Good medical practice: a code of conduct for doctors in Australia
Good medical practice (the code) describes what is expected of all doctors registered to practise medicine in Australia.1 It sets out the principles that characterise good medical practice and makes explicit the standards of ethical and professional conduct expected of doctors by their professional peers and the community. The code was developed after wide consultation with the medical profession and the community. It is addressed to doctors and is also intended to let the community know what they can expect from doctors. The application of the code will vary according to individual circumstances, but the principles should not be compromised.
This code complements the Australian Medical Association Code of ethics2 and is aligned with its values. It is also consistent with the Declaration of Geneva3 and the International code of medical ethics4, issued by the World Medical Association.
This code does not set new standards. It brings together, into a single Australian code, standards that have long been at the core of medical practice.
The Board will also issue additional guidance from time to time, to support good medical practice. Examples include:5
The practice of medicine is challenging and rewarding. No code or set of guidelines can ever encompass every situation or replace the insight and professional judgement of good doctors. Good medical practice means using this judgement to try to practise in a way that would meet the standards expected of you by your peers and the community.
Doctors have a professional responsibility to be familiar with Good medical practice and to apply the guidance it contains.
This code will be used:
The code can also be used in medical education; in orientation, induction and supervision of junior doctors and international medical graduates; and by administrators and policy makers in hospitals, health services and other institutions.
The code applies in all settings. It is valid for technology-based patient consultations (including online/remote prescribing), for traditional face-to-face consultations and applies to how doctors use social media. To guide doctors further, the Medical Board of Australia has issued Guidelines for technology-based patient consultations7 and social media guidance8.
This code is not a substitute for the provisions of legislation and case law. If there is any conflict between this code and the law, the law takes precedence.
This code is not an exhaustive study of medical ethics nor is it an ethics textbook. It does not address in detail the standards of practice within particular medical disciplines; these are found in the policies and guidelines issued by medical colleges and other professional bodies.
While good medical practice respects patients’ rights, this code is not a charter of rights.9
In this code, reference to the term ‘patient’ also includes substitute decision-makers for patients who do not have the capacity to make their own decisions. These include parents, guardians, a person nominated by the patient or legally appointed. If in doubt, seek advice from the relevant guardianship authority or from your professional indemnity insurer.
Australia is culturally and linguistically diverse. We inhabit a land that, for many ages, was held and cared for by Aboriginal and Torres Strait Islander Peoples, whose history and culture have uniquely shaped our nation. Our society is further enriched by the contribution of people from many nations who have made Australia their home.
Doctors in Australia reflect the cultural diversity of our society and this diversity strengthens our profession.
There are many ways to practise medicine in Australia. The core tasks of medicine are caring for people who are unwell and seeking to keep people well. This code focuses primarily on these core tasks. While not all of this code may apply to doctors who undertake roles that have little or no patient contact, the principles underpinning it will still apply.
1 The Medical Board of Australia has defined ‘practice’ in its registration standards, available at: www.medicalboard.gov.au
2 AMA (2017) Code of ethics ama.com.au/position-statement/code-ethics-2004-editorially-revised-2006-revised-2016
3 WMA (2017) Declaration of Geneva www.wma.net/policies-post/wma-declaration-of-geneva/
4 WMA (2006) International code of medical ethics www.wma.net/policies-post/wma-international-code-of-medical-ethics/
5 Medical Board of Australia guidelines are available at: www.medicalboard.gov.au/Codes-Guidelines-Policies
6 The Health Practitioner Regulation National Law, as in force in each state and territory (the National Law)
7 Guidelines for technology-based patient consultations issued by the Medical Board of Australia, available at: www.medicalboard.gov.au.
8 Social media: How to meet your obligations under the National Law issued by the Medical Board of Australia, available at: www.medicalboard.gov.au.
9 The Australian Commission on Safety and Quality in Health Care (2008) Australian charter of healthcare rights www.safetyandquality.gov.au/national-priorities/charter-of-healthcare-rights/.
While individual doctors have their own personal beliefs and values, there are certain professional values on which all doctors are expected to base their practice.
Doctors have a duty to make the care of patients their first concern and to practise medicine safely and effectively. They must be honest, ethical and trustworthy.
Patients trust their doctors because they believe that, as well as being competent, their doctor will not take advantage of them and will display qualities such as integrity, truthfulness, dependability and compassion. Patients rely on their doctors to protect their confidentiality.
Doctors have a responsibility to protect and promote the health of individuals and the community.
Good medical practice is patient-centred. For individual doctors, it involves working in partnership with your patients, understanding that each patient is unique, and adapting what you do to address their needs and reasonable expectations. Good medical practice also involves practising in a way that is culturally safe and respectful; being aware of your own culture and beliefs and respectful of the beliefs and cultures of others, and recognising that these cultural differences may impact on the doctor–patient relationship and on the delivery of health services.
Good communication underpins every aspect of good medical practice.
Professionalism includes self-awareness and self-reflection. Good medical practice requires doctors to reflect regularly on their practice and its effectiveness, consider what is happening in their relationships with patients and colleagues, and look after their own health and wellbeing. It requires doctors to learn from what has gone well and what hasn’t. Doctors have a duty to keep their skills and knowledge up to date, to develop and refine their clinical judgement as they gain experience, and contribute to their profession.
The community trusts the medical profession. Every doctor has a responsibility to behave ethically to justify this trust.
While there are professional values that underpin good medical practice, all doctors have a right to have and express their personal views and values. However, the boundary between a doctor’s personal and public profile can be blurred. As a doctor, you need to consider the effect of your public comments and your actions outside work, including online, related to medical and clinical issues, and how they reflect on your role as a doctor and on the reputation of the profession.
In clinical practice, the care of your patient is your primary concern. Providing good patient care includes:
Maintaining a high level of medical competence and professional conduct is essential for good patient care. Good medical practice involves:
Making decisions about healthcare is the shared responsibility of the doctor and the patient. Patients may wish to involve their family, carer or others. See section 1.4 on substitute decision-makers.
Your decisions about patients’ access to medical care must be free from bias and discrimination. Good medical practice involves:
Treating patients in emergencies requires doctors to consider a range of issues, in addition to the patient’s best care. Good medical practice involves offering assistance in an emergency that takes account of your own safety, your skills, the availability of other options and the impact on any other patients under your care; and continuing to provide that assistance until your services are no longer required.
10 In some jurisdictions, legislation mandates doctors who do not wish to participate in certain treatments, to refer on the patient.
11Australian Human Rights Commission (2014), A quick guide to Australian discrimination laws http://humanrights.gov.au/info_for_ employers/law/index.html.
A good doctor–patient partnership requires high standards of professional conduct. It involves:
Effective communication is an important part of the doctor–patient relationship. It involves:
Patients have a right to expect that doctors and their staff will hold information about them in confidence, unless release of information is required or permitted by law. Good medical practice involves:
Informed consent is a person’s voluntary decision about medical care that is made with knowledge and understanding of the benefits and risks involved. Good medical practice involves:
Caring for children and young people brings additional responsibilities and challenges for doctors. Good medical practice involves:
Aboriginal and Torres Strait Islander Peoples have inhabited and cared for the land as the first peoples of Australia for millennia, and their diverse histories and cultures have uniquely shaped our nation. Aboriginal health means not just the physical wellbeing of an individual but refers to the social, emotional and cultural wellbeing of the whole community in which each individual is able to achieve their full potential as a human being, thereby bringing about the total wellbeing of their community. It is a whole-of-life view and includes the cyclical concept of life-death-life.14
Understanding and acknowledging factors such as colonisation and its impact on Aboriginal and Torres Strait Islander Peoples’ health, helps inform care. In particular, Aboriginal and Torres Strait Islander Peoples bear the burden of gross social and health inequity. It is for these reasons that cultural safety in the context of Aboriginal and Torres Strait Islander health needs to be specifically considered.
Good medical practice supports the health of Aboriginal and Torres Strait Islander Peoples, including cultural safety. For Aboriginal and Torres Strait Islander Peoples, the National Registration and Accreditation Scheme’s definition of cultural safety is as follows.
Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities.
Culturally safe practice is the ongoing critical reflection of health practitioner knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible and responsive healthcare free of racism.
To ensure culturally safe and respectful practice, medical practitioners must:
Section 4.7 (above) defines cultural safety for Aboriginal and Torres Strait Islander Peoples specifically for their status as First Nations Peoples. Culturally safe and respectful practice is also important for all communities.
Australia is a culturally and linguistically diverse nation.
Culturally safe practice requires you to understand how your own culture, values, attitudes, assumptions and beliefs influence your interactions with patients and their families, the community, colleagues and team members.
Culturally safe care acknowledges the social, economic, cultural, historic and behavioural factors influencing the health of individuals, communities and populations. It is characterised by respect for the diverse cultures, beliefs, gender identities, sexualities and experiences of people, including patients and their families, colleagues and team members.
Cultural safety involves understanding what individual patients and/or their family believe is culturally safe. Culturally safe and respectful practice requires genuine efforts to adapt your practice as needed, to respect diversity and avoid bias, discrimination and racism. It also involves challenging assumptions that may be based on, for example, gender, disability, race, ethnicity, religion, sexuality, age or political beliefs. Culturally safe practice, like all good medical practice, does not require doctors to provide care that is medically unsafe or inappropriate.
Doctors can create a positive, inclusive, culturally safe work environment by practising in a way that is culturally safe and supports the rights, dignity and safety of others.
Some patients (including those with impaired decision-making capacity) have additional needs. Both capacity and needs may fluctuate over time. Good medical practice in managing the care of these patients involves:
Good medical practice involves:
When adverse events occur, you have a responsibility to be open and honest in your communication with your patient, to review what has occurred and to report appropriately. When something goes wrong you should seek advice from your colleagues and from your professional indemnity insurer. Good medical practice involves:
Patients who are dissatisfied have a right to complain about their care. When a complaint is made, good medical practice involves:
Doctors have a vital role in assisting the community to deal with the reality of death and its consequences. In caring for patients towards the end of their life, good medical practice involves:
Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the patient and doctor. In particular, medical practitioners must not prescribe Schedule 8, psychotropic medication and/or drugs of dependence or perform elective surgery (such as cosmetic surgery), to anyone with whom they have a close personal relationship.
In some cases, providing care to those close to you is unavoidable, for example in an emergency. Whenever this is the case, good medical practice requires recognition and careful management of these issues.
12The Australian Government Translating and Interpreting Service (TIS) can be contacted on 131 450, or via the website: www.tisnational. gov.au. Aboriginal and Torres Strait Islander fee-for-service language interpreters are available through state based services, e.g. Northern Territory Aboriginal Interpreter Service (also services border regions of SA and WA), available at: https://nt.gov.au/community/ interpreting-and-translating-services/aboriginal-interpreter-service, Aboriginal Interpreting WA, available at http://aiwaac.org.au/ and 2M Language Queensland, available at www.2m.com.au. The National Auslan Interpreter Booking and Payment Service is available at: www.nabs.org.au.
13Social media: How to meet your obligations under the National Law issued by the Medical Board of Australia, available at: www.medicalboard.gov.au.
14National Aboriginal Health Strategy Working Party (1989), National Aboriginal Health Strategy, Canberra.
15Australian Commission on Safety and Quality in Health Care (2013) The Australian open disclosure framework www.safetyandquality.gov. au/our-work/open-disclosure/the-open-disclosure-framework/.
16Resources are available for medical practitioners including NHMRC (2016) Ethical guidelines for transplantation from deceased donors www.nhmrc.gov.au/guidelines-publications/e76, Transplantation Society of Australia and New Zealand (TSANZ) (2016) Clinical guidelines for organ transplantation from deceased donors https://donatelife.gov.au/resources/clinical-guidelines-and-protocols/clinical-and- ethical-guidelines-organ-transplantation and NHMRC (2010) National protocol for donation and cardiac death https://donatelife.gov. au/resources/clinical-guidelines-and-protocols/national-protocol-donation-after-cardiac-death-2010.
Respectful relationships with medical colleagues, other healthcare professionals, team members and patients are essential for safe patient care.
Good patient care is enhanced when there is mutual respect and clear communication between all healthcare professionals involved in the care of the patient. Good medical practice involves:
Most doctors work closely with a wide range of healthcare professionals. The care of patients is improved when there is mutual respect and clear communication, as well as an understanding of the responsibilities, capacities, constraints and ethical codes of each other’s professions. Working in a team does not diminish a doctor’s personal accountability for professional conduct and the care provided. When working in a team, good medical practice involves:
There is no place for discrimination (including racism),17 bullying18 and sexual harassment19 in the medical profession or in healthcare in Australia. Respect is a cornerstone of good medical practice and of patient safety. It is a feature of constructive relationships between medical practitioners, their peers and colleagues on healthcare teams, and with patients. Discrimination, bullying and sexual harassment adversely affect individual health practitioners, increase risk to patients and compromise effective teamwork by healthcare teams.
Good medical practice in the management of discrimination, bullying or sexual harassment requires a timely, proportionate and fair response, including:
Good communication and clear understanding between healthcare professionals improves patient care.
Good patient care requires coordination between all treating health practitioners.
Delegation involves you asking another healthcare professional to provide care on your behalf while you retain overall responsibility for the patient’s care.
Referral involves you sending a patient to obtain opinion or treatment from another doctor or healthcare professional. Referral usually involves the transfer (in part) of responsibility for the patient’s care, usually for a defined time and for a particular purpose, such as care that is outside your area of expertise.
Handover is the process of transferring all responsibility to another healthcare professional.
Doctors have a responsibility to contribute to the effectiveness and efficiency of the healthcare system.
It is important to use healthcare resources wisely. Good medical practice involves:
There are significant disparities in the health status of different groups in the Australian community. These disparities result from social, economic, historic, geographic and other factors. In particular, Aboriginal and Torres Strait Islander Peoples bear the burden of gross social and health inequity.
Good medical practice involves using your expertise and influence to identify and address healthcare inequity and protect and advance the health and wellbeing of individual patients, communities and populations.
Doctors have a responsibility to promote the health of the community through disease prevention and control, education and screening. Good medical practice involves:
20Resources are available for medical practitioners, e.g. www.choosingwisely.org.au/home and https://evolve.edu.au/about.
Risk is inherent in healthcare. Minimising risk to patients is an important component of medical practice. Good medical practice involves making patient safety your first priority and understanding and applying the key principles of risk minimisation and management in your practice. Good medical practice involves:
Good medical practice in relation to risk management involves:
The welfare of patients may be put at risk if a doctor is performing poorly. If you consider there is a risk to patients from poor performance, good medical practice involves:
21Sections 140–143 of the National Law, and Guidelines for mandatory notifications issued by the Medical Board of Australia available at: www.medicalboard.gov.au.
22Doctors’ health services are available at www.drs4drs.com.au/.
Maintaining and developing your knowledge, skills and professional behaviour are core aspects of good medical practice. Regular performance feedback, collaboration with peers and self-reflection are among the cornerstones of lifelong learning.
Registration standards developed by the Medical Board of Australia set out the requirements for continuing professional development and for recency of practice (including when changing scope of practice).23
You must continue to develop your knowledge, skills and professional behaviour throughout your working life. Good medical practice involves:
Doctors may work in multiple roles and fields over the span of their career. Changing roles, reducing practice load or considering retirement can be challenging. Changing the scope of your practice, making career transitions and starting the transition to retirement requires active forward planning and management. The Board’s recency of practice registration standard sets out the requirements for medical practitioners who are changing their scope of practice.
23Registration standard: Continuing professional development and Registration standard: Recency of practice issued by the Medical Board of Australia, available at: www.medicalboard.gov.au.
In professional life, doctors must display a standard of behaviour that warrants the trust and respect of the community. This includes observing and practising the principles of ethical conduct.
The guidance contained in this section emphasises the core qualities and characteristics of good doctors outlined in section 2 on Professionalism.
Professional boundaries in medicine are the limits that define the relationship between a doctor and their patient. Professional boundaries are integral to a good doctor–patient relationship. They promote good care for patients and protect both parties. Good medical practice involves:
Doctors have statutory obligations under the National Law to report various proceedings or findings to the Medical Board of Australia.24 They also have professional obligations to report to the Board and their employer if they have had any limitations placed on their practice. Good medical practice involves:
Legitimate complaints are motivated by genuine concerns about patient safety. Vexatious complaints lack substance and have other motivations. They are often characterised by an intention to protect commercial interests and/or cause harm to another health practitioner, instead of a genuine concern about patient safety. Good medical practice involves:
The Board may take regulatory action against a medical practitioner who makes a vexatious notification about another health practitioner.
Maintaining clear and accurate medical records is essential for the continuing good care of patients. Good medical practice involves:
You have a professional obligation to ensure that your practice is appropriately covered by professional indemnity insurance. You must meet the requirements set out in the Registration standard: Professional indemnity insurance arrangements issued by the Medical Board of Australia.25
Advertisements for medical services can be useful in providing information for patients. All advertisements (including on social media) must comply with relevant consumer protection legislation, therapeutic goods legislation, the advertising provisions in the National Law and Guidelines for advertising regulated health services issued by the Medical Board of Australia.26
When you are contracted by a third party to provide a medico-legal, insurance or other assessment of a person who is not your patient, the usual therapeutic doctor–patient relationship does not exist. In this situation, good medical practice involves:
The community places a great deal of trust in doctors. Consequently, doctors have been given the authority to sign a variety of documents, such as a Medical certificate of cause of death (death certificates) and sickness certificates, on the assumption they will only sign statements that they know, or reasonably believe, to be true. Good medical practice involves:
When providing your curriculum vitae, good medical practice involves:
Doctors have responsibilities and rights relating to any legitimate investigation of their practice or that of a colleague. In meeting these responsibilities, it is advisable to seek advice from a lawyer or your professional indemnity insurer. Good medical practice involves:
Patients rely on the independence and trustworthiness of doctors for any advice or treatment. A conflict of interest in medical practice arises when a doctor, entrusted with acting in the interests of a patient, also has financial, professional or personal interests, or relationships with third parties, which may affect their care of the patient. Multiple interests are common. They require identification, careful consideration, appropriate disclosure and accountability. When these interests compromise, or might reasonably be perceived by an independent observer to compromise, the doctor’s primary duty to the patient, doctors must recognise and resolve this conflict in the best interests of the patient. If in doubt, seek advice from colleagues, your employer, professional organisation or professional indemnity insurer.
Doctors must be honest and transparent in financial arrangements with patients. Good medical practice involves:
24Section 130 of the National Law.
25Section 38(1)(a) of the National Law and registration standards issued by the Medical Board of Australia, available at: www.medicalboard.gov.au
26Section 133 of the National Law, Guidelines for advertising regulated health services and advertising resources for practitioners, available at: www.medicalboard.gov.au.
As a doctor, it is important for you to maintain your own health and wellbeing. This includes seeking an appropriate work-life balance.
Doctors have a responsibility to assist medical colleagues to maintain good health. Good medical practice involves:
27Sections 140–143 of the National Law and Guidelines: Mandatory notifications about registered health practitioners issued by the Medical Board of Australia, available at: www.medicalboard.gov.au.
Teaching, supervising and mentoring doctors and medical students is important for their development and for the care of patients. It is part of good medical practice to contribute to these activities and provide support, assessment, feedback and supervision for colleagues, doctors in training and students.
Good medical practice involves doctors acknowledging their influence as role models and their responsibility to help shape the professional behaviour and values of future clinicians.
Good medical practice also involves doctors understanding that there is a power imbalance between teachers, supervisors and assessors and those they are teaching, supervising and assessing and not taking advantage of this imbalance.
Assessing colleagues is an important part of making sure that the highest standards of medical practice are achieved. Good medical practice involves:
Medical students are learning how best to care for patients. Creating opportunities for learning improves their clinical practice and nurtures the future workforce. Good medical practice involves:
28The Medical Board of Australia has issued guidelines for supervised practice for international medical graduates, available at: www.medicalboard.gov.au.
Research involving humans, their tissue samples or their health information is vital in improving the quality of healthcare and reducing uncertainty for patients now and in the future, and in improving the health of the wider population. Research in Australia is governed by guidelines issued in accordance with the National Health and Medical Research Council Act 1992.29 If you undertake research, you should familiarise yourself with, and follow, these guidelines.
Research involving animals is governed by legislation in states and territories and by guidelines issued by the National Health and Medical Research Council (NHMRC).30
Being involved in the design, organisation, conduct or reporting of health research involving humans brings particular responsibilities for doctors. These responsibilities, drawn from the NHMRC guidelines, include:
When you are involved in research that involves your patients, good medical practice includes:
29 NHMRC (2018) National statement on ethical conduct in human research www.nhmrc.gov.au/about-us/publications/national- statement-ethical-conduct-human-research-2007-updated-2018 and NHMRC (2018) Australian code for the responsible conduct of research www.nhmrc.gov.au/about-us/publications/australian-code-responsible-conduct-research-2018 and NHMRC (2003) Ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities www.nhmrc.gov.au/about-us/resources/ ethical-conduct-research-aboriginal-and-torres-strait-islander-peoples-and-communities.
30NHMRC (2013) Australian code for the care and use of animals for scientific purposes, 8th edition www.nhmrc.gov.au/guidelines- publications/ea28.
The Medical Board of Australia acknowledges the work of the Australian Medical Council (AMC) and stakeholders in developing the original code. In 2010 it was adopted by the Medical Board of Australia after minor revisions to ensure it was consistent with the Health Practitioner Regulation National Law, as in force in each state and territory.
In developing the original code, the AMC considered and drew on information about standards from codes of good medical practice issued by the then state and territory medical boards and the Australian Medical Association Code of ethics. The process was also informed by similar documents issued by the General Medical Council of the United Kingdom, the Medical Council of New Zealand, the National Alliance for Physician Competence in the United States and the Royal College of Physicians and Surgeons in Canada. In addition, sections of the code were informed by relevant guidelines issued by the National Health and Medical Research Council and by guidelines developed by specialist medical colleges in Australia and New Zealand.
In revising the code for this latest edition, the Board acknowledges the recent work of regulators, medical colleges and associations which have informed the revision process.
The Board acknowledges the contribution of the Aboriginal and Torres Strait Islander Health Strategy Group, particularly in section 4.7 Aboriginal and Torres Strait Islander health and cultural safety.
This code is issued under section 39 of the Health Practitioner Regulation National Law, as in force in each state and territory (the National Law).