4th November 2011, Volume 124 Number 1345

Preamble

In an environment of changing societal expectations, workforce pressures, significant scientific and technological advancements, including the increasing influence of the internet, the medical profession has developed this Consensus Statement that defines our aspirations as to the role of the doctor in 21st Century New Zealand and reaffirms our commitment to patients and the community.

Key statements

  • Doctors regularly take ultimate responsibility for medical decisions and diagnoses in situations of complexity and uncertainty, drawing on scientific knowledge and principles, clinical experience, and well developed judgement.
  • Doctors accept their ethical responsibilities to act in the best interests of their patients, and the population as a whole, and undertake this in a caring, compassionate, competent, and trustworthy manner.
  • Doctors work in partnership with patients in the delivery of their healthcare and serve as advisors and interpreters in the pursuit of optimal health outcomes using evidence-based medicine and in accordance with available resources.
  • Doctors work effectively as leaders. As members of healthcare teams, doctors recognise and respect skills and attributes of other practitioners.
  • Doctors are advocates for improved population health and health equity for all people.
  • Doctors are committed to the spirit and principles of The Treaty of Waitangi, particularly as it relates to the attainment of health equity for Māori.
  • Doctors have diverse roles, within and outside of the health sector, in the promotion and maintenance of both individual and population health.
  • Doctors accept responsibility for maintaining the high standards of the medical profession to uphold the trust placed in them by patients and the community, and demonstrate this through adherence to relevant declarations including the New Zealand Medical Association Code of Ethics and the Code of Health and Disability Services Consumers Rights.

Doctors as scientists

Doctors have the ability to access, interpret and assimilate new knowledge critically, have strong intellectual skills and grasp of scientific principles, and are capable of effectively managing uncertainty, ambiguity and complexity. They have the capacity to work out solutions from first principles when patterns do not fit, and the ability to work outside guidelines when circumstances demand.

Doctors use scientific tools and techniques, including audit and research, to develop new knowledge.

Doctors as health professionals

Doctors share attributes with many health professionals that include listening and communication skills, the ability to work as part of a team, non-judgmental behaviour, compassion and integrity which combine to merit the trust of patients and whānau (extended family). They have the ability to assess patients’ healthcare needs taking into account personal and social circumstances, culture and beliefs.

Doctors are trained to:

  • Integrate information from a variety of sources in order to make decisions or reach diagnoses.
  • Provide medical and/or surgical interventions, including the prescription of medicines, in both elective and emergency situations.
  • Practise specific clinical skills such as the art of history taking and physical examination.
  • Identify and minimise risk and harm.
  • Identify and advise on appropriate tests, treatment options (including non-intervention) or preventative measures, and explain and discuss any associated risks, benefits and uncertainties.
  • Support patients in understanding their condition and empower them to make informed decisions.
  • Assist patients and whānau to decide when supportive care is preferable to intervention, including in relation to end-of-life decisions..

Doctors recognise the importance of maintaining their own health and are committed to supporting each other in achieving this.

Doctors’ breadth and depth of training enables them to provide oversight of patient care in both acute and longer term care settings. This breadth and depth of training also enables doctors to move between a variety of roles in their daily practice and throughout their careers.

Doctors as leaders

Doctors embrace the concepts of clinical leadership and clinical governance, and are well suited to leadership roles within healthcare teams and the health sector more broadly.

Doctors exhibit leadership in making day-to-day clinical decisions based on using their medical knowledge to assess the impact, risk and likely outcome of decisions. Further, it is the role of doctors as leaders to apply their skills in the development of policy, strategy, service design, and clinical processes. As leaders, doctors have a responsibility for ensuring patient safety and monitoring both individual and service level outcomes.

Doctors have a key role in providing higher level sector leadership, including in leading and facilitating change. Some doctors will further utilise their skills in formal leadership or management roles at various levels.

Doctors as health advocates

Doctors uphold the primacy of the individual patient:doctor relationship, with the requirement to advocate for the patient and advise about all treatment options. Doctors also appreciate the needs of their patients in the context of the wider health needs of the population. Where the capacity to treat is growing but resources are finite, doctors, as critical decision makers with responsibility for allocation of significant health resources, have a duty to use those resources wisely, and to engage in constructive debate about such use. As significant resources themselves, they are committed to ensuring their own and others’ skills and knowledge are deployed to best effect. When appropriate, doctors use their influence to advocate for increased resources to improve health outcomes for their patients and populations.

Doctors have a role in the promotion of population health, including ongoing efforts to achieve health equity. Some doctors will take an increased focus on the health of the population through formal roles in health education or promotion, service improvement, public health and/or health advocacy. This commitment is to the health of all New Zealanders, but it exists alongside a professional responsibility for the health of individuals and communities throughout the world.

Doctors as teachers and learners

Doctors are committed to the education of current and future generations of medical practitioners, with the apprenticeship model central to this education. In addition, doctors recognise the importance of new methods of learning, such as simulation based learning, as vital adjuncts.

Doctors are also involved in the education of other medical and health practitioners as well as their patients, whānau and communities.

Doctors accept their responsibility to continue personal education and other professional development activities throughout their careers.

Doctors interact with colleagues in clinical practice, quality improvement and educational settings, are involved in supporting each others’ practice, and in identifying and remediating each others’ performance. Through these collaborative endeavours, doctors strive to ensure that they and their colleagues are fit to practise.

Doctors as members of the healthcare team and the broader health sector

Doctors accept responsibility to positively influence the culture and the environment in which they work. They achieve this through exhibiting behaviours that are nurturing, supportive and respectful, and which enable individuals and teams to flourish and enjoy their work, and through advocacy for safe and health promoting workplaces and health care settings.

Doctors are committed to excellence in healthcare both in their individual performance as well as contributing to the systems essential to delivering quality care.

Doctors possess the ability to work effectively as members of healthcare teams, recognising and respecting skills and attributes of other practitioners and of patients and whānau.

This Statement has been developed through extensive consultation over a 6-month period that began with a 2-day symposium, at which over 80 leaders of the profession and other key players in the health sector expressed their vision as to the role of the doctor in 21st Century New Zealand. The signatories recognise that the role of the doctor will continue to evolve and offer this Statement to assist both the profession and policy makers to attract, train, and retain the most appropriate medical workforce for our needs.

Acknowledgements

The NZMA acknowledges the particular contributions of Dr Andrew Old, Professor Harvey White and Dr Peter Foley who led the development of the written Statement and ensured that it accurately reflected the consensus view of the stakeholders involved.