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. 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 following wide consultation with the medical profession and the community. The code 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 ethics1 and is aligned with its values, and is also consistent with the Declaration of Geneva and the international code of medical ethics2, 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 practice of medicine is challenging and rewarding. No code or guidelines can ever encompass every situation or replace the insight and professional judgment 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.
1AMA code of ethics.
2WMA International Code of Medical Ethics.
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 applies in all settings. It is valid for technology-based patient consultations as well as for traditional face-to-face consultations and also applies to how doctors use social media. To guide doctors further, the Medical Board of Australia has issued Guidelines for technology-based patient consultations.3
3Section 39 of the National Law and Guidelines for technology-based patient consultations issued by the Medical Board of Australia.
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 or 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.4
4The Australian Commission on Safety and Quality in Health Care’s Australian 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 ethical and trustworthy.
Patients trust their doctors because they believe that, in addition to being competent, their doctor will not take advantage of them and will display qualities such as integrity, truthfulness, dependability and compassion. Patients also 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. It involves doctors understanding that each patient is unique, and working in partnership with their patients, adapting what they do to address the needs and reasonable expectations of each patient. This includes cultural awareness: being aware of their own culture and beliefs and respectful of the beliefs and cultures of others, 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 embodies all the qualities described here, and includes self-awareness and self-reflection. Doctors are expected to reflect regularly on whether they are practising effectively, on what is happening in their relationships with patients and colleagues, and on their own health and wellbeing. They have a duty to keep their skills and knowledge up to date, refine and develop their clinical judgement as they gain experience, and contribute to their profession.
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 Australians, 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. For the doctors who undertake roles that have little or no patient contact, not all of this code may be relevant, but the principles underpinning it will still apply.
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. This can be the parents - or a legally appointed decision-maker. If in doubt, seek advice from the relevant guardianship authority.
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 1.6 on substitute decision-makers.
Your decisions about patients’ access to medical care need to be free from bias and discrimination. Good medical practice involves:
5Australian Human Rights Commission, A guide to Australia's anti-discrimination laws.
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.
Relationships based on respect, openness, trust and good communication will enable you to work in partnership with your patients.
A good doctor–patient partnership requires high standards of professional conduct. This involves:
An important part of the doctor–patient relationship is effective communication. This involves:
6The Australian Government Department of Immigration and Citizenship’s Translating and Interpreting Service (TIS) National can be contacted on 131 450, or via the website.
Patients have a right to expect that doctors and their staff will hold information about them in confidence, unless release of information is required by law or public interest considerations. Good medical practice involves:
7Social media policy issued by the Medical Board of Australia.
Informed consent is a person’s voluntary decision about medical care that is made with knowledge and understanding of the benefits and risks involved. The information that doctors need to give to patients is detailed in guidelines issued by the National Health and Medical Research Council (NHMRC).8 Good medical practice involves:
8National Health and Medical Research Council’s documents, General guidelines for medical practitioners on providing information to patients 2004 and Communicating with patients: advice for medical practitioners 2004.
Caring for children and young people brings additional responsibilities for doctors. Good medical practice involves:
Good medical practice involves genuine efforts to understand the cultural needs and contexts of different patients to obtain good health outcomes. This includes:
Some patients (including those with impaired decision-making capacity) have additional needs. 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.9 When something goes wrong you should seek advice from your colleagues and from your medical indemnity insurer. Good medical practice involves:
9Australian Commission on Safety and Quality in Health Care, The Australian Open Disclosure Framework.
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:
In some circumstances, the relationship between a doctor and patient may become ineffective or compromised, and you may need to end it. Good medical practice involves ensuring that the patient is adequately informed of your decision and facilitating arrangements for the continuing care of the patient, including passing on relevant clinical information.
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 doctor and patient. In some cases, providing care to those close to you is unavoidable. Whenever this is the case, good medical practice requires recognition and careful management of these issues.
When closing or relocating your practice, good medical practice involves:
Good relationships with medical colleagues, nurses and other healthcare professionals strengthen the doctor–patient relationship and enhance 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:
Delegation involves you asking another health care 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. 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 alter a doctor’s personal accountability for professional conduct and the care provided. When working in a team, good medical practice involves:
Good patient care requires coordination between all treating doctors. Good medical practice involves:
Doctors have a responsibility to contribute to the effectiveness and efficiency of the healthcare system.
It is important to use healthcare resources wisely.
There are significant disparities in the health status of different groups in the Australian community. These disparities result from social, cultural, geographic, health related and other factors. In particular, Aboriginal and Torres Strait Islander Australians bear the burden of gross social, cultural and health inequity. Good medical practice involves using your expertise and influence to 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:
Risk is inherent in healthcare. Minimising risk to patients is an important component of medical practice. Good medical practice involves understanding and applying the key principles of risk minimisation and management in your practice.
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, good medical practice involves:
10Sections 140-143 of the National Law, and Guidelines for mandatory notifications issued by the Medical Board of Australia.
Maintaining and developing your knowledge, skills and professional behaviour are core aspects of good medical practice. This requires self-reflection and participation in relevant professional development, practice improvement and performance-appraisal processes, to continually develop your professional capabilities. These activities must continue throughout your working life, as science and technology develop and society changes.
The Medical Board of Australia has established registration standards that set out the requirements for continuing professional development and for recency of practice under the National Law.11
Development of your knowledge, skills and professional behaviour must continue throughout your working life. Good medical practice involves:
11Section 38(1)( c) and (e) of the National Law and registration standards issued by the Medical Board of Australia.
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 1.4 Professional values and qualities of doctors.
Professional boundaries are integral to a good doctor–patient relationship. They promote good care for patients and protect both parties. Good medical practice involves:
12Section 39 of the National Law and Sexual boundaries: guidelines for doctors issued by the Medical Board of Australia.
Doctors have statutory obligations under the National Law to report various proceedings or findings to the Medical Board of Australia.13 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:
13Sections 130, 140-143 of the National Law and Guidelines for mandatory notifications issued by the Medical Board of Australia.
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 for professional indemnity insurance established by the Medical Board of Australia under the National Law.14
14Section 38(1)( a) of the National Law and registration standards issued by the Medical Board of Australia.
Advertisements for medical services can be useful in providing information for patients. All advertisements must conform to relevant consumer protection legislation, the advertising provisions in the National Law and Guidelines for advertising regulated health services issued by the Medical Board of Australia.15
15Section 133 of the National Law and Guidelines for advertising regulated health services available on the Medical Board of Australia website.
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 death certificates and sickness certificates, on the assumption that they will only sign statements that they know, or reasonably believe, to be true. Good medical practice involves:
When providing 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 legal advice or advice from your professional indemnity insurer. Good medical practice involves:
Patients rely on the independence and trustworthiness of doctors for any advice or treatment offered. 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.
Good medical practice involves:
Doctors must be honest and transparent in financial arrangements with patients. Good medical practice involves:
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. All health professionals have responsibilities in certain circumstances for mandatory notification under the National Law.16 Good medical practice involves:
16Sections 140-143 of the National Law and Guidelines for mandatory notifications issued by the Medical Board of Australia.
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.
17The Medical Board of Australia has issued guidelines for supervised practice.
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:
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 population as a whole. Research in Australia is governed by guidelines issued in accordance with the National Health and Medical Research Council Act 1992.18 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).19
18National statement on ethical conduct in human research NHMRC 2007 and the Australian code for the responsible conduct of research NHMRC 2007.
19Australian code of practice for the care and use of animals for scientific purposes, 7th edition NHMRC 2004.
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:
The Medical Board of Australia acknowledges the work of the Australian Medical Council (AMC) in developing this code. In 2010 it was adopted by the Medical Board of Australia after minor revisions to ensure it is consistent with the Health Practitioner Regulation National Law, as in force in each state and territory.
In the first edition of the code, the AMC acknowledged the working group that guided the development of the code; the contribution of the organisations and individuals whose thoughtful feedback informed its development; the contribution of the Australian Government Department of Health and Ageing to the extensive consultation process that supported it; and the then state and territory medical boards that endorsed it.
In developing this code, the AMC considered and drew on both general and specific 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.
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).