public has a right to expect that their doctors will make
accurate notes of what was said and done in the consultation.”
In decision 30/Med05/11D the Tribunal stated that:

“The Tribunal regards these failings to document as serious. Note-keeping should not be regarded as
a minor matter. A detailed note recording diagnosis and formulation, assessment of Mrs L’s mental
state, her current symptoms, her psychiatric history, a treatment plan and the reason for that
treatment plan were imperative ... It is the Tribunal’s view that they are serious matters and they
reflect upon [a doctor’s] clinical competency because his failure to document (other than in his GP
4
For more information, see the Council’s statement on Safe practice in an environment of resource limitation.
See the Council’s statement on The maintenance and retention of patient records
6
You can read the Tribunal’s decisions in full at www.hpdt.org.nz.
5
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letters) did not allow him (or any doctor assuming Mrs L’s care) to subsequently re-examine the
conclusions, diagnosis and plan to see whether the conclusions were still valid, whether there has
been any documented change in the patient’s mental state, whether there had been any change in
the symptoms, and thus, whether any change in the treatment plan was warranted. The lack of
history also meant that if there were errors in the doctor’s understanding of the history they could
not be subsequently corrected. Thorough note taking is the cornerstone of safe and effective
medical practice.”
5. You must keep clear and accurate patient records that report:
 relevant clinical findings information
 decisions made
 information given to patients
 any drugs or other treatment prescribed.
Do you agree with the proposed change? Will this standard ensure that doctors record all the relevant
information needed to help inform future decisions about care, without requiring them to record
irrelevant information? Are there any other changes you would like the Council to make to this section?
6. Make these records at the same time as the events you are recording or as soon as possible
afterwards.
It is proposed to include a new standard here as follows:
7. Records that contain personal data about patients, colleagues or others must be kept securely.
Do you agree with the new duty? Are there any other changes you would like the Council to make to
this section?
Prescribing drugs or treatment7
8. You may prescribe drugs or treatment, including repeat prescriptions, only when you:
 have adequate knowledge of the patient’s health
 are satisfied that the drugs or treatment are in the patient’s best interests.
It is proposed that the following paragraph be amended to better align with the requirements outlined
in Council’s statement on Good prescribing practice.
9. Before prescribing any medicine you should Usually this will require that you have a face-to-face
consultation with the patient or discuss the patient’s treatment with another New Zealand registered
health practitioner who can verify the patient’s physical data and identity. Without a face-to-face
consultation it is also reasonable practice to:
7
See the Council’s statements on Improper prescribing practice with respect to addictive drugs and The use of
drugs and doping in sport. See the Council’s statement on Good prescribing practice.
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Complete a prescription for a patient if you have access to the patient’s notes and are providing
cover for an absent colleague or are discharging a patient from hospital.
Renew a prescription of a patient you, or a colleague in the same practice, have seen previously,
following a review of its appropriateness for the patient. When the prescription has potentially
serious side effects, you should regularly assess the patient.
You may not need a face-to-face consultation if you are prescribing on behalf of a colleague in the same
team who usually practises at the same physical location.
Do you agree with the standards outlined in this section, and the suggested changes? Are there any
other changes you would like the Council to make? Are there any other circumstances where it may be
appropriate for a doctor to write a prescription without first assessing the patient in a face-to-face
consultation?
Providing care to yourself or those close to you8
The Council has published a separate statement on Providing care to yourself and those close to you.
We therefore propose to only outline the key principle that should apply in these circumstances here,
and to refer readers to the statement for more information.
10. Wherever possible, avoid providing In most circumstances you should not provide medical care to
yourself or anyone with whom you have a close personal relationship. The Council recognises that in
some cases providing care to those close to you is unavoidable. However, in most cases, providing care
to friends, those you work with and family members is inappropriate because of the lack of objectivity
and possible discontinuity of care.
Do you agree with the standard outlined in this section, and the suggested changes? Are there any
other changes you would like the Council to make?
Treating people in emergencies9
11. In an emergency, offer to help, taking account of your own safety, your competence, and the
availability of other options for care.
Do you agree with the standard outlined in this section, or do you think changes should be made?
8
9
See the Council’s statement on Providing care to yourself and those close to you.
See the Council’s statement on The doctor’s duties in an emergency.
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Treating patients who present a risk of harm
It is proposed that the first sentence of this paragraph be deleted, as it does not set a standard or
outline a duty.
12. All patients are entitled to care and treatment that meets their clinical needs. If a patient poses a risk
to your own health and safety, you should take all possible steps to minimise the risk before providing
treatment or making suitable arrangements for treatment.
Do you agree with the standard outlined in this section, and the suggested deletion? Are there any
other changes you would like the Council to make?
The Council believes that Good Medical Practice should focus on core, high level standards. Where
more specific advice is needed, the Council proposes to either address these matters through a separate
statement or through a text box included within Good Medical Practice. We propose to include a text
box here to provide new guidance to outline how the paragraph on Treating patients who present a risk
of harm and the other standards outlined in this resource should be interpreted in the case of a violent
patient.
Supplementary guidance – Treating patients who present a risk of violence
If you are asked to examine or treat a patient who presents a risk of violence, you should make
reasonable efforts to assess any possible underlying clinical causes of the violent behaviour. However,
you are not obliged to put yourself or other healthcare staff at risk of harm in the course of such
assessment or in providing treatment. If the patient needs to be restrained, then the level of restraint
provided should be the minimum needed to protect those at risk.
Do you agree with the advice contained in this supplementary guidance?
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Communication Respecting patients
Principles
Treat patients as individuals and respect their dignity by:
 treating them politely and considerately
 respecting their right to confidentiality and privacy.
Establishing and maintaining trust
This section currently includes a number of principles that are expanded on in more detail elsewhere in
the resource. To avoid duplication, it is recommended that this section only include the principal duties
that are necessary to establish and maintain trust with patients. We also propose to delete those duties
which are important, but not fundamental to every interaction with a patient, and which are discussed
in greater detail in other parts of Good Medical Practice.
To establish and maintain trust you should:
 listen to patients, ask for and respect their views about their health, and respond to their concerns
and preferences
 be readily accessible to patients when you are on duty.
13. Make sure you respect treat patients as individuals and respect patients’ their dignity and privacy
and.
 the right of patients to be fully involved in decisions about their care
 the right of patients to seek a second opinion.
Do you agree with the proposed changes, and the duty outlined?
The below duty is new to this section, but simply repeats a key principle which is currently outlined in
the introduction.
14. You must be polite and considerate.
Do you agree with the inclusion of this duty? Being polite and considerate is clearly an important part of
establishing and maintaining trust with patients, but if we make this a duty that also means it has to be
enforced. And how do we measure compliance? In some cases a failure to comply might be obvious –
for example if a doctor used foul and abusive language when talking to a patient. But in a case like this
the doctor has likely breached duties that are already outlined elsewhere in Good Medical Practice, such
as the duty to respect the dignity of patients. In other cases, the breach might not be so obvious and
might be complicated by the circumstances in which care is being provided. For example, a patient
might feel that a doctor was rude and obstructive – but the doctor’s view might be that complying with
the patient’s requests would have been clinically inappropriate. In such circumstances it may be
reasonably straightforward for Council to decide whether the clinical decision to deny care was
appropriate, but very hard for it to make a finding on the question of whether the doctor was “polite” in
communicating that decision to the patient.
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Cultural competence10
It is proposed that we include a new duty here that highlights how the principles of the Treaty of
Waitangi are relevant to medical care.
We also propose to include a new paragraph, which requires doctors to adjust their practice if this is
reasonable and will ensure that patients receive the care that meets their needs. This addition was
suggested by members of the Council’s consumer advisory group, who felt that doctors can sometimes
be inflexible when it comes to responding to the needs of patients – particularly disabled patients. It
also seems a reasonable expectation that doctors adjust the way they deliver care to meet the needs of
other patient groups – such as children and emotionally vulnerable patients. This clause is also intended
to link with the supplementary advice which requires a doctor to obtain the services of a competent
interpreter when this is needed to ensure appropriate communication (see the text-box which follows
paragraph 32).
15. New Zealand has as its founding document the Treaty of Waitangi. You should acknowledge the
place of the Treaty, and apply the principles of partnership, participation and protection in the
delivery of medical care. You must also be aware of cultural diversity and function effectively and
respectfully when working with and treating people of all cultural backgrounds. You should
acknowledge:
 that New Zealand has a culturally diverse population
 that each patient has cultural needs specific to him/her
 that a doctor’s culture and belief systems influence his or her interactions with patients and accept
this may impact on the doctor-patient relationship
 that a positive patient outcome is achieved when a doctor and patient have mutual respect and
understanding
16. You must consider and respond to the needs of all patients. You should make reasonable
adjustments to your practice to enable them to receive care that meets their needs.
Do you agree with the standards outlined in this section and the suggested additions? Are there any
other changes you would like the Council to make?
10
See the Council’s Statement on cultural competence. For specific guidance on providing care to Māori patients,
see the Council’s Statement on best practices when providing care to Māori patients and their whānau and Best
health outcomes for Māori: Practice implications. For advice on providing care to Pacific patients, see Best health
outcomes for Pacific peoples: Practice implications. See also Cole’s Medical practice in New Zealand for advice
on providing care to Asian people in New Zealand.
17
Avoiding discrimination
Advising patients about Personal beliefs and the patient
We propose to merge and re-order the sections on Avoiding discrimination and Advising patients about
personal beliefs. Because the paragraphs on the subject of Personal beliefs discuss how such beliefs
might impact on treatment or care, we propose to delete the similar requirements which were outlined
in paragraph 17. We also propose shifting the requirement to “Challenge colleagues if their behaviour
does not comply with this guidance” from paragraph 17 so that it forms a stand-alone requirement at
the end of this section.
17. You must not refuse or delay treatment because you believe that a patient’s actions have
contributed to their condition. Nor should you unfairly discriminate against patients by allowing your
personal views to affect your relationship with them or the treatment you arrange or provide. Challenge
colleagues if their behaviour does not comply with this guidance.
Do you agree with this standard? Are there any changes to this section you would like the Council to
make?
18. Your personal beliefs, including political, religious or moral beliefs, should not affect your advice or
treatment. If you feel your beliefs might affect the advice or treatment you provide, you must explain
this to patients and tell them about their right to see another doctor. You must be satisfied that the
patient has sufficient information to enable them to exercise that right.
We are proposing to move the below paragraph to here from the section on Acting ethically as it
appears to fit better here, and complements the paragraph which precedes it. As noted above, we also
propose making the requirement to “Challenge colleagues if their behaviour does not comply with this
guidance” a stand-alone requirement which will apply to all three paragraphs in this section, and not
just paragraph 17.
19. Do not express to your patients your personal beliefs, including political, religious or moral beliefs, in
ways that exploit their vulnerability or that are likely to cause them distress.
20. Challenge colleagues if their behaviour does not comply with this guidance
Do you agree with the standards outlined? Are there any changes you would like the Council to make?
Involving relatives, carers and partners
21. You must be considerate to relatives, carers, partners and others close to the patient. Make sure you
are sensitive and responsive in providing information and support, for example, after a patient has died.
18
Do you agree with the standard outlined? Are there any changes you would like the Council to make to
this section?
End of life care can be difficult. It is often a distressing time for patients and their families, and the
Council is aware of a small number of cases where doctors have failed to effectively provide important
clinical information to patients and their families out of fear of causing distress. We feel that it is
important to define what the duty to “make the care of patients your first concern” should mean in the
context of a patient who is dying. We propose including a text box here intended to clarify how that
duty, and other duties outlined elsewhere in Good Medical Practice, apply at this difficult time.
End of life care
As a doctor you play an important role in assisting patients, families/whānau and the community in
dealing with the reality of death. In caring for patients at the end of life, you share with others the
responsibility to take care that the patient dies with dignity, in comfort and with as little suffering as
possible. You should take care to communicate effectively and sensitively with patients, their families
and support people so that they have a clear understanding of what can and cannot be achieved. You
should offer advice on other treatment or palliative care options that may be available to them. You
should ensure that support is provided to patients and their families, particularly when the outcome is
likely to be distressing to them.
Do you agree with the standards proposed in this text-box? Are there any changes you would like
Council to make to this section?
We also suggest including the current advice on the subject of euthanasia as supplementary advice, as
below. We also suggest adding an introductory sentence to make it clear that we expect doctors to
comply with the requirements of the law. In this sentence we have also attempted to clarify how the
law defines “euthanasia” – as it is important to note that the law distinguishes between “deliberate
killing by active means” and other conduct which may result in a patient dying – such as ending lifesustaining care to allow a patient to die a natural death. In the second set of circumstances we expect
doctors to act in accordance with the other standards outlined in this resource – in particular those on
informed consent, advance directives and, where the doctor has a conscientious objection and does not
wish to participate, paragraphs 17–19. Chapter 22 of the Council’s handbook, Cole’s Medical practice in
New Zealand, contains a discussion of this legally complex area. A copy of this chapter can be found on
Council’s website, www.mcnz.org.nz. It is important to note that the addition of the introductory
sentence does not reflect any change in the Council’s position on the issue of euthanasia.
Euthanasia
You must not participate in the deliberate killing of a patient by active means. Euthanasia is an offence
under the Crimes Act 1961 and illegal in New Zealand.
19
Do you agree with the standard outlined? Are there any changes you would like the Council to make to
this section?
Dealing with adverse outcomes11
It is proposed that this section include new duties which require a doctor to provide additional
information to a patient in the event of an adverse outcome. It is also suggested that we delete the
sentence about cooperation with a complaints procedure, because this subject is already covered under
a separate paragraph under the heading Accepting the obligation to maintain and improve standards.
22. If a patient under your care has suffered serious harm or distress you should act immediately to put
matters right, if possible. You should express regret at the outcome, apologise if appropriate, and
explain fully and without delay to the patient:
 what has happened
 the likely short-term and long-term effects
 what you and your health service can do to alleviate the problem
 what steps have been or will be taken to investigate what happened and (if possible) prevent it
from happening again.
23. When a patient under 16 has died, explain to the parents or caregivers to the best of your
knowledge why and how the patient died. When an adult patient has died, give this information to the
patient’s partner or next of kin, unless you know that the patient would have objected.
24. Patients who have a complaint about the care or treatment they have received have a right to a
prompt, constructive and honest response, including an explanation and, if appropriate, an apology. You
must cooperate with any complaints procedure that applies to your work.
25. Do not allow a patient’s complaint to prejudice the care or treatment you provide or arrange for that
patient.
Do you agree with the standards outlined, and the suggested changes? Are there any other changes you
would like the Council to make?
Reporting of alleged abuse
It is proposed that we include some new duties here on the subject of reporting abuse. This is a difficult
area, and it is felt that such advice may be useful to doctors. It is also noted that a recent amendment
to the Crimes Act 1961 has placed a specific duty on doctors to report concerns in some circumstances.
26. If you have any concerns about alleged or suspected sexual, physical or emotional abuse or
neglect of vulnerable patients, you should report this to the appropriate authorities without delay.
11
Refer to the Council’s statement on Disclosure of harm.
20
You should inform the patient’s parents or guardians of your intention to report your concerns unless
this action might endanger you or the patient. Giving information to others for the protection of a
patient may be a justifiable breach of confidentiality12 and, where a vulnerable adult is at risk of
injury, is a legal duty13.
Do you agree with the new duties outlined here? Are there any changes you would like the Council to
make?
Ending a professional relationship14
Only minor changes, aimed at making the guidance more directive, are proposed for this section.
27. In some rare cases, you may need to end a professional relationship with a patient. If you do so, you
must be prepared to justify your decision. You should usually tell the patient – in writing if possible –
why you have made this decision. You must also make sure you arrange for the patient’s continuing care
and pass on the patient’s records without delay.
Do you agree with the standards outlined, and the suggested changes? Are there any other changes you
would like the Council to make?
12
As outlined in the Privacy Act and the Health Information Privacy Code.
As outlined in s.151 of the Crimes Act 1961.
14
See the Council’s statement on Ending a doctor-patient relationship.
13
21
Collaboration Working in partnership with patients and colleagues
Principles
Work in partnership with patients by:
 listening to them and responding to their concerns and preferences
 giving them the information they want or need in a way they can understand
 respecting their right to reach decisions with you about their treatment and care
 supporting them in caring for themselves to improve and maintain their health.
Be aware of cultural diversity, and function effectively and respectfully when working with and
treating people of different cultural backgrounds.
Maintain the trust of colleagues, and treat them politely and considerately.
Assessing patients’ needs and priorities
It is proposed that the below paragraph be shifted to this part of the resource from the chapter on
Medical care.
28. It will be expected that investigations The care or treatment you provide or arrange will must be
made on the assessment you and the patient make of his or her needs and priorities, and on your
clinical judgement about the likely effectiveness of the treatment options.
Do you agree with the standard outlined? Are there any changes you would like the Council to make to
this section?
Supporting self care
It is proposed that the below paragraph be shifted to this part of the resource from the chapter on
Caring for patients.
29. Encourage your patients and the public to take an interest in their health and to take action to
improve and maintain their health. For example, this may include advising patients on the effects their
life choices may have on their health and wellbeing and the outcome of treatments.
Do you agree with the standard outlined? Are there any changes you would like the Council to make to
this section? In recent years there has been a significant amount of research which has demonstrated
the health benefits of work and other purposeful activities15. Should this paragraph suggest that
supporting self-care may sometimes mean that a doctor should encourage a patient to stay in, or return
to, work or engage in other purposeful activities?
15
The Royal Australasian College of Physicians’ Consensus Statement on the Health Benefits of Work outlines the
evidence that work is generally good for health and wellbeing, and that long-term work absence and
unemployment generally have a negative impact on health and wellbeing. A copy of this paper can be
downloaded from http://www.racp.edu.au/page/policy-and-advocacy/occupational-and-environmentalmedicine.
22
Should a section on a doctor’s duties in relation to public health also be included here? This could state,
for example, that doctors are expected to “advise patients on the effect of life choices on their health
and wellbeing and the outcome of treatments”, “direct patients to resources that will support them in
making the changes necessary to enhance their health” and “offer patients appropriate preventative
measures, such as screening tests and immunisations, that are appropriate to their particular health
status and consistent with guidelines and best practice”.
Information, choice of treatment and informed consent16
It is proposed that this section be given a significant overhaul. Previous editions included very little
advice on the subject of informed consent, despite its importance in medical care. Primarily this was
because comprehensive advice is already outlined in the Code of Health and Disability Services
Consumers’ Rights and in our statement on Information, choice of treatment and informed consent.
However, Good Medical Practice does include advice in other places where a corresponding law or
standard exists (such as in relation to euthanasia), and we feel that the resource should outline all the
relevant principles that make up good medical practice. We have therefore suggested amending this
section, and propose incorporating some of the principles outlined in the Code of Rights and in our
statement on Information, choice of treatment and informed consent as follows:
Relationships based on openness, trust and good communication will enable you to work in partnership
with your patients to address their individual needs.
30. You must familiarise yourself with the:
 Code of Health and Disability Services Consumers’ Rights17
 Health Information Privacy Code18.
In certain circumstances you may also need to tell your patients about their rights.
31. In most situations you should not provide treatment unless:
 the patient has received all the relevant information about their treatment options, including the
expected risks, side effects, costs and benefits of each option; and
 you have determined that he or she has an adequate understanding of that information; and
 you have provided the patient with an opportunity to consider and discuss the information with
you; and
 the patient has made an informed choice; and
 the patient consents to treatment.
32. You must respect the patient’s right to seek a second opinion or to decline treatment, or to
decline involvement in education or research.
16
See the Council’s statement on Information, choice of treatment and informed consent.
For a copy of the Code of Health and Disability Services Consumers’ Rights go to http://www.hdc.org.nz/the-act-code/the-code-of-rights
18
For a copy of the Health Information Privacy Code go to http://privacy.org.nz/health-information-privacy-code/
17
23
Do you agree with the standards outlined? Are there any changes you would like the Council to make to
this section?
Are there any situations where it might be acceptable for a doctor to delay in sharing information with a
patient about his or her condition, for example because the doctor believes that it might cause the
patient unwarranted stress?
It seems reasonable to expect that a doctor should be aware of, and can provide advice to their patients
on, other medical treatments that might be available. For example, a doctor treating a patient with a
skin cancer should probably be aware of the treatments provided by both dermatologists and
oncologists. Similarly, there are circumstances where a doctor should be expected to know about nonmedical options. Obstetricians should certainly be aware of the services that midwives provide, and
doctors dealing with muscle injuries should be able to help a patient obtain services from a
physiotherapist. But how wide should this expectation be? For example, if a patient expresses an
interest in alternative medicine should a doctor be expected to advise the patient about treatment
options – even when the doctor believes those options to be ineffective or even fraudulent?
Supplementary guidance – Informed consent in specific situations19
You should obtain separate written consent for research, experimental procedures, general or
regional anaesthesia, blood transfusion or any procedure with a significant risk of adverse effects.
You should pay careful attention to the process of informed choice and consent when a proposed
treatment is expensive or in any way innovative. If a patient is choosing between evidence-based
medicine and innovative treatments for which there is no scientific evidence, you should attempt to
present to the patient a clear and balanced summary of the scientific information available.
Supplementary guidance – Use of interpreters
When treating patients whose English language ability is limited, you should arrange to use a
competent interpreter. When an interpreter has been used to assist in obtaining the patient’s
informed consent you should note this in the records, along with the interpreter’s name and status
(professional interpreter, family member etc) and, if possible, a note signed by the interpreter to
certify that they believe the patient understands the information provided.
19
Additional requirements apply in certain circumstances, such as where the patient is a minor or not
competent to make an informed decision. In addition, there are several pieces of law that can override the
requirements of the Code. The Council’s statement on Information, choice of treatment and informed consent
outlines these requirements.
24
Do you agree with the standards outlined in the supplementary guidance? Are there any other changes
you would like the Council to make?
Advance directives
As worded, the current paragraph on the subject of advance directives could be read to imply that a
doctor does not need to “respect” an advance directive when it is not legally binding. Council believes
that a doctor should always take a directive into account, even if he or she is not bound to comply with
it, and to respect the wishes of the patient.
33. You must always respect a patient’s wishes expressed in an advance directive, unless the patient is
being treated under specific legislation such as the Mental Health (Compulsory Assessment and
Treatment) Amendment Act 1992. Advance directives have legal standing in the Code of Health and
Disability Services Consumers’ Rights. If you hold a moral objection, you should transfer responsibility
for the patient to another doctor. Advance directives have legal standing in the Code of Health and
Disability Services Consumers’ Rights. There may be circumstances in which it may not be appropriate
to comply with the wishes outlined in an advance directive20, however you must always respect and
consider those wishes.
Do you agree with the standards outlined, and the suggested changes? Are there any other changes you
would like the Council to make?
Giving information to patients about their condition
The Council proposes to delete the advice outlined in this section, and to cover the subject in greater
detail as part of a proposed new section on Information, choice of treatment and informed consent. We
do propose to retain the advice on sharing information with family members, but as supplementary
advice under the broader heading of Treating information as confidential.
Give patients all information they want or need to know about:
 their condition and its likely progression
 treatment options, including expected risks, side effects, costs and benefits.
Do your best to ensure the patient understands the information you give them about their condition
and its treatment. Give information to patients in a form they can understand and, if necessary, make
arrangements to meet any language or special communication needs that patients may have.
Make sure the patient agrees before you provide treatment or investigate a patient’s condition. Respect
the patient’s right to decline treatment.
20
For example, where the patient is being treated under specific legislation such as the Mental Health
(Compulsory Assessment and Treatment) Amendment Act 1992.
25
Follow the guidance outlined in the Health Information Privacy Code.
Support people
34. Patients have the right to have one or more support persons of their choice present21, except where
safety may be compromised or another patient’s rights unreasonably infringed.
Do you agree with the standard outlined? Are there any changes you would like the Council to make?
Advertising22
The Council has recently published a Statement on advertising. It is therefore recommended that the
corresponding section of Good Medical Practice be reduced and outline only the key principles that
should apply, and that readers should otherwise be referred to the statement.
35. Make sure Make sure any information you publish or broadcast about your medical services is
factual and verifiable and does not put pressure on people to use a service, for example by arousing illfounded fear for their future health or by fostering unrealistic expectations. The information must
conform to the requirements of the Council’s Statement on advertising, the Fair Trading Act 1986 and
Advertising Standards Authority guidelines.
Claims you make about the quality or outcomes of your services should be evidence-based. You should
not compare your services with those your colleagues provide.
Advertising and promotional material should not foster unrealistic expectations.
You must not falsely claim a high success rate or overstate your qualifications.
36. Patients can find medical titles confusing. To reduce confusion, avoid using you should not use titles
such as “specialist” that refer to an area of expertise (unless you are registered with the Council in an
appropriate vocational scope).
You must not put pressure on people to use a service, for example, by arousing ill-founded fear for their
future health. Similarly, you must not advertise your services by visiting or telephoning prospective
patients, either in person or through an agent.
Do you agree with the standards outlined, and the suggested changes? Are there any other changes you
would like the Council to make?
21
22
This right is outlined in Right 8 of the Health and Disability Services Consumers’ Rights.
See the Council’s Statement on advertising.
26
Patients can find the use of titles in medicine confusing. Their understanding isn’t helped by the wide
range of titles that are in use, including general terms (such as, house surgeon, registrar, specialist and
consultant) and specialist terms (such as surgeon or general practitioner). Understanding isn’t helped
when these terms are used in different ways. The HDC has recently considered two complaints from
patients relating to the use of titles; one from a patient who incorrectly (but reasonably) assumed that
the person who was performing surgery on her must be vocationally registered because the consent
form referred to that doctor as a “surgeon”, and one from a patient who was seen by a “consultant”
who did not hold a specialist qualification. The standard outlined above may not be helpful in clarifying
matters much when the doctor has vocational registration but works solely within a special interest (for
example, general practitioners who hold a special interest in appearance medicine or physicians who
work in gastroenterology). What titles should doctors use (and in what contexts – for example, on
consent forms) to assist patients in understanding their knowledge, skills and expertise?
Working with colleagues23
It is suggested that a new duty be included here as below.
37. You must be aware of the impact of your conduct on members of your colleagues, and how that
may affect quality care and treatment for patients.
Do you agree with the inclusion of this new duty?
The following is currently included as a duty under the heading Working in teams, but it is suggested
that it should apply in all circumstances and we therefore propose moving it here.
38. You should respect the skills and contributions of your colleagues.
It is suggested that the final part of the following duty is overly specific, and should therefore be
removed.
39. Treat your colleagues fairly and with respect. Do not bully or harass them. By law, You must not
discriminate against colleagues, including doctors applying for other jobs.
You must not allow your professional relationship with colleagues to be affected by their:
 age
 colour, race, or ethnic or national origin
 culture or lifestyle
 disability
 gender or sexual orientation
 marital or parental status
23
Colleagues are those you work with, including doctors and other health professionals.
27


religion or beliefs
social or economic status.
It is suggested that the duty below be incorporated into the previous paragraph.
You must Do not make malicious or unfounded criticisms of colleagues that may undermine patients’
trust in the care or treatment they receive, or in the judgement of those treating them.
Do you agree with the suggested changes to this section, and the standards outlined?
Should this section include additional duties, intended to ensure that all members of a team feel
confident and supported in raising concerns and are treated respectfully? Should doctors be required to
provide support for junior less experienced doctors and to ensure that they work in an appropriately
supportive environment? What duties should apply?
Working in teams24
It is suggested that the following section be deleted, and the duties outlined moved to other parts of the
document. Many of the dot points apply more widely than just working in a team, and so have been
included in the section on Working with colleagues. The dot points about communicating and sharing
information to ensure continuity of care have been included and expanded upon under the heading
Continuity of care.
Most doctors work in teams with a wide variety of health professionals and non-medical health and
disability workers. Working in teams is likely to become even more common in the future. Working in
teams does not change your personal accountability for your professional conduct and the care you
provide. In all dealings with team members, doctors must act in, and advocate for, the best interests of
the patient.
When working in a team:
 respect the skills and contributions of your colleagues
 communicate effectively with colleagues both within and outside the team
 make sure that your patients and colleagues understand your responsibilities in the team and who is
responsible for each aspect of patient care
 participate in regular reviews and audit of the standards and performance of the team, taking steps
to remedy any deficiencies
 support colleagues who have problems with performance, conduct or health25
 share information necessary for the continuing care of the patient.
24
If you are responsible for leading a team, see the Council’s statement on The responsibilities of doctors in
management and governance.
25
See the Council’s online advice Deciding whether to make a competence referral at www.mcnz.org.nz
under the heading Guidance => Competence.
28
Management
It is suggested that this paragraph be reworded and made more directive.
40. Doctors and managers need to work together in a constructive manner to create an environment
that encourages good medical practice. You should work with managers and administrators in a
constructive manner to create an environment that encourages good medical practice. If you are a
manager or employer of doctors you should adhere to the guidance contained in the Council’s
statement on Responsibilities of doctors in management and governance.
Do you agree with the standards outlined, and the suggested changes? Are there any other changes you
would like the Council to make?
Being accessible
It is proposed that the below paragraph be shifted to this part of the resource from the section on Good
clinical care.
41. Be readily accessible when you are on duty. Depending on the situation, this may mean you are
accessible to patients, or it may mean that you are accessible to colleagues or a triage service.
Do you agree with the standard outlined? Are there any changes you would like the Council to make?
Going off duty
42. When you are going off duty, make suitable arrangements for your patients’ medical care. Use
effective handover procedures and communicate clearly with colleagues.
Do you agree with the standard outlined? Are there any changes you would like the Council to make?
It is suggested that the advice on handover and arranging a locum be included as supplementary advice,
rather than in the main text, as it expands on principles already outline elsewhere in the resource. We
also propose to expand the duties that apply when arranging a locum in general practice to cover other
situations in which a locum will be working without collegial support.
Supplementary guidance – Shift handover
In an environment where doctors work in rotating shifts, you should insist that time is set aside for the
sole purpose of organising appropriate handover.
29
Supplementary guidance - Arranging a locum
General practitioners and other doctors in private practice must take particular care when arranging
locum cover. You must be sure that the locum has the qualifications, experience, knowledge and skills to
perform the duties he or she will be responsible for.
Do you agree with the standards outlined, and the change proposed? Are there any other changes you
would like the Council to make?
Treating information as confidential26
The Council proposes to make a number of changes to this section, and to include two new duties. The
first requires a doctor to treat all information about patients sensitively. The second is intended to be
included as supplementary advice, and outlines new standards that should be adhered to when a doctor
is sharing information in public.
43. Treat all information about patients as confidential and sensitive. Be prepared to justify your
decision if, in exceptional circumstances, you feel you should pass on information without a patient’s
consent, or against a patient’s wishes.
Do you agree with the standard outlined, and the changes proposed? Are there any other changes you
would like the Council to make?
Supplementary guidance – Sharing information in public
When sharing information in any public forum (including, for example, chatting in a hospital cafeteria
or posting to a social networking site), do not disclose information about yourself that might
undermine your relationship with patients. Similarly, do not disclose information that might identify
and cause distress to colleagues, patients or their families.
Do you agree with the new standard outlined here? Are there any changes you would like the Council
to make?
26
See the Council’s statement on Confidentiality and the public safety for information about
the requirements of the Health Information Privacy Code.
30
It is suggested that the advice on sharing information with parents and caregivers be moved here, and
that it be included as supplementary guidance.
Supplementary guidance – Sharing Giving information with to parents or
caregivers
When working with patients under 16 years, you should give information about the patient’s condition
and treatment to parents or caregivers only if the patient consents or the following conditions apply:
 the patient lacks the maturity to understand their condition or what its treatment may involve
 you judge that you are acting in the young patient’s best interests by informing a parent or
caregiver.
Follow the guidance outlined in the Health Information Privacy Code.
Do you agree with the standards outlined, and the suggested changes? Are there any other changes you
would like the Council to make?
Sharing information with colleagues the patient’s general practitioner
It is suggested that the scope of this section be expanded to cover other circumstances where
information should be shared, rather than just in relation to a general practitioner. It is further
suggested that some of the less directive language be removed.
44. Many types of care arrangements27 are possible and You should ensure that patients need to know
how information is shared among those who provide their care. For example, you may have seen and
treated the patient but not be the patient’s general practitioner. The patient may have self-referred or
you may have seen the patient on referral from his or her general practitioner or another health
professional.
45. In all these situations You should seek the patient’s permission to, and explain the benefits of,
sharing information with other health practitioners involved in their care, including their the general
practitioner principal health provider (who will usually be their general practitioner). such as:
 test results
 details of your opinion
 any treatment you have started or changed
 any other information necessary for the patient’s continuing care.
The duty outlined in paragraph 46 is a merger of two separate current duties, one of which was a
general duty included as a dot point under the heading Working in teams – and the second of which
applied only to general practice. The wording used in these two earlier duties is included, with the text
struck through, so that you can compare them.
Share all relevant information clearly and promptly with colleagues involved in your patients’ care.
27
For example, you may have seen and treated the patient but not be the patient’s general practitioner. The
patient may have self-referred or you may have seen the patient on referral from his or her general practitioner or
another health professional.
31
Once you have the patient’s permission to share information provide the general practitioner with this
information without delay.
46. Once you have the patient’s permission to share information, you must provide the general
practitioner your colleagues with this the information they need to ensure that the patient receives
appropriate care without delay.
47. In most situations you should not pass on information if the patient does not agree. Some situations
exist in which colleagues the general practitioner should be informed even if the patient does not agree
(for example where disclosure is necessary to ensure appropriate ongoing care). Under the Health Act
1956 you may share information in these situations when a colleague the general practitioner is
providing ongoing care and has asked for the information.
Do you agree with the standards outlined, and the suggested changes? Are there any other changes you
would like the Council to make?
The central role of the general practitioner Continuity of care
The transition of care between one practitioner and another is often fraught, and miscommunication or
a lack of clarity about responsibility can result in significant adverse consequences for the patient. It is
therefore proposed that this section be bolstered, and begin with a new duty as follows.
48. Work collaboratively with colleagues to improve care, or maintain good care for patients, and to
ensure continuity of care wherever possible.
It is in patients’ best interests for one doctor, usually their general practitioner, to be:
 fully informed about patients’ medical care
 responsible for maintaining continuity of medical care.
The following were included as dot points under the heading Working in teams, but it is suggested that
they be listed as separate duties here.
49. Make sure that your patients and colleagues understand your responsibilities in the team and who
is responsible for each aspect of patient care.
50. If you are the patient’s principal health provider, you are responsible for maintaining continuity of
care. To facilitate this, you should know the range of treatment options available.
If you are a general practitioner and refer patients to specialists, you need to know the range of
specialist services available.
Do you agree with the proposed new duty and the other standards outlined in this section? Are there
any changes you would like the Council to make?
32
As noted above, the transition of care between one practitioner and another is often fraught. We
therefore propose to include separate pieces of supplementary advice on ensuring continuity of care
through a transfer of care, and when referring or delegating care to a colleague to make the standard of
care expected in these circumstances more explicit. Some of this advice is currently included in Good
Medical Practice, but much of it is new.
Supplementary guidance – Transferring a patients
When a patient is being transferred between a doctor and another health-care practitioner, he or she
must remain under the care of one of the two at all times. Formal handover is essential. The higher the
degree of activity the more important it is to ensure appropriate communication at the point of transfer.
The chain of responsibility must be clear throughout the transfer.
Transfer of care involves transferring some or all of the responsibility for the patient’s ongoing care.
When you transfer care of a patient to another practitioner, you must ensure that the patient remains
under the care of one of you at all times. You should also provide your colleague with appropriate
information about the patient and his or her care, and must ensure that the chain of responsibility is
clear throughout the transfer. Where the transfer is for acute care, you should provide this
information should be provided in a face-to-face or telephone discussion with the admitting doctor.
You must appropriately document all transfers.
You should ensure that the patient is aware of who is responsible for their care throughout the
transfer, and how information about them is being shared.
Supplementary guidance – Referring patients28
Referring involves transferring some or all of the responsibility for some aspects of the patient’s care.
Referring the patient is usually temporary and for a particular purpose, such as additional investigation,
or treatment that is outside your competence scope of practice. When you refer a patient, you should
provide all relevant information about the patient’s history and present condition.
You must Make sure you appropriately document all referrals.
When you order a test and expect that the result may mean urgent care is needed, your referral must
include one of the following:
 your out-of-hours contact details
 the contact details of the another health practitioner who will be providing after-hours cover in
your absence.
You must also have a process for identifying and following up on overdue results.
You should ensure that the patient is aware of how information about them is being shared and who
is responsible for providing treatment, undertaking an investigation and reporting results.
28
Cole’s Medical practice in New Zealand contains some useful advice in the chapter on The management of
clinical investigations.
33
One of the recurring issues in cases considered by the HDC is the management of a patient’s transition
to another service or practitioner29. There have been a number of cases where an “urgent” referral for
treatment has not been conducted in a timely manner, or where a referral for laboratory tests has not
been managed appropriately. What should the duties of a doctor making a referral be? And what
should the duties of the doctor accepting the referral be? Who should have overall responsibility for
ensuring that the test is conducted and the results reported?
To what extent should specialists treating a patient make themselves available to the patient’s GP to
discuss ongoing care and treatment that fall outside of the GP’s area of expertise?
Supplementary guidance – Delegating patient care to colleagues
Delegating involves asking a colleague to provide treatment or care on your behalf. When you delegate
care to a colleague, you must make sure that they have the appropriate qualifications, skill and
experience to provide care for the patient. Although you are not responsible for the decisions and
actions of those to whom you delegate, you remain responsible for your decision to delegate and for the
overall management of the patient.
Always You should pass on complete, relevant information about patients and the treatment they need.
You should ensure that the patient is aware of who is responsible for all aspects of their care, and
how information about them is being shared.
Do you agree with the inclusion of supplementary advice on transferring, referring or delegating care to
a colleague? Do you agree with the standards outlined? Are there any other changes you would like the
Council to make?
It is suggested that the advice on overseeing prescribing also be included here as supplementary advice,
rather than in the core text, because it builds on principles contained elsewhere in the resource. It is
also proposed that this section be reworded to differentiate (as the law does) between “prescribing”
and “administering” medicines.
29
Two such reports have recently been published, You might like to read the Commissioner’s opinions
09HDC01833, 10HDC00454 and 10HDC00974 at www.hdc.org.nz for a good summary of some of the issues we are
concerned about.
34
Supplementary guidance – Overseeing prescribing Prescribing and
administering of medicines by other health professionals practitioners
You may also need to oversee prescribing by other health professionals in one of the situations
described below.
You should support any non-doctor colleagues who are involved in prescribing or administering
medicines as outlined below.
When other health professionals have prescribing rights
Some other health professionals have legal and independent prescribing rights. If you are working in a
team with other health professionals who have prescribing rights, you should offer appropriate advice
when needed to help ensure patient safety.
When non-doctor colleagues have prescribing rights are supplying or administering medicines
More and more, other health professionals work in teams with doctors. Some teams delegate to nondoctors the responsibility for initiating and/or changing drug therapy. If the non-doctor prescriber is
working from standing orders, then the responsibility for the effects of the prescription rests with the
doctor who signed the standing order. If a colleague is working from standing orders30 that have been
issued under your authority, then you are responsible for the effects of the medicine being supplied
or administered. You should be available to give them advice, and should regularly review how the
standing order arrangement is working.
Support your non-doctor colleagues in these situations by:
 regularly auditing the non-doctor prescriber
 making yourself available by phone for advice.
Do you agree with the standards outlined and the suggested changes? Are there any other changes you
would like the Council to make?
It is also proposed that supplementary advice be included here on the subject of advanced planning for
transfer of care.
Supplementary guidance – Planning for transfer of care
You should have a plan in place to ensure continuity of care if you become unexpectedly ill.
If you are thinking of retiring or reducing your patient list, you should put transfer arrangements in
place and let your patients know before these arrangements take effect. With the patient’s consent,
all relevant medical records should be sent to the doctor taking over the care of the patient.
30
Refer to the Ministry of Health’s Standing Order Guidelines. You can view or download a copy of these
guidelines at http://www.health.govt.nz/publication/standing-order-guidelines
35
Do you agree with the inclusion of supplementary advice on advanced planning for transfer of care? Do
you agree with the standards outlined? Are there any other changes you would like the Council to
make?
Mentoring, teaching, training, appraising and assessing doctors and students31
It is suggested that the wording of paragraph 51 be made more directive. It is also suggested that the
current advice on supervision of new doctors be included as supplementary advice, rather than included
in the core text.
51. An integral part of professional practice is the teaching, training, appraising and assessing doctors
and students, which is important for the care of patients now and in the future. Teaching and the
passing on of knowledge is a professional responsibility. When you are involved in teaching you need
to develop should demonstrate the attitudes, awareness, knowledge, skills and practices of a competent
teacher.
Supplementary guidance – Supervision for newly registered doctors32
Make sure that all staff for whom you are responsible and who require supervision, including locums,
junior less experienced colleagues, and international medical graduates who are new to practice in New
Zealand are properly supervised. If you are responsible for supervising staff, you should make sure you
supervise at an appropriate level taking into account the work situation and the level of competence of
those being supervised.
Do you agree with the standards proposed, and the suggested changes to this section? Are there any
other changes you would like the Council to make?
Learning in medicine has long included an element of apprenticeship. New models of education have
begun to take precedence, but we feel that the apprenticeship model remains important – particularly
when a doctor is a new graduate or is new to a workplace. Should an additional duty be included which
requires doctors to seek out a mentor in their first years working as a doctor and when changing roles,
and a corresponding duty to be willing to act as a mentor to less experienced colleagues?
31
32
See the Council’s publication Education and supervision for interns.
See the Council’s booklet on Induction and supervision for newly registered doctors.
36
Professionalism Acting ethically
Principles
Act ethically and in accordance with relevant standards.
Be honest and open when working with patients; act with integrity by:
 acting without delay to prevent risk to patients
 acting without delay if you have good reason to believe that a colleague may be putting patients
at risk
 never discriminating unfairly against patients or colleagues
 never abusing your patients’ trust in you or the public’s trust of the profession.
Integrity in professional practice
We suggest amending this paragraph so that the advice is more directive and explicit.
52. Integrity – being honest and trustworthy – is at the heart of medical professionalism. Make sure that
at all times your conduct justifies your patients’ trust in you and the public’s trust in the profession. You
must be honest and trustworthy in your professional practice and in all communications with
patients.
Do you agree with the standards outlined, and the suggested changes to this section? Are there any
other changes you would like the Council to make?
Sexual and emotional boundaries33
The Council’s guidance on Sexual boundaries in the doctor-patient relationship makes clear that it is
usually inappropriate for a doctor to engage in a sexual or improper emotional relationship with a
former patient, as well as with current patients. It is recommended that the wording of the following
paragraph be amended to reflect that.
53. Do not become involved in any sexual or improper emotional relationship with a patient or someone
close to them. In most circumstances you should also avoid becoming sexually or inappropriately
emotionally involved with someone close to a patient, or a former patient.
Do you agree with the standards outlined and the suggested changes? Are there any other changes you
would like the Council to make?
33
See the Council’s guidance on Sexual boundaries in the doctor-patient relationship.
37
Writing reports, giving evidence and signing documents34
Some wording changes are suggested for this section, to clarify Council’s expectation. It is also
suggested that the sections currently included under the heading of Teaching, training, appraising and
assessing doctors and students fit better here, and that they be included as supplementary advice.
54. If you have agreed or are required to write reports, complete or sign documents or give evidence,
you should do so honestly, accurately and without delay.
Supplementary guidance – Providing objective assessments of performance
Be honest and objective when appraising or assessing the performance of colleagues, including those
whom you have supervised or trained. Patients may be put at risk if you describe as competent
someone who has not reached or maintained a satisfactory standard of practice.
Supplementary guidance – Writing references and reports
Provide only honest, justifiable and accurate comments when giving references for, or writing reports
about, colleagues. When providing references do so promptly and include all relevant information about
your colleagues’ competence, performance and conduct.
Do you agree with the standards outlined, and the suggested changes to this section? Are there any
other changes you would like the Council to make?
Financial and commercial dealings35
The Council has recently published a revised statement on Doctors and health related commercial
organisations which provides more explicit and directive advice on the subject of financial and
commercial dealings. It is therefore recommended that the following section cover only the key
principles that a doctor should adhere to, and that readers otherwise be referred to the statement.
55. Be honest and open in any financial or commercial dealings with patients, employers, insurers or
other organisations or individuals, declaring any interest, financial or otherwise, you have.
In particular, note the following:
 inform patients about your fees and charges before asking for their consent to treatment
 do not exploit patients’ vulnerability or lack of medical knowledge when making charges for
treatment or services
 do not encourage patients to give, lend or bequeath money or gifts that will benefit you
 do not put pressure on patients or their families to make donations to other people or organisations
 do not put inappropriate pressure on patients to accept private treatment.
Be honest in financial and commercial dealings with employers, insurers and other organisations or
individuals. In particular, note the following:
34
35
See the Council’s statement on Medical certification.
See also the Council’s statement on Doctors and health related commercial organisations.
38



before taking part in discussions about buying goods or services, declare any relevant financial
or commercial interest you or your family might have in the purchase
make sure funds you manage are used for the purpose for which they were intended and are
kept in a separate account from your personal finances
declare any relevant financial or commercial interest in goods or services provided by you or
another person or entity.
Hospitality, gifts and inducements
56. Act in your patients’ best interests when making referrals and providing or arranging treatment or
care. You must not allow any financial or commercial interests to affect the way you prescribe for,
treat or refer patients. You must Do not ask for or accept any inducement, gift, or hospitality that may
affect, or be perceived to have the capacity to affect, the way you prescribe for, treat or refer patients.
The same applies to offering such inducements to colleagues.
Do you agree with the standards outlined, and the suggested changes to this section? Are there any
other changes you would like the Council to make?
Conflicts of interest36
As noted above, the Council has recently revised its statement on Doctors and health related
commercial organisations. It is therefore recommended that the following section be amended so that
it only outlines the key principles that a doctor should adhere to, and that readers otherwise be referred
to the statement. This paragraph also includes a new duty, that doctors be prepared to exclude
themselves from relevant decision-making processes when they have a conflict of interest.
57. When making recommendations or referrals, you must declare any relevant financial or commercial
interest. If you have a conflict of interest, you must be open about the conflict, declaring your interest.
You should also be prepared to exclude yourself from related decision making.
Do you agree with the standards outlined, and the suggested changes to this section? Are there any
other changes you would like the Council to make?
36
See also the Council’s statement on Doctors and health related commercial organisations.
39
Accepting the obligation to maintain and improve standards
Principles
Keep your professional knowledge and skills up to date
Recognise, and work within, the limits of your competence.
Be committed to autonomous maintenance and improvement in your clinical standards.
Demonstrate reflectiveness, personal awareness, the ability to seek and respond constructively to
feedback and the willingness to share your knowledge and to learn from others.
Accept a responsibility for maintaining the standards of the profession.
Work cooperatively with, and be honest and open in your dealings with, managers, employers, the
Medical Council and other authorities.
Applying your knowledge and experience to practice
It is proposed that this chapter begin with a new section entitled Applying your knowledge and
experience to practice. The first paragraph of this new section outlines a new duty and is intended to
make clear that the requirements of Good Medical Practice apply to all aspects of a doctor’s practise.
Paragraph 59 outlines an existing duty, which was previously included under the heading Providing good
clinical care. This paragraph has been shifted, because the principles it outlines appear relevant to all
aspects of a doctor’s work (and not just when providing clinical care).
58. You must be competent in each professional role you hold. You must follow relevant guidance,
including the guidance published by the Council, and continue to develop your knowledge and skills.
This applies to all doctors, and to all aspects of your work including management, research and
teaching.
59. Recognise and work within the limits of your competence.
Do you agree with the standards outlined in this section, and the suggested changes? Are there any
other changes you would like the Council to make?
Research
The below sections have been shifted from another part of the resource. It is also proposed that this
section be reworded to make it more directive, and that we delete the first paragraph – because this
does not set a standard. We also propose to include some of the requirements relating to research in
other sections of the resource (for example, under the section on Financial and commercial dealings), so
it is suggested that those requirements be deleted from here.
Research is vital for improving care and reducing uncertainty for patients now and in the future, and for
improving the health of the population as a whole.
40
60. Use the following guidelines if you are involved in When designing, organising or carrying out
research:
 put the protection of the participants’ interests first
 act with honesty and integrity
 make sure that a properly accredited research ethics committee has approved the research
protocol, and that the research meets all regulatory and ethical requirements
 accept only payments that a research ethics committee has approved
 do not allow payments or gifts to influence your conduct
 do not make unjustified claims for authorship when publishing results
 report any concerns to an appropriate person or authority.
Do you agree with the standards outlined in this section, and the suggested changes? Are there any
other changes you would like the Council to make?
We have proposed to delete the statement emphasising the importance of research, because this
statement is non-directive and does not set a standard. Should a standard be included in its place? This
might, for example, state that doctors “should support research, for example through your own
involvement, or by encouraging patients to participate”.
Maintaining and improving your professional performance37
The below sections have been shifted from another part of the resource. We also propose to delete the
dot point on assessing treatments, because that appears to be separately captured under the heading
Research. We also propose to extend the breadth of the duty in relation to sentinel events, requiring
doctors to not just participate in recognition and reporting of such events – but also to contribute to the
analysis. The final dot point was originally included as a separate duty under the heading Working in
teams, but it is suggested that it fits better within this section.
61. Work with patients and colleagues to maintain and improve the quality of your work and promote
patient safety. In particular:
 take part in clinical audit, peer review and continuing medical education
 respond constructively to the outcome of audit, appraisals and performance reviews, undertaking
further training where necessary
 assess treatments to improve future services
 contribute to inquiries and sentinel event recognition, analysis and reporting, to help reduce risks to
patients
 report suspected drug reactions using the relevant reporting scheme
 cooperate with legitimate requests for information from organisations monitoring public health
 participate in regular reviews and audit of the standards and performance of any teams of group
in which you are a member, taking steps to remedy any deficiencies identified.
37
See the Council’s guidelines on Continuing professional development and recertification
41
Keeping up to date
62. Keep your knowledge and skills up to date throughout your working life:
 familiarise yourself with relevant guidelines and developments that affect your work
 take part regularly in professional development activities that maintain and further develop your
competence and performance
 observe and keep up to date with all laws and codes of practice relevant to your work.
Do you agree with the standards outlined, and the suggested changes? Are there any other changes you
would like the Council to make?
Openness and investigatory or legal processes
A number of wording changes have been proposed for this section. The most significant is the inclusion
of a new duty that doctors do not attempt to contact or influence complainants or witnesses in a
disciplinary proceeding. This move has unfortunately been prompted by a small number of cases where
doctors have attempted to do so.
We also propose to include the advice on giving evidence as supplementary advice, rather than in the
core text, and to reword the paragraph on notification so that it better aligns with the requirements
outlined in the Health Practitioners Competence Assurance Act 2003.
63. You must cooperate fully with any formal inquiry or inquest into the treatment of a patient
(although you have the right not to give evidence that may lead to criminal proceedings being taken
against you).
64. You must not withhold relevant information from any formal inquiry or inquest, or attempt to
contact or influence complainants or witnesses except where directed by the relevant authority. You
must also help the coroner when an inquest or inquiry is held into a patient’s death.
Supplementary guidance – Giving evidence
If you are asked to give evidence or act as a witness in litigation or formal proceedings, be honest in all
your spoken and written statements. Make clear the limits of your knowledge or competence.
65. You have additional responsibilities if you are involved in management or governance38. For example
In particular, you must ensure that procedures are in place for raising and responding to concerns.
Do you agree with the standards outlined, and the suggested changes to this section? Are there any
other changes you would like the Council to make?
38
See the Council’s statement on Responsibilities of doctors in management and governance.
42
Raising concerns about patient safety39
A number of changes have been suggested to this section to ensure that the advice is clear and directive
and consistent with the advice contained in the Council’s statement on Raising concerns about a
colleague.
66. Protect patients from risk of harm posed by a colleague’s conduct, performance or health. Patient
safety comes first at all times.
67. If a colleague behaves in a manner which is inappropriate or unprofessional you should speak to
them and raise your concerns in a constructive manner.
68. If your colleague does not respond to your concerns and continues to act inappropriately or
unprofessionally, raise your concerns with a manager, appropriate senior colleague or the relevant
external authority. Your comments about colleagues must be made honestly and in good faith. If you
are not sure how to raise your concerns what to do, ask an experienced colleague for advice.
69. If you have reasonable grounds to believe that patients are, or may be, at risk of harm for any
reason, do your best to find out the facts. Then you should follow your employer’s procedures or
policies, or tell an appropriate person or organisation straight away. Do not delay taking action
because you yourself are not in a position to put the matter right.
70. Under the HPCAA Health Practitioners Competence Assurance Act 2003 you must tell the Council if
a doctor’s ill-health is adversely affecting patient care.
71. You should also tell the Council about:
 incompetence concerns you have that another doctor is not fit to practise or is not providing an
appropriate standard of care
 behaviour by another doctor that risks causing harm to patients.
72. If a colleague raises concerns about your practice, you should respond constructively.
In less serious circumstances, or in situations involving other health professionals, you may prefer to tell
the:
 medical officer of health
 chief medical officer
 chief nursing officer
 chief executive
 appropriate registration authority
 Health and Disability Commissioner’s office.
Do you agree with the standards outlined, and the suggested changes to this section? Are there any
other changes you would like the Council to make?
39
See the Council’s statement on Raising concerns about a colleague.
43
Concerns about premises, equipment, resources, policies and systems
73. If you are concerned that patient safety may be at risk from inadequate premises, equipment or
other resources, policies or systems, put the matter right if possible. In all other cases you should record
your concerns and tell the appropriate body.
Do you agree with the standard outlined? Would you like the Council to make any changes to this
paragraph? Should doctors also hold some responsibility for the cleanliness, access, suitability and
privacy of their workplace? If so, what standards should apply?
Your health
74. You should Make sure you register with an independent general practitioner so that you have access
to objective medical care. You should Do not treat yourself40.
75. You should protect your patients, your colleagues and yourself by:
 following standard precautions and infection control practices
 undergoing appropriate screening
 being immunised against common serious communicable diseases where vaccines are available.
76. You must tell the Council’s Health Committee if you have a condition that may affect your practice,
judgement or performance. The Committee will help you decide how to change your practice if needed.
Do You should not rely on your own assessment of the risk you may pose to patients.41
77. If you think you have a condition that you could pass on to patients, you must consult a suitably
qualified colleague. Ask for and follow their advice about investigations, treatment and changes to your
practice that they consider necessary.
Do you agree with the standards outlined, and the suggested changes to this section? Are there any
other changes you would like the Council to make?
Disclosing concerns to the Council
A minor change is proposed for this section, to clarify the Council’s expectations around disclosure. “A
finding against your registration” is a limited phrase, which might not be relevant in some overseas
jurisdictions or cover the full range of adverse findings that might arise from a fitness to practise
procedure.
78. You must inform the Council without delay if, anywhere in the world:
 you have been charged with or found guilty of a criminal offence
 you have been suspended or dismissed from duties by your employer
 you have resigned for reasons relating to competence
40
Refer to the Council’s statement on Providing care to yourself and those close to you.
See The HRANZ joint guidelines for registered healthcare workers on transmissible major viral infections (a
statement developed by the Council with other regulatory bodies).
41
44

another professional body has found against your registration made a finding against you as a result
of ‘fitness to practise’ procedures.
Do you agree with the standards outlined, and the suggested changes to this section? Are there any
other changes you would like the Council to make?
Being open about concerns and restrictions on your practice
A number of wording changes are proposed for this section. We have also included a new duty here
that doctors provide honest and accurate answers to questions from patients about restrictions or
conditions on their practice. While this duty is new to Good Medical Practice, it is already a requirement
under Right 6(3) of the Code of Health and Disability Services Consumers’ Rights.
79. If you are suspended from working, or have restrictions or conditions placed on your practice, you
must inform without delay:
 any other persons or organisations in which you are in partnership or association with, or for
whom which you undertake medical work
 any patients you see independently.
80. You must also give patients honest and accurate answers to any questions they have about
restrictions or conditions on your practice.
Do you agree with the standards outlined, and the suggested changes to this section? Are there any
other changes you would like the Council to make?
Supporting colleagues
The following are currently included as duties under the heading Working in teams, but it is suggested
that they should apply in all circumstances where doctors work with colleagues and we therefore
propose moving them here.
81. You should support colleagues who have problems with performance, conduct or health42.
82. You should challenge colleagues if their own behaviour does not comply with the guidance in this
section.
Do you agree with the standards outlined, and the suggested changes to this section? Are there any
other changes you would like the Council to make?
42
See paragraph 68, and the Council’s statement on Raising concerns about a colleague.
45
Related documents
It is recommended that this appendix be updated to include new resources published (and resources
withdrawn) since the last edition was published.
The guidelines contained in Good Medical Practice do not cover all forms of professional practice or
discuss all types of misconduct that may bring your registration into question.
You should familiarise yourself with the series of statements and other publications produced by the
Council. The Council’s statements expand on points raised in this document. Some statements also
cover issues not addressed in this document, such as internet medicine and alternative medicine.
Standards set by the Council43
Below we list relevant Council statements and other publications.
Definitions
Clinical practice and non-clinical practice
Fitness to practise
Practice of medicine
Administrative practice
Non-treating doctors performing medical assessments of patients for third parties
Raising concerns about a colleague
Responsibilities of doctors in management and governance
Safe practice in an environment of resource limitation
General subjects
Advertising
Complementary and alternative medicine
Confidentiality and the public safety
Cosmetic procedures
Disclosure of harm following an adverse event
A doctor’s duty to help in a medical emergency
Ending a doctor-patient relationship
Fitness for registration – statement for medical students
Improper prescribing practice with respect to addictive drugs
Good prescribing practice
Information and consent
Information,choice of treatment and informed consent
Legislative requirements about patient rights and consent
The maintenance and retention of patient records
Medical certification
Doctors and health related commercial organisations
The use of drugs and doping in sport
Use of the internet and electronic communication
When another person is present during a consultation
Sexual boundaries in the doctor-patient relationship, a resource for doctors
43
For the most recent versions of the statements, go to www.mcnz.org.nz under the heading News and
Publications. New and updated statements are sent to all doctors with the Council’s newsletter.
46
Health
HRANZ Joint guidelines for registered health care workers on transmissible major viral infections
Providing care to yourself and those close to you
Cultural competence
Best practices when providing care to Māori patients and their whānau
Cultural competence
Other Council publications
Best health outcomes for Māori: Practice implications
Best health outcomes for Pacific peoples: Practice implications
Cole’s Medical practice in New Zealand (2008 ed)
Continuing professional development and recertification
Deciding whether to make a competence referral
Doctors’ health, a guide to how the Council manages doctors with health conditions
Education and supervision for interns, a resource for new registrants and their supervisors
Induction and supervision for newly registered doctors
The importance of clear sexual boundaries in the patient-doctor relationship, a guide for patients
Medical registration in New Zealand
Sexual boundaries in the doctor-patient relationship, a resource for doctors
What you can expect. The performance assessment
You and your doctor, guidance and advice for patients
Standards set by other agencies
The Code of Health and Disability Services Consumers’ Rights gives rights to consumers, and places
obligations on all people and organisations providing health and disability services, including doctors.
Traditionally the Code of Ethics for the medical profession in New Zealand is that of the New Zealand
Medical Association.
Legislation places further legal obligations on doctors – consult your lawyer if you need advice about
your legal obligations.
Do you agree with the suggested changes to this section? Are there any other resources that should be
referred to here?
47
The Council has found that patients often refer to Good Medical Practice when they are uncertain about
the quality of care they have received. This is appropriate, and Council has tried to make the resource
easy for members of the public to read and understand. But we also publish a separate resource, You
and your doctor, which includes additional information that is relevant to patients (and doctors too).
For example, this resource outlines what doctors should expect from their patients, and what patients
should look for when reading information they find on the internet. The resources have very different
purposes, but it may be useful to include them alongside one another for ease of reference. Should You
and your doctor be included as an appendix to Good Medical Practice?
48
Additional consultation questions
Does Good Medical Practice provide advice on all relevant aspects of medical
practice?
Are there any areas where Good Medical Practice should provide advice, but doesn’t? If so, what advice
should it provide? Here are some topics to help you in your thinking:
- Patient centred care.
- Patient safety.
- Issues relevant to doctors in training.
- Evidence-based practice.
- Human rights.
How far should the Council go in regulating doctors’ behaviour outside medicine?
Council currently takes the view that in some cases a doctor’s conduct outside the workplace might
impact on patient care or undermine trust in the profession, and we may therefore have a legitimate
concern about their suitability to practise medicine. Recent cases where Council has taken action have
included where a doctor was convicted of child pornography offences, and where doctors have been
arrested on charges relating to the use of illegal recreational drugs or drink driving (in these cases our
interest is usually to assure ourselves that a doctor does not have a problem with substance abuse).
How far should the Council go in regulating doctors’ behaviour outside medicine?
Can Good Medical Practice better assist patients in making choices about their care?
Consumers have advised Council that they value being able to see a doctor of their own choosing. Often
the ability to see a preferred doctor can be restricted by workforce limitations, but the ability to choose
a doctor you can relate to has important implications for the doctor-patient relationship. There also
appear to be some circumstances where a choice should be available, but is not. One example is in
elder care, and Council is aware of situations where patients moving into a residential care facility have
been told that they can no longer see the GP of their choice, but must instead see a doctor chosen by
the facility. Should Good Medical Practice capture issues of patient choice, when it comes to their right
to see their preferred doctor? If so, how?
49
Should You and your doctor be included as an appendix?
The Council has found that patients often refer to Good Medical Practice when they are uncertain about
the quality of care they have received. This is appropriate, and the Council has tried to make the
resource easy for members of the public to read and understand. But we also publish a separate
resource, You and your doctor, which includes additional information that is relevant to patients (and
doctors too). For example, this resource outlines what doctors should expect from their patients, and
what patients should look for when reading information they find on the internet. The resources have
very different purposes, but it may be useful to include them alongside one another for ease of
reference. Should You and your doctor be included as an appendix to Good Medical Practice?
Is a glossary needed?
Are there any terms used in the resource that require definition or explanation?
Would examples and case studies be helpful
Would it be helpful to outline examples and case studies? If so, can you suggest examples or case
studies that would be helpful in illustrating a particular principle?
50