Physicians to be prescribed “courtesy”

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In Russia will be elaborated ethical behaviour standards for physicians and nurses.

For Russian health care workers will be elaborated ethical behaviour standards, stated the Russian Deputy Prime Minister Olga Golodets. According to her, patients should be treated “politely, carefully and correctly” at all the levels of health care, from registration offices in hospitals to in-patient clinics. Experts believe that physicians should not be allowed to swear and discuss their colleagues’ errors, and violators of these rules should be fined.

This year for medical institutions’ staff will be developed and introduced ethical behaviour standards. That information was given by the Deputy Prime Minister Olga Golodets at the meeting of the Council on social assistance that took place on 25 February 2015.

According to Golodets, it’s a must to create a unified code of ethics for all the levels of health care, from registration offices in hospitals to the institutions where people have to spend much time and where they need special care and attention.

The Deputy Prime Minister added those rules of conduct should be developed not only for health care workers, but also for registration offices’ employees as against them patients made more complaints. “We want people to feel a friendly, cooperative attitude to patients at all the levels of health care,” pointed out Golodets.

The creation of this code of ethics has been discussed by non-governmental organizations and professional communities for several years. However, there’s no a specific document nor as a system of sanctions for violations. At the moment majority agrees with the words of Veronika Skvortsova (the Minister of Health) who stated at the end of 2014 that the physician “should have high moral values, be smart, wise and kind”.

Experts believe the basic points of this code of ethics should be the following: a ban on the use of swears (however, if the patient’s life is threatened may be made some exceptions), limits on the discussion of other physicians’ errors and a ban on the discussion of other patients’ cases, even anonymously.

“It is also a good idea to teach physicians the basics of conflict management. 90% of all the conflicts and legal proceedings can be avoided if the health worker simply apologizes and admits he/she was wrong,” said the President of the League advocates for patients Alexander Saversky.

“For a long time I had been looking for an example, when a doctor made a public apology to his/her patient. The nearest town, where such a case was registered was in Bulgaria”. Saversky added that complaints of rudeness and brutal treatment were found in almost every situation when patients made complaints against physicians. In the majority of cases it happens in public in-patient institutions, because there is no enough time for interaction with the patient there.

“At the same time it is very important to identify the cases in which the patient is wrong. Health care is an area connected with pain, fear and asymmetric information. So the doctor can speak something very neutral, and the patient understands it as something nasty due to his/her keen perception,” explains Saversky.

According to experts, the Russian health care needs a system of administrative punishment, from fines for rudeness to the deprivation of medical license, if the violation of medical ethics has led to serious consequences. “The mechanism should be the following: a patient makes a complaint and Roszdravnadzor (the Federal Service for the Supervision of Public Health) examines the situation and imposes sanctions, but if a doctor does not agree, he/she can challenge it. We need an immediate response, not legal procedures. In our country people rarely go to court, even if they were inflicted physical harm, without speaking of a compensation for moral damages,” says Saversky.

It will be possible to watch the compliance with the rules thanks to the help of special equipment and health care workers’ colleagues’ involvement. Thus, last summer in Moscow clinics there was launched an experiment: they began recording all the patients’ phone calls in registration offices. The clinic’s administration should selectively listen to the recordings once a month and reward or punish employees from those registration offices.

Furthermore, last year in Moscow clinics they planned to create a post of an administrator. That employee would be responsible for managing conflicts peacefully, creating a favorable psychological atmosphere, and helping patients find the right office in the hospital. Their future is unknown considering a large-scale reform in the health care system. But experts believe that the clinic will continue trying to improve the culture of communication with patients due to a new principle according to which institution’s money is simply proportional to the number of new patients.

Private clinics have had such a system for a long time, so many physicians managed to elaborate their own codes of conduct. “In our clinic it’s forbidden to talk about the reasons the patient went to hospital in other people’s presence, including other clinic’s clients. Moreover, one cannot discuss other specialists’ errors before the patient. I believe the physician has no rights to criticize the work of other specialists out of a doctor’s medical concilium, as self-assertion in such a way can damage the specialist’s reputation, and reputation is everything we have,” said a plastic surgeon, the president of the clinic The Platinental Aesthetic Lounge Andrey Iskornev.

According to Mikhail Gavrilov, the scientific director of Dr. Gavrilov’s Centers, “We have a code of conduct that explains in details how to meet, serve and accompany the patient. We have a certain format of phone calls: the health care worker can’t have a rude, indifferent attitude. Formalism is also excluded. The patient should get answers to all their questions. If the clinic’s employee fails to meet all the requirements, they will be fined from 1,000 to 10,000 rubles ($16-160).

Employees should not discuss private issues in front of the patient, it’s also forbidden to have meals, drink tea in the area where the centre’s visitors are situated.

Any heart-to-heart talks or public conflicts are strongly prohibited. Violators are fined and if they are fined three times they should be dismissed”.

Ethical behaviour standards for medical staff should be elaborated by non-governmental organizations in close cooperation with professional communities, not by the Ministry of Health, believes a Professor from I.M. Sechenov First Moscow State Medical University, M.D. Evgeny Achkasov.

“In this case, we should determine what we mean by “boorish behaviour”, how to estimate its consequences, how to punish, who is to deal with such cases and what can be considered as evidence. For example, what to do if a doctor was rude with a patient, the latter had a sharp increase in blood pressure and was prescribed hypertension medication, although he/she didn’t need it? Besides, we are to determine how doctors should treat other health care professionals. By the way, they must study these regulations at their medical universities,” said Achkasov.

Text and pictures by GAZETA.RU