Medical professionalism matters #gooddoctors

Niall Dickson Chief Executive and Registrar General Medical Council

Our partners This programme has been developed by the GMC in partnership with an advisory group: Tonight’s event has been sponsored by:

Medical professionalism Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors.

Putting safety and quality improvement first #gooddoctors

Chris Kenny Chief Executive Officer MDDUS

Putting safety and quality improvement first #gooddoctors

Which of the following are not displayed on the Glasgow coat of arms? 1.Bird 2.River 3.Tree 4.Bell 5.Fish

Who are we? 1.Patient or carer/relative 2.Consultant 3.GP 4.Doctor in training 5.SAS/other doctor 6.Medical student 7.Medical educator/trainer 8.Employer (inc. RO) 9.Other health professional 10.Other

Doctors today are less compassionate than 20 years ago. Do you…? 1.Agree – it’s the product of too little time, increasing patient demand and expectations 2.Agree – it’s the product of pressure on organisational performance and management demands 3.Agree – the way we train doctors removes much of the idealism and compassion that attracted them to medicine in the first place 4.Disagree – whatever the pressures, compassion still motivates the vast majority of doctors 5.Not sure

Doctors today are less compassionate than 20 years ago. Do you…? 1.Agree – it’s the product of too little time, increasing patient demand and expectations 2.Agree – it’s the product of pressure on organisational performance and management demands 3.Agree – the way we train doctors removes much of the idealism and compassion that attracted them to medicine in the first place 4.Disagree – whatever the pressures, compassion still motivates the vast majority of doctors 5.Not sure

In my current role I am able to prioritise patient safety 1.Always 2.Most of the time 3.Some of the time 4.Rarely 5.Never

In my current role I am able to prioritise quality improvement A.Always B.Most of the time C.Some of the time D.Rarely E.Never

If I were to raise a serious concern in my institution I would be… A.Reasonably confident that I would be supported by clinical and other leaders B.Unsure as to whether I would be supported by clinical and other leaders C.Not at all confident that I would be supported by clinical and other leaders D.Not sure

If I were struggling to cope as a result of pressures on the service, I am confident that I could ask for and receive help without being penalised in any way. A.Strongly agree B.Agree C.Neither agree nor disagree D.Disagree E.Strongly disagree

Don Berwick said the NHS should continually and forever be reducing patient harm by embracing wholeheartedly an ethic of learning. How far is the health system achieving that? A.Huge progress has been made, though obviously more to do B.Some progress has been made, a great deal more to do C.No more than rhetoric, system does not yet realise the extent of change required D.I don’t agree that’s the way to go about it E.Not sure

Dr Catherine Calderwood Chief Medical Officer for Scotland, obstetrician and gynaecologist

First Annual Report as CMO Report divided into 2 sections Realistic medicine – challenges that face us as doctors today Surveillance data – health of the nation Feedback welcomed on both – contact me to agree or disagree with the content, use the data to evidence successes or as levers to drive further improvements. Plan to engage in conversation with clinicians and ask questions on infographic Encourage you and colleagues to also use this for discussion among yourselves and feedback to me.

Feedback so far….

Added Value of Doctors in a Complex System Current models of healthcare are stretched This doesn’t always suits patients, the people who care for them or the aspirations of workforce Good clinical leadership linked to good patient care Strong clinical leadership single most effective force to prevent failings in future

The Hippocratic Oath: ὄ μνυμι Ἀ πόλλωνα ἰ ητρ ὸ ν κα ὶ Ἀ σκληπι ὸ ν κα ὶ Ὑ γείαν κα ὶ Πανάκειαν κα ὶ θεο ὺ ς πάντας τε κα ὶ πάσας, ἵ στορας ποιεύμενος, ἐ πιτελέα ποιήσειν κατ ὰ δύναμιν κα ὶ κρίσιν ἐ μ ὴ ν ὅ ρκον τόνδε κα ὶ συγγραφ ὴ ν τήνδε: ἡ γήσεσθαι μ ὲ ν τ ὸ ν διδάξαντά με τ ὴ ν τέχνην ταύτην ἴ σα γενέτ ῃ σιν ἐ μο ῖ ς,κα ὶ βίου κοινώσεσθαι, κα ὶ χρε ῶ ν χρηΐζοντι μετάδοσιν ποιήσεσθαι, κα ὶ γένος τ ὸ ἐ ξ α ὐ το ῦἀ δελφο ῖ ς ἴ σον ἐ πικρινε ῖ ν ἄ ρρεσι, κα ὶ διδάξειν τ ὴ ν τέχνην ταύτην, ἢ ν χρηΐζωσι μανθάνειν, ἄ νευ μισθο ῦ κα ὶ συγγραφ ῆ ς, παραγγελίης τε κα ὶ ἀ κροήσιος κα ὶ τ ῆ ς λοίπης ἁ πάσης μαθήσιοςμετάδοσιν ποιήσεσθαι υ ἱ ο ῖ ς τε ἐ μο ῖ ς κα ὶ το ῖ ς το ῦ ἐ μ ὲ διδάξαντος, κα ὶ μαθητ ῇ σισυγγεγραμμένοις τε κα ὶ ὡ ρκισμένοις νόμ ῳ ἰ ητρικ ῷ, ἄ λλ ῳ δ ὲ ο ὐ δενί. διαιτήμασί τε χρήσομαι ἐ π ᾽ ὠ φελεί ῃ καμνόντων κατ ὰ δύναμιν κα ὶ κρίσιν ἐ μήν, ἐ π ὶ δηλήσει δ ὲ κα ὶ ἀ δικί ῃ ε ἴ ρξειν. ο ὐ δώσω δ ὲ ο ὐ δ ὲ φάρμακον ο ὐ δεν ὶ α ἰ τηθε ὶ ς θανάσιμον, ο ὐ δ ὲ ὑ φηγήσομαι συμβουλίην τοιήνδε: ὁ μοίως δ ὲ ο ὐ δ ὲ γυναικ ὶ πεσσ ὸ ν φθόριον δώσω. ἁ γν ῶ ς δ ὲ κα ὶ ὁ σίως διατηρήσω βίοντ ὸ ν ἐ μ ὸ ν κα ὶ τέχνην τ ὴ ν ἐ μήν. ο ὐ τεμέω δ ὲ ο ὐ δ ὲ μ ὴ ν λιθι ῶ ντας, ἐ κχωρήσω δ ὲ ἐ ργάτ ῃ σιν ἀ νδράσι πρήξιος τ ῆ σδε. ἐ ς ο ἰ κίας δ ὲ ὁ κόσας ἂ ν ἐ σίω, ἐ σελεύσομαι ἐ π ᾽ ὠ φελεί ῃ καμνόντων, ἐ κτ ὸ ς ἐὼ ν πάσης ἀ δικίης ἑ κουσίης κα ὶ φθορίης, τ ῆ ς τε ἄ λλης κα ὶ ἀ φροδισίων ἔ ργων ἐ πί τε γυναικείων σωμάτων κα ὶ ἀ νδρ ῴ ων, ἐ λευθέρων τε κα ὶ δούλων. ἃ δ ᾽ ἂ ν ἐ νθεραπεί ῃ ἢ ἴ δω ἢ ἀ κούσω, ἢ κα ὶ ἄ νευ θεραπείης κατ ὰ βίον ἀ νθρώπων, ἃ μ ὴ χρή ποτε ἐ κλαλε ῖ σθαι ἔ ξω, σιγήσομαι, ἄ ρρητα ἡ γεύμενος ε ἶ ναι τ ὰ τοια ῦ τα. ὅ ρκον μ ὲ ν ο ὖ ν μοι τόνδε ἐ πιτελέα ποιέοντι, κα ὶ μ ὴ συγχέοντι, ε ἴ η ἐ παύρασθαι κα ὶ βίου κα ὶ τέχνης δοξαζομέν ῳ παρ ὰ π ᾶ σιν ἀ νθρώποις ἐ ς τ ὸ ν α ἰ ε ὶ χρόνον: παραβαίνοντι δ ὲ κα ὶ ἐ πιορκέοντι, τ ἀ ναντία τούτων. [4] [4]

I swear to fulfil, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. Above all, I must not play at God. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. This modern version was written in 1964 by Louis Lasagna, Dean of the School of Medicine at Tufts University

2. Good doctors work in partnership with patients and respect their rights to privacy and dignity. They treat each patient as an individual. They do their best to make sure all patients receive good care and treatment that will support them to live as well as possible, whatever their illness or disability. 24. You must promote and encourage a culture that allows all staff to raise concerns openly and safely GMC Good Medical Practice (2013) 1. Patients need good doctors. Good doctors make the care of their 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 and within the law. *

“...everyone in healthcare really has two jobs when they come to work every day: to do their work and to improve it.” What is ‘‘quality improvement’’ and how can it transform healthcare? Batalden,P; Davidoff.F Qual Saf Health Care February; 16(1): 2–3

Positive Leadership influence not power Excellence under pressure Purpose- vision Integrity Ensure there is a team and team spirit Leaders find solutions when the going gets tough Leaders know when things aren’t ‘right’ and they make efforts to change Openminded, fair, take the bigger view not their own

“Change will not come if we wait for some other person or some other time. We are the ones we've been waiting for. We are the change that we seek.” Barack Obama

Your feedback will help shape policy… calderwood/108/979/691

Putting safety and quality improvement first #gooddoctors

Table discussions We would like each table to cover:  Things that enable us to/prevent us from putting safety and quality improvement first Plus one or two of the following topics:  Human factors  Leadership  The role of governance Please also agree a question per table for the panel discussion later.

Supper Please fill in a card for our solutions wall

Putting safety and quality improvement first #gooddoctors

Question time panel  Dr Catherine Calderwood Chief Medical Officer, Scotland  Chris Kenny Chief Executive Officer, MDDUS  Dr Miles Mack Chair of the Scottish Council of the Royal College of General Practitioners  Mr Samit Majumdar Consultant Surgeon NHS Tayside and Scottish Patient Safety Programme Fellow  Professor Bill Reid Dean of Postgraduate Medicine, South East Region, Scotland Deanery  Dr Chris Sheridan Chair of BMA Scotland’s Junior Doctors Committee

Thank you #gooddoctors