Articles

The British Medical Association

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The main function of the BMA (established 1832) is to protect the interests of its members; it is the trade union for doctors in the UK. It is involved in the negotiations on behalf of doctors at national level as well as representing members at a local level in employment-related disputes (English et al. 2004). Membership of the BMA is optional. A doctor who is a ‘paid-up’ BMA member has to raise a problem locally for industrial relations officers to become involved in a local dispute over work conditions (otherwise there would be no point in paying to be a member of a trade union). As well as representing members’ interests, it also passes comment on behalf of the profession on matters related to health such as banning tobacco advertising, and on global issues such as the role of doctors in executions and torture. The BMA also has a research unit and an ethics department, which provides guidance on contentious issues (see below). BMA members can seek personal advic...
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The Royal Medical Colleges

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The chief role of the Royal Medical Colleges is to set educational, professional and clinical standards for their specialty. Trainees in a given specialty must now generally pass a membership examination from the relevant college before obtaining a certificate of completion of specialist training. Some newer specialties have their standards set by a faculty of a Royal Medical College. For example, forensic medical examiners have their standards set by the Faculty of Forensic Medical Examiners at the Royal College of Physicians. Now that doctors will have to supply evidence of fitness to practise after specialization (a process called revalidation), the Royal Colleges will set specialty-specific standards on behalf of the GMC. The colleges also pass comment on issues relating to their specialty and the health service. The colleges support research (e.g. with financial grants and opportunities to showcase research at conferences and in college journals) and will have a ...
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DUTIES FOR MEDICAL STUDENTS

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The GMC also sets out duties for medical students. Medical students have legal restrictions on the clinical work they can do, but must be aware that they are often doing things that a qualified doctor might do (such as ‘taking a history’) and that their activities will affect patients. Patients may see students as knowledgeable, and may consider them to have the same responsibilities and duties as a doctor. Students must be aware that their behaviour outside the clinical environment, including in their personal lives, may have an impact on their fitness to practise (professional boundaries are discussed later in this chapter). Therefore: • students have a duty to make sure that patients know that they are students and not doctors. For example: should medical undergraduates introduce themselves as medical students or as student doctors? The title ‘Student doctor’ could mislead a patient that the person seeing them is medically qualified • students have a duty to beha...
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The General Medical Council

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The role of the GMC (established 1868) is broadly: • to set professional standards of practice • to ensure that those allowed to practise medicine (registered medical practitioners) are fit to do so, in terms of knowledge, skills and their behaviour • to maintain a register of doctors who are licensed to practise medicine in the UK. It is illegal to practise medicine without a licence in the UK • to supervise standards of undergraduate and postgraduate education – the GMC sets out a syllabus for medical schools to follow, and since 2008, now also works with the Royal Colleges to ensure appropriate standards for specialist training and continuing medical education. (The GMC has taken over this role from the Postgraduate Medical Education and Training Board.) This latter role includes supervising revalidation (see below), supervision of doctors’ fitness to practise after qualification as a general practitioner (GP) or specialist • to enforce professional discipline –...
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PROFESSIONALISM, OATHS AND DECLARATIONS

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Oaths and declarations are a way in which professions promise to the public that they will uphold a publically accepted set of values, enabling that profession to be trusted and have a certain status within society. They also represent a way in which a profession can remind its members of those core values. The Hippocratic Oath ( 425 BC) has historically been seen as part of the Western medical tradition. It encourages a number of concepts that are still relevant today: the teaching of medicine; the consideration of the patient’s best interests; confidentiality and the abstinence from ‘whatever is deleterious and mischievous’. However, it does not mention concepts such as autonomy or justice, and forbids performing surgery. The original Hippocratic Oath is now rarely taken in UK medical schools, though some have written modern versions. The Declaration of Geneva (1948, amended 1968 and most recently revised in 2006) is a modern-day Hippocratic Oath, requiring doctor...
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Medical negligence

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Doctors may sometimes fall foul of the criminal law (this is discussed in relevant sections over the next four chapters) but the majority of cases against doctors are heard in the civil courts. Civil law cases involving doctors are usually actions in medical negligence. There are some basic components of a medical negligence action. A duty of care: it must be shown that the defendant (that is the person or authority accused of negligence) owed the claimant (that is the injured party or the person accusing the defendant of negligence) a duty of care: • The duty of care of a GP crystallizes when the patient registers with that GP and then consults with the GP on the occasion in question. • The duty of care of a hospital doctor crystallizes when the patient is formally accepted into hospital. English law does not oblige doctors to give emergency treatment outside of the above situations except when: • a patient presents to an A&E department • when a GP is requested ...
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Respect for autonomy

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Autonomy literally means ‘self-rule’. In essence, it refers to an ability: (1) to reason and think about one’s own choices; (2) to decide how to act and (3) to act on that decision, all without hindrance from other people. Autonomy is more than simply being free to do what one wants to do. It implies that rational thought is involved in a decision. While many animals are free to do what they want, they are not autonomous because they do not critically evaluate the benefits and risks to themselves, or others, involved in their decisions. In respecting a person’s autonomy, we recognize that they are entitled to make decisions that affect their own lives. Justification for this principle is most obviously found in Kantian theory: the idea that people should be treated not simply as means, but as ends in themselves. However, support for autonomy can also be found in those versions of rule-utilitarianism which hold that the best outcomes arisewhen autonomy is respected. O...
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