Membership Code of Conduct

Preamble

As medical practitioners, all surgeons must be familiar with their relevant code(s) of conduct. Surgical speciality societies and associations have codes of conduct relevant to their practice, and Fellows must also abide by these codes.

Leadership

The College embraces its position as the leader in setting standards for surgery across Uganda and recognises that our Fellows are active leaders and role models in their places of work. Fellows of the College play an important role in ensuring that healthcare is provided in positive and supportive environments that are focused on excellence in patient care.

NSU supports Fellows by providing collegial support, professional development activities and targeted advocacy across a broad range of issues. NSU expects all Fellows to be personally accountable for their conduct in the workplace, and the College has no tolerance for unacceptable behaviour. Discrimination, bullying and sexual harassment are breaches of the Code.

Breaches of The Code of Conduct

NSU promotes and enforces the standards set out in the provisions of the Code. It is a breach of the Code for a Fellow not to comply with any provision of the Code. Fellows who are found to have breached the Code may be subject to sanctions outlined in relevant College policies.

All Trainees of the College and Medical Graduates on a pathway to Fellowship are expected to understand and adhere to the Code, but their conduct and any complaints or alleged misconduct are investigated in accordance with applicable NSU policies.

1 Standard of Clinical Practice

Excellence in patient care requires a range of clinical, interpersonal and management skills,

medical and technical expertise, clinical decision-making, communication and teamwork all

contribute to achieving a high standard of clinical practice and patient care.

A surgeon will

1. Always act in the best interests of patients
2. Provide clinical care consistent with the prevailing standards of their speciality
3. Ensure that they remain competent and provide clinical care that is informed by current and relevant evidence
4. Ensure that their professional behaviour is at all times respectful of others
5. Promote a cohesive team approach that benefits patients
6. Treat patients without discriminating based on personal characteristics such as age, gender, marital status, ethnicity, religion, lifestyle, sexual orientation, gender identity, culture, disability or based on insurance status
7. Protect the privacy of patients within the confines of the law
8. Facilitate ongoing care of the patient when the surgeon terminates the surgeon-patient relationship
9. Manage only those patients whose clinical conditions are within the surgeon’s scope of practice, considering individual training, experience, credentialing and current practice profile, except in an emergency when alternatives are not available
10. Respond promptly to requests from other clinicians for advice or opinion, and respond as a priority to requests for help in the operating theatre
11. Participate in the emergency management of a patient when requested, provided they are reasonably able to do so, and when refusal might adversely affect the patient’s outcome.
12. Ensure informed consent has been obtained from the patient (or substitute decision-maker) before undertaking elective operations or procedures, and whenever possible in an emergency
13. Ensure that operating safety practices for patients and theatre staff are adhered to, including completing a surgical safety checklist
14. Ensure elective and scheduled urgent procedures are performed in an institution capable of providing the appropriate level of perioperative care
15. Prioritise intervention on the basis of clinical need when confronted with multiple demands

2 Relationships with Patients

The surgeon-patient relationship is critical to the quality of patient care, safety and outcomes. Surgeons must pay attention to all aspects of this relationship and be aware of laws, regulations and guidelines relevant to their field of practice. Patients are entitled to feel that their surgeon listens to them, respects their autonomy and treats them with dignity.

Surgeons will be open and honest with their patients at all times.

A surgeon will

1. Provide the patient with a recommendation that is determined by clinical need
2. seek to communicate effectively with patients or substitute decision-makers
3. be sensitive to and aware that different beliefs, backgrounds, values and cultures may influence a patient’s understanding, decisions or responses
4. make arrangements for the use of qualified language or cultural interpreters to facilitate patients’ language, cultural and communication needs
5. discuss the patient’s diagnosis, proposed investigations, associated risks and proposed treatment in a way that the patient can understand
6. answer patient questions and allow time for them to decide about treatment
7. respect the wishes of their patient to involve family or carers in their decision making and/or accommodate a patient’s request for a chaperone or support person to be present during meetings
8. not coerce a patient into agreeing to a treatment plan
9. offer to refer the patient to another clinician if the patient’s wishes are not compatible with actions the surgeon believes are in the patient’s best interests
10. not undertake a procedure on a family member except in a life-threatening emergency when no other appropriately trained surgeon is available
11. Refer a patient to another clinician when the best procedure for the patient is not within their scope of practice
12. Protect the confidentiality of all information provided by or obtained from the patient (e.g. imaging, photographs and pathology results) unless otherwise required by law or agreed to by the patient
13. Ensure that their professional contact details are available to hospitals and current patients
14. Maintain appropriate personal boundaries with patients at all times
15. ensure that their relationship with the patient is free from any form of abuse
16. not engage in a sexual relationship with a patient or use their current relationship with a patient to promote such a relationship in the future
17. ensure that their treatment recommendation does not promote or advance a business arrangement
18. participate in any applicable open disclosure processes after surgery.

3 Working with other Health Care Professionals

Safe and effective patient care involves surgeons working closely with other surgeons and healthcare professionals. Surgeons provide leadership and respect the training, knowledge, experience and views of others. Participation in constructive peer review and multi-disciplinary activities is a vital part of surgical practice.

A surgeon will

1. Seek the involvement of other health care professionals or more experienced colleagues if this will benefit the patient
2. When appropriate, participate in a multi-disciplinary approach with other healthcare professionals for the optimal care of the patient
3. participate in effective handover procedures and make arrangements for continuity of patient care when they are not personally available
4. Care for a patient in urgent need if a colleague is unavailable (even if no formal arrangement has been made)
5. Not discriminate against, bully or sexually harass another healthcare professional or another person
6. Not criticise a colleague in an untruthful, misleading or deceptive manner
7. Not denigrate another surgeon or healthcare professional
8. Not seek to enhance their practice by actively denigrating or inhibiting a colleague’s practice
9. Be receptive to their patient seeking a second opinion, and assist the patient to obtain a second opinion if requested

4 The Surgeon’s Responsibilities to Society

Surgeons are afforded certain privileges and autonomy in the use of healthcare resources, which should be used wisely and equitably. Surgeons should ensure that services arranged or provided are necessary for the patient and understand that their use of resources can affect the access of other patients to healthcare. Promoting public awareness of surgical issues and advocating for improvements in the healthcare system that benefit patients are important aspects of surgical practice.

A surgeon will

1. Recognise their responsibility to advocate for changes to laws and regulations that do not serve the best interests of patients
2. Identify and address issues that compromise patient safety and act to minimise risks
3. Report to a relevant authority incidents or events that may lead to patient harm
4. comply with any mandatory reporting responsibilities
5. where appropriate, advocate for measures aimed at improving individual and public health
6. Promote sustainability in healthcare through judicious use of health resources
7. Allocate healthcare resources in a transparent and equitable manner
8. Not use resources primarily for their own financial gain or for career or academic advancement
9. Not directly or indirectly perform or encourage indiscriminate or unnecessary medical interventions

5 Maintaining Professional Performance

Individual surgeons are responsible for maintaining their professional standards and performance, and for demonstrating to NSU and any regulatory body that they comply with Continuing Professional Development (CPD) requirements. Surgeons are also expected to be aware of and understand new developments in their field of expertise.

A surgeon will

1. Satisfy UMDPC requirements for Continuing Professional Development (CPD)
2. Participate in the National Audit of Surgical Mortality or state-based equivalent, where this is available
3. Participate in ASOU, speciality society, institutional, and other quality assurance and improvement activities
4. Participate in systems for surveillance, monitoring and reducing risk
5. Be appropriately credentialed by the employing authority and/or the facility provider
6. Not undertake a procedure that they are not trained and credentialed to undertake, except in a life-threatening emergency when no other appropriately trained surgeon is available
7. Maintain appropriate medical indemnity insurance
8. Report any loss of hospital privileges, limitations or conditions placed on their medical registration, formal disciplinary action, restricted rights of practice, deregistration or indemnity restrictions to the Registrar of UMDPC and all relevant registration and credentialing authorities
9. Claim only such training, experience or expertise as can be substantiated

6 The Surgeon’s Health

A surgeon should seek to maintain good physical, psychological and emotional health, regularly reflecting on whether any impairment, either temporary or permanent, will affect their individual performance and/or that of their team, always being mindful of any risks to patient safety. It is vital for all health professionals to promote a culture that recognises, supports and responds effectively to colleagues in need.

A surgeon will

1. refrain from practising if impaired by any physical, psychological or emotional ill-health that could affect patient care
2. Refrain from practising if impaired by drugs or alcohol
3. If impaired, arrange the involvement of a suitably qualified colleague in the management of a patient
4. Ensure they seek appropriate treatment for any physical, psychological or emotional impairment
5. Be aware of the effects of ageing and ensure that these are managed to prevent any harm to patients, and/or consider a reduced scope of practice or retirement where this may be necessary
6. Volunteer to be tested if they may be infected with a blood-borne virus, and participate in notifications and testing as required by law in relation to potentially infectious conditions
7. Be aware of their blood-borne virus status and inform the relevant authorities of an infection with a blood-borne virus or other infection that could be transmitted through surgical practice, and comply with all regulatory and employer requirements

7 Financial and Commercial Dealings

Surgeons must behave ethically in their financial and commercial dealings, ensuring that their professional conduct and advertising of services meet regulatory standards. Surgical records must include enough detail to allow another practitioner to assume immediate management of a patient in the event that the treating surgeon is temporarily or permanently not available to continue managing the patient.

A surgeon will

1. Ensure that the professional fee charged is justifiable and reasonable and does not exploit a patient’s need or take financial advantage of the patient
2. Ensure informed consent and informed financial consent are obtained before providing treatment
3. Disclose to patients any interests in matters related to their care, including financial interests in facilities utilised or financial gain from the use of devices
4. Provide information about the likelihood, risks and costs of subsequent or revisional surgery should these be required
5. Not participate in fee splitting nor provide recompense, either direct or indirect, in return for preferential patient referrals
6. Not pay to receive retainers from other professionals in return for referrals or preferential work arrangements
7. Comply with the Medical Board of Uganda’s Guidelines for Advertising of
8. Be responsible for any advertising issued on their behalf
9. Provide clear, factually correct and verifiable information in all of their advertising
10. Not advertise in a manner that is misleading or deceptive
11. Not offer any gifts, discounts or inducements in an advertisement without applicable Terms and conditions, or in a manner that undermines the informed consent process
12. Not advertise in a manner that promotes the perception that their services are better than those provided by peer specialist surgeons
13. Where prohibited by law, not use testimonials in their advertising
14. Not use ‘before and after’ photographs that could give patients unrealistic expectations of surgical outcomes
15. Not directly or indirectly attempt to reduce the reputation or standing of the surgical colleagues, particularly by attempting to elevate oneself with comparative claims of superior experience, techniques or outcomes
16. Maintain legible and up-to-date patient records, ensuring that clinical notes are dated and that the author is identifiable
17. Ensure operation notes outline the procedure performed, including any specific problems encountered
18. Document a post-operative plan that includes treatment until the patient is next reviewed
19. Maintain clinical records that document clinical assessment, decisions and plans for a patient
20. Not falsify records at any time or deliberately destroy, lose or hide records
21. When retiring from practice, determine and document a process to ensure a smooth handover of patients currently under the surgeon’s care
22. When retiring from practice, ensure that relevant medical records, whether physical or electronically archived or otherwise stored, of patients currently under the surgeon’s care or follow-up, are transferred to another surgeon in the speciality and that any legal, regulatory body or insurer guidelines on transfer or retention of records are met
23. Respect a patient’s right to access information contained in their medical records and their right to control the use and disclosure of their personal information

8 Supervision, Education and Training

Surgeons often take an active role in teaching other surgeons, Trainees, junior doctors, and other healthcare professionals, including International Medical Graduates (IMGs), on a pathway to Fellowship of the College. Surgeons should maintain and develop their skills as supervisors, trainers and educators, in line with their roles and responsibilities. When providing an assessment, a surgeon will include only accurate and verifiable information, ensuring that all feedback is respectful and timely.

A surgeon will

1. In accordance with their teaching role, take responsibility for the teaching and training of future surgeons, junior doctors, medical students and other health care professionals
2. Provide supervision that minimises risks to patients and maintains responsibility for patient welfare
3. Give honest and respectful feedback on progress and performance to Trainees and IMGs, and assist in a remediation program when asked to do so
4. Participate in surgical audit, self-assessment and reflection through established processes to maintain competence as a teacher, trainer and supervisor
5. Ensure Trainees and IMGs are safe in the workplace, addressing issues that may impact on a Trainee’s or IMGs physical, psychological and emotional health
6. Encourage Trainees to attend courses and workshops when this does not compromise patient care or service delivery
7. Not discriminate against, bully, or sexually harass a Trainee, junior doctor, student or any other healthcare professional
8. Not make prejudicial decisions or judgements that are influenced by a Trainee’s, junior doctor’s or student’s age, gender, marital status, ethnicity, religion, lifestyle, sexual orientation, gender identity, culture or disability
9. Be honest, factual and objective when providing an assessment
10. Participate in the assessment process and communicate assessment results in a constructive and supportive manner
11. Only provide a satisfactory assessment when it is justified
12. When conducting a surgical demonstration, always place the interests of the patient first
13. Obtain informed consent from the patient before the patient participates in a surgical demonstration
14. Adhere to the NSU Position Papers on Live Transmission of Surgery, And Telementoring and Teleassessment of Live Surgery
15. Declare any financial or non-financial benefit, direct or indirect, that may accrue to the demonstrating surgeon from a surgical demonstration

9 Research and New Technology

Research is a vital part of surgical practice and benefits the quality of healthcare provided to patients. When conducting research, surgeons should adhere to the guidelines published by the Uganda National Council for Science and Research (UNCST). New techniques, technology or prostheses are constantly becoming available to surgeons. If there is proven benefit and it will be appropriate for their patients, it is incumbent upon surgeons to acquire the knowledge and skills to apply new techniques and/or technology.

A surgeon will

1. Acknowledge the wellbeing of the individual patient as the paramount concern, regardless of the value of the research project
2. Disclose any known risks to the patient and seek to minimise these risks
3. Ensure that patients who participate in research have given their informed written consent
4. Ensure that patients retain the right to withdraw from research at any time with out prejudice to their treatment and that they are offered counselling after withdrawing
5. If in the role of primary researcher, be responsible for proposing, designing and reporting the research and be responsible for any work conducted on the project by other individuals
6. Perform research under the oversight of an accredited Human Research Ethics Committee (HREC) when required, and seek to participate in a properly constructed clinical trial
7. Ensure that all research on animals is consistent with institutional and government regulations and guidelines
8. Declare to research subjects and to the relevant oversight body, the nature of any contractual involvement with industry involved with their research or any other identified conflicts of interest
9. Make relevant disclosures before any presentation or publication
10. Only report and publish factual and verifiable data, and not falsify research results for any purpose or plagiarise the work of others
11. Appropriately recognise the contribution of others in research
12. Not accept being cited as an author on an article where they have had no real input
13. Obtain all necessary permissions when engaging in the use of new technology
14. Fully inform the relevant regulatory or credentialing authority before employing a new intervention, technique or prosthesis and not introduce a new procedure or technology to a hospital or health service without seeking approval from the local new technology committee or relevant body
15. Recognise and acknowledge to the patient whether a new technique, procedure or prosthesis is experimental and/or how it has been shown to be effective in properly conducted trials elsewhere
16. Obtain informed consent from a patient before employing a new intervention, technique or prosthesis
17. Maintain a personal register of experience with a new procedure and participate in peer review of new techniques and technology

References

Uganda National Council for Science and Research, Ethics and Regulatory Guidelines.

Uganda Medical and Dental Practitioners council, Good medical practice: a code of conduct for Doctors in Uganda