The newly updated Guide to professional conduct and ethics for registered medical practitioners comes into effect on 1 January 2024 and sets the standards expected of doctors, as well as informing medical education and fitness to practise decisions by the Medical Council. Doctors in Ireland need to become familiar with the contents and apply them to their practice.

The guide is shorter and with a new structure than its 2016 predecessor, making it easier to read. It includes new and revised guidance on areas such as communicating with the public, responsible use of healthcare resources, record-keeping and self-reporting health concerns.

At its heart are 15 values and principles underpinning good professional practice, including acting with honesty, integrity and compassion and being honest and open with patients when things go wrong.

The eight domains of good practice

The Medical Council describes this as 'a framework of competencies applicable to all doctors.' They have a statutory basis , which is a departure from the three pillars of professionalism which had shaped previous guidance. The eight domains are listed below.

Patient safety and quality of patient care - being accountable for ensuring patients receive the best possible care is at "the core of health service delivery."
Relating to patients - partnership based on mutual respect, confidentiality, honesty, responsibility and accountability.
Communication and interpersonal skills - for exchanging information and effective collaboration.
Collaboration and teamwork - protecting patients through co-operation, clear lines of communication and systems of accountability.
Management (including self-management) - understanding how professional and personal actions affect colleagues, the healthcare system and wider society.
Scholarship - continuing professional development and being guided by the best available information and evidence.
Professionalism - meeting the standards set by the Medical Council.
Clinical skills - maintaining professional competence in line with standards set by relevant postgraduate training body.

The six chapters in the new guide make it easier to find relevant information. Here is a summary of each:

Good medical practice and patient safety (paragraphs 1-12)

This focuses on the fundamentals of providing and promoting safe, patient-centred care, including working in partnership with patients, raising concerns, being honest and open following a patient safety incident (open disclosure), protecting children and vulnerable adults and looking after your own health and wellbeing. Although you may not be in a leadership role, you're expected to raise concerns if appropriate about premises, processes and systems.

Recognising that resources are finite, it says: "You should strive to use resources equitably, efficiently and sustainably, consistent with evidence-based patient care, and in the context of planetary health and the environment. You should balance your duty of care to each patient with your responsibility to the community, the wider population and global health." (paragraph 9).

In the section on health and wellbeing, it makes clear that you, "must inform the Medical Council as soon as you become aware of" any risk you pose "to yourself, patients and others."

Consent (paragraphs 13-24)

This section emphasises the importance of treating each patient as an individual and obtaining their informed consent before initiating any treatment (or having another lawful authority). The guide sets out the requirements for informed patient consent, including the need to provide sufficient information in a way they can understand, taking into account their wishes, level of understanding and the likely success of different options (paragraph 15).

Patients' rights to decline or withdraw consent, the importance of advanced care planning, involving children in decision-making and consent for specific procedures such as genetic testing, intimate examinations and clinical research are also covered.

Confidentiality (paragraphs 25-32)

Doctors' professional and ethical duty to maintain patient confidentiality is a well understood principle but it is not absolute and the guide looks at situations when it may be necessary to disclose information, such as in the interest of patient care, by law or in the public interest. Ideally disclosures would be made with patient consent.

The previous guide was forthright in stating that parents and guardians, "have a legal right to access medical records of their children until they are 18", but this newer version is more nuanced. It explains that "you should usually try to encourage [the child] to involve a parent", but if they refuse and you consider it is necessary and in the child's best interests for the information to be shared, you may, depending on the circumstances, consider disclosing information to parents.

However, it recognises that, "Parents may be entitled by law to access their child's medical records" and you should explain to young patients that you, "cannot give an absolute guarantee of confidentiality."

This section also covers the confidentiality of audio and video recordings, including facilitating requests by patients to record all or part of their consultation, unless you consider this could have a negative impact.

Continuity of care (paragraphs 33-46)

This chapter focuses on coordination of care between different practitioners across primary, secondary and tertiary care settings, looking at areas that present particular risk such as handover, prescribing and record-keeping.

In a positive development, it is no longer stipulated that notes should be dated and timed using the 24-hour clock, which meant doctors were vulnerable to criticism. The guidance on prescribing is also simpler as it omits some of the clinical points in the previous version.

This section also covers some of the more difficult situations you might face in professional practice, such as refusing treatment where it's not clinically indicated or where you have a conscientious objection, dealing with challenging behaviour or patients that pose a risk of harm and end of life care.

Professionalism (paragraphs 47-59)

High standards of professional behaviour are necessary for retaining public trust, and the guide is clear that this goes beyond your interactions with patients and relationships with colleagues.

As well as maintaining professional boundaries and showing respect towards others, it covers a number of other areas of practice including your use of social media and other communication, fees and advertising, clinical research and medical reports. The guidance on medical reports includes a new requirement to explain to patients that, "you cannot omit relevant information from the report", which we hope will pre-empt complaints on this issue.

Regulatory requirements (paragraphs 60-64)

The final chapter considers Medical Council requirements of doctors before they can practice in Ireland; registration, maintaining professional competence, professional indemnity and proficiency in written and spoken English. It also sets out its own role in acting if doctor poses a potential risk to patient safety, to retain public confidence in the profession or maintain standards. The Medical Council complaints process is set out in detail on its website.

In summary

This article is an introduction, but we recommend you familiarise yourself with the new guide and bookmark the page so you can find relevant content when it matters. While you'll be able to use your professional judgement to apply the principles in most cases, members can also contact the MDU for specific advice.

Understanding the updates to the Irish Medical Council's good practice guidance

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