Special Information

Guidence to Doctors on Medical Ethics

The Medical Council of India registers doctors to practice medicine in the India.  It protects, promotes and maintains the health and safety of the public by ensuring proper standards in the practice of medicine.The ethical standards doctors must meet are described in Good Medical Practice.Doctors of the future

Indian Medical Council set the standards for the next generation of doctors in medical colleges in India.

 IMA & Medical Council of India protect patients by dealing firmly and fairly with serious concerns about doctors.

Medical Council ensure that only properly qualified doctors are registered and allowed to practice in India

Medical Council sets and promotes the principles of good practice which doctors follow throughout their careers.
Good Medical Practice (which sets out the principles and values on which good practice is founded).

Good Medical Practice sets out the principles and values on which good practice is founded; these principles together describe medical professionalism in action. The guidance is addressed to doctors, but it is also intended to let the public know what they can expect from doctors.

How Good Medical Practice applies to you

The guidance that follows describes what is expected of all doctors registered with the Indian Medical Council.  It is your responsibility to be familiar with Good Medical Practice and to follow the guidance it contains. It is guidance, not a statutory code, so you must use your judgment to apply the principles to the various situations, you will face as a doctor, whether or not you hold a license to practice and whether or not you routinely see patients. You must be prepared to explain and justify your decisions and actions. Serious or persistent failure to follow this guidance will put your registration at risk.
Duties of a doctor

Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and you must:

  • Make the care of your patient your first concern
  • Protect and promote the health of patients and the public
  • Provide a good standard of practice and care
    • Keep your professional knowledge and skills up to date
    • Recognize and work within the limits of your competence
    • Work with colleagues in the ways that best serve patients' interests
  • Treat patients as individuals and respect their dignity
    • Treat patients politely and considerately
    • Respect patients' right to confidentiality
  • Work in partnership with patients
    • Listen to patients and respond to their concerns and preferences
    • Give patients the information they want or need in a way they can understand
    • Respect patients' right to reach decisions with you about their treatment and care
    • Support patients in caring for themselves to improve and maintain their health 
  • Be honest and open and act with integrity
    • Act without delay if you have good reason to believe that you or a colleague may be putting patients at risk
    • Never discriminate unfairly against patients or colleagues
    • Never abuse your patients' trust in you or the public's trust in the profession.

You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.
Good Doctors
           Patients need good doctors. Good doctors make the care of their patients their first concern: they are competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues*, are honest and trustworthy, and act with integrity.

Providing good clinical care

  1.  Good clinical care must include:

a. adequately assessing the patient's conditions, taking account of the history (including the symptoms, and psychological and social factors), the patient's views, and where necessary examining the patient

    1. b. providing or arranging advice, investigations or treatment where necessary
    2. c. referring a patient to another practitioner, when this is in the patient's best interests
  1.  In providing care you must:

a. recognise and work within the limits of your competence
b. prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient's health, and are satisfied that the drugs or treatment serve the patient's needs
c. provide effective treatments based on the best available evidence
d. take steps to alleviate pain and distress whether or not a cure may be possible
e. respect the patient's right to seek a second opinion;

  1. a. keep clear, accurate and legible records, reporting the relevant clinical findings, the decisions made, the information given to patients, and any drugs prescribed or other investigation or treatment

b. make records at the same time as the events you are recording or as soon as possible afterwards
c. be readily accessible when you are on duty;
d. consult and take advice from colleagues, where appropriate;
e. make good use of the resources available to you.
Supporting Self care

  1. You should encourage patients and the public to take an interest in their health and to take action to improve and maintain it. This may include advising patients on the effects of their life choices on their health and well-being and the possible outcomes of their treatments. 

Avoid treating those close to you:

  1. Wherever possible, you should avoid providing medical care to anyone with whom you have a close personal relationship.
  2.  

Raising concerns about Patients’ safety

 6. If you have good reason to think that patient safety is or may be seriously compromised by inadequate premises, equipment, or other resources, policies or systems, you should put the matter right if that is possible. In all other cases you should draw the matter to the attention of your employing or contracting body. If they do not take adequate action, you should take independent advice on how to take the matter further. You must record your concerns and the steps you have taken to try to resolve them.

Decisions about access to medical care

7. The investigations or treatment you provide or arrange must be based on the assessment you and the patient make of their needs and priorities, and on your clinical judgment about the likely effectiveness of the treatment options. You must not refuse or delay treatment because you believe that a patient's actions have contributed to their condition. You must treat your patients with respect whatever their life choices and beliefs. You must not unfairly discriminate against them by allowing your personal views* to affect adversely your professional relationship with them or the treatment you provide or arrange. You should challenge colleagues if their behavior does not comply with this guidance.
8. If carrying out a particular procedure or giving advice about it conflicts with your religious or moral beliefs, and this conflict might affect the treatment or advice you provide, you must explain this to the patient and tell them they have the right to see another doctor. You must be satisfied that the patient has sufficient information to enable them to exercise that right. If it is not practical for a patient to arrange to see another doctor, you must ensure that arrangements are made for another suitably qualified colleague to take over your role.
9. You must give priority to the investigation and treatment of patients on the basis of clinical need, when such decisions are within your power. If inadequate resources, policies or systems prevent you from doing this, and patient safety is or may be seriously compromised, you must follow the guidance in paragraph 6.
10. All patients are entitled to care and treatment to meet their clinical needs. You must not refuse to treat a patient because their medical condition may put you at risk. If a patient poses a risk to your health or safety, you should take all available steps to minimize the risk before providing treatment or making suitable alternative arrangements for treatment.
*This includes your views about a patient's age, color, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status.

Treatment in emergencies

11. In an emergency, wherever it arises, you must offer assistance, taking account of your own safety, your competence, and the availability of other options for care.

 Keeping up to date
12. You must keep your knowledge and skills up to date throughout your working life. You should be familiar with relevant guidelines and developments that affect your work. You should regularly take part in educational activities that maintain and further develop your competence and performance.
13. You must keep up to date with, and adhere to, the laws and codes of practice relevant to your work.

Maintaining & improving your performance

 14.  You must work with colleagues and patients to maintain and improve the quality of your work and promote patient safety. In particular, you must:
a. maintain a folder of information and evidence, drawn from your medical practice
b. reflect regularly on your standards of medical practice in accordance with GMC guidance on licensing and revalidation
c. take part in regular and systematic audit
d. take part in systems of quality assurance and quality improvement
e. respond constructively to the outcome of audit, appraisals and performance reviews, undertaking further training where necessary
f. help to resolve uncertainties about the effects of treatments
g. contribute to confidential inquiries and adverse event recognition and reporting, to help reduce risk to patients
h. report suspected adverse drug reactions in accordance with the relevant reporting scheme
i. co-operate with legitimate requests for information from organizations monitoring public health - when doing so you must follow the guidance in Confidentiality.

Teaching and training, appraising and assessing

This is the Teaching and training, appraising and assessing section of Good Medical Practice.
15. Teaching, training, appraising and assessing doctors and students are important for the care of patients now and in the future. You should be willing to contribute to these activities.
16. If you are involved in teaching you must develop the skills, attitudes and practices of a competent teacher.
17. You must make sure that all staff for whom you are responsible, including locums and students, are properly supervised.
18. You must be honest and objective when appraising or assessing the performance of colleagues, including locums and students. Patients will be put at risk if you describe as competent someone who has not reached or maintained a satisfactory standard of practice.
19. You must provide only honest, justifiable and accurate comments when giving references for, or writing reports about, colleagues. When providing references you must do so promptly and include all information that is relevant to your colleague's competence, performance or conduct.


Doctor patient partnership

20. Relationships based on openness, trust and good communication will enable you to work in partnership with your patients to address their individual needs.
21. To fulfill your role in the doctor-patient partnership you must:
a. be polite, considerate and honest
b. treat patients with dignity
c. treat each patient as an individual
d. respect patients' privacy and right to confidentiality
e. support patients in caring for themselves to improve and maintain their health
f. encourage patients who have knowledge about their condition to use this when they are making decisions about their care.

Good communication

22. To communicate effectively you must:
a. listen to patients, ask for and respect their views about their health, and respond to their concerns and preferences
b. share with patients, in a way they can understand, the information they want or need to know about their condition, its likely progression, and the treatment options available to them, including associated risks and uncertainties
c. respond to patients' questions and keep them informed about the progress of their care
d. make sure that patients are informed about how information is shared within teams and among those who will be providing their care.
23. You must make sure, wherever practical, that arrangements are made to meet patients' language and communication needs. 

Children and young people

24. The guidance that follows in paragraphs 25-27 is relevant whether or not you routinely see children and young people as patients. You should be aware of the needs and welfare of children and young people when you see patients who are parents or carers, as well as any patients who may represent a danger to children or young people.
25. You must safeguard and protect the health and well-being of children and young people.
26. You should offer assistance to children and young people if you have reason to think that their rights have been abused or denied.
27. When communicating with a child or young person you must:
a. treat them with respect and listen to their views
b. answer their questions to the best of your ability
c. provide information in a way they can understand.
28. The guidance in paragraphs 25-27 is about children and young people, but the principles also apply to other vulnerable groups.

Relatives, carers and partners

29. You must be considerate to relatives, carers, partners and others close to the patient, and be sensitive and responsive in providing information and support, including after a patient has died. In doing this you must follow the guidance in Confidentiality.
30. If a patient under your care has suffered harm or distress, you must act immediately to put matters right, if that is possible. You should offer an apology and explain fully and promptly to the patient what has happened, and the likely short-term and long-term effects.
31. Patients who complain about the care or treatment they have received have a right to expect a prompt, open, constructive and honest response including an explanation and, if appropriate, an apology. You must not allow a patient's complaint to affect adversely the care or treatment you provide or arranged.

Maintaining trust in the profession

32. You must not use your professional position to establish or pursue a sexual or improper emotional relationship with a patient or someone close to them.
33. You must not express to your patients your personal beliefs, including political, religious or moral beliefs, in ways that exploit their vulnerability or that are likely to cause them distress.
34. You must take out adequate insurance or professional indemnity cover for any part of your practice not covered by an employer's indemnity scheme, in your patients' interests as well as your own
35. You must be familiar with your MCI  registration  number. You must make sure you are identifiable to your patients and colleagues, for example by using your registered name when signing statutory documents, including prescriptions. You must make your registered name and Registration number available to anyone who asks for them.

Consent

36. You must be satisfied that you have consent or other valid authority before you undertake any examination or investigation, provide treatment or involve patients in teaching or research. Usually this will involve providing information to patients in a way they can understand, before asking for their consent.
You must follow the guidance in Seeking patients' consent: The ethical considerations, which includes advice on children and patients who are not able to give consent.

Confidentiality

37. Patients have a right to expect that information about them will be held in confidence by their doctors. You must treat information about patients as confidential, including after a patient has died. If you are considering disclosing confidential information without a patient's consent, you must follow the guidance in with Confidentiality.

Ending your professional relationship with a patient

38. In rare circumstances, the trust between you and a patient may break down, and you may find it necessary to end the professional relationship. For example, this may occur if a patient has been violent to you or a colleague, has stolen from the premises, or has persistently acted inconsiderately or unreasonably. You should not end a relationship with a patient solely because of a complaint the patient has made about you or your team, or because of the resource implications* of the patient's care or treatment.
39. Before you end a professional relationship with a patient, you must be satisfied that your decision is fair and does not contravene the guidance in paragraph 7. You must be prepared to justify your decision. You should inform the patient of your decision and your reasons for ending the professional relationship, wherever practical in writing.
40. You must take steps to ensure that arrangements are made promptly for the continuing care of the patient, and you must pass on the patient's records without delay.
* If you charge fees, you may refuse further treatment for patients unable or unwilling to pay for services you have already provided. You must follow the guidance in paragraph 39.

Working in teams

41. Most doctors work in teams with colleagues from other professions. Working in teams does not change your personal accountability for your professional conduct and the care you provide. When working in a team, you should act as a positive role model and try to motivate and inspire your colleagues. You must:
a. respect the skills and contributions of your colleagues
b. communicate effectively with colleagues within and outside the team
c. make sure that your patients and colleagues understand your role and responsibilities in the team, and who is responsible for each aspect of patient care
d. participate in regular reviews and audit of the standards and performance of the team, taking steps to remedy any deficiencies
e. support colleagues who have problems with performance, conduct or health.
42. If you are responsible for leading a team, you must follow the guidance in Management for doctors.

Conduct and performance of colleagues

43. You must protect patients from risk of harm posed by another colleague's conduct, performance or health. The safety of patients must come first at all times. If you have concerns that a colleague may not be fit to practice, you must take appropriate steps without delay, so that the concerns are investigated and patients protected where necessary. This means you must give an honest explanation of your concerns to an appropriate person from your employing or contracting body, and follow their procedures.
44. If there are no appropriate local systems, or local systems do not resolve the problem, and you are still concerned about the safety of patients, you should inform the relevant regulatory body. If you are not sure what to do, discuss your concerns with an impartial colleague or contact your defense body, a professional organization, or the MCI for advice.
45. If you have management responsibilities you should make sure that systems are in place through which colleagues can raise concerns about risks to patients, and you must follow the guidance in Management for doctors.

Respect for colleagues

46. You must treat your colleagues fairly and with respect. You must not bully or harass them, or unfairly discriminate against them by allowing your personal views* to affect adversely your professional relationship with them. You should challenge colleagues if their behavior does not comply with this guidance.
47. You must not make malicious and unfounded criticisms of colleagues that may undermine patients' trust in the care or treatment they receive, or in the judgment of those treating them.
* This includes your views about a colleague's age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status.

Arranging cover

48. You must be satisfied that, when you are off duty, suitable arrangements have been made for your patients' medical care. These arrangements should include effective hand-over procedures, involving clear communication with healthcare colleagues. If you are concerned that the arrangements are not suitable, you should take steps to safeguard patient care and you must follow the guidance in paragraph 6.

Taking up and ending appointments

49. Patient care may be compromised if there is not sufficient medical cover. Therefore, you must take up any post, including a locum post, you have formally accepted, and you must work your contractual notice period, unless the employer has reasonable time to make other arrangements.

Sharing information with colleagues

50. Sharing information with other healthcare professionals is important for safe and effective patient care.
51.When you refer a patient, you should provide all relevant information about the patient, including their medical history and current condition.
52. If you provide treatment or advice for a patient, but are not the patient's general practitioner, you should tell the general practitioner the results of the investigations, the treatment provided and any other information necessary for the continuing care of the patient, unless the patient objects.
53. If a patient has not been referred to you by a general practitioner, you should ask for the patient's consent to inform their general practitioner before starting treatment, except in emergencies or when it is impractical to do so. If you do not inform the patient's general practitioner, you will be responsible for providing or arranging all necessary after-care.

Delegation and referral

54. Delegation involves asking a colleague to provide treatment or care on your behalf. Although you will not be accountable for the decisions and actions of those to whom you delegate, you will still be responsible for the overall management of the patient, and accountable for your decision to delegate. When you delegate care or treatment you must be satisfied that the person to whom you delegate has the qualifications, experience, knowledge and skills to provide the care or treatment involved. You must always pass on enough information about the patient and the treatment they need.
55. Referral involves transferring some or all of the responsibility for the patient's care, usually temporarily and for a particular purpose, such as additional investigation, care or treatment that is outside your competence. You must be satisfied that any healthcare professional to whom you refer a patient is accountable to a statutory regulatory body or employed within a managed environment. If they are not, the transfer of care will be regarded as delegation, not referral. This means you remain responsible for the overall management of the patient, and accountable for your decision to delegate

Being honest and trustworthy

56. Probity means being honest and trustworthy, and acting with integrity: this is at the heart of medical professionalism.
57. You must make sure that your conduct at all times justifies your patients' trust in you and the public's trust in the profession.
58. You must inform the MCI without delay if, anywhere in the world, you have accepted a caution, been charged with or found guilty of a criminal offence, or if another professional body has made a finding against your registration as a result of fitness to practice procedures.
59. If you are suspended by an organization from a medical post, or have restrictions placed on your practice you must, without delay, inform any other organisations for which you undertake medical work and any patients you see independently.

Providing and publishing information about your services

60. If you publish information about your medical services, you must make sure the information is factual and verifiable.
61. You must not make unjustifiable claims about the quality or outcomes of your services in any information you provide to patients. It must not offer guarantees of cures, nor exploit patients' vulnerability or lack of medical knowledge.
62. You must not put pressure on people to use a service, for example by arousing ill-founded fear.
 63. You must be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents.
 64. You must always be honest about your experience, qualifications and position, particularly when applying for posts.
65. You must do your best to make sure that any documents you write or sign are not false or misleading. This means that you must take reasonable steps to verify the information in the documents and that you must not deliberately leave out relevant information.
66. If you have agreed to prepare a report, complete or sign a document or provide evidence, you must do so without unreasonable delay.
67. If you are asked to give evidence or act as a witness in litigation or formal inquiries, you must be honest in all your spoken and written statements. You must make clear the limits of your knowledge or competence.
68. You must co-operate fully with any formal inquiry into the treatment of a patient and with any complaints procedure that applies to your work. You must disclose to anyone entitled to ask for it any information relevant to an investigation into your own or a colleague's conduct, performance or health. In doing so, you must follow the guidance in Confidentiality.
69. You must assist the coroner or procurator fiscal in an inquest or inquiry into a patient's death by responding to their enquiries and by offering all relevant information. You are entitled to remain silent only when your evidence may lead to criminal proceedings being taken against you.

Research

70. Research involving people directly or indirectly is vital in improving care and reducing uncertainty for patients now and in the future, and improving the health of the population as a whole.
71. If you are involved in designing, organising or carrying out research, you must:
a. put the protection of the participants' interests first
b. act with honesty and integrity
c. follow the appropriate national research governance guidelines and the guidance in Researcs.

Financial and commercial dealings

72. You must be honest and open in any financial arrangements with patients. In particular:
a. you must inform patients about your fees and charges, wherever possible before asking for their consent to treatment
b. you must not exploit patients' vulnerability or lack of medical knowledge when making charges for treatment or services
c. you must not encourage patients to give, lend or bequeath money or gifts that will directly or indirectly benefit you
d. you must not put pressure on patients or their families to make donations to other people or organisations
e. you must not put pressure on patients to accept private treatment
f. if you charge fees, you must tell patients if any part of the fee goes to another healthcare professional.
73. You must be honest in financial and commercial dealings with employers, insurers and other organisations or individuals.
 In particular:
a. before taking part in discussions about buying or selling goods or services, you must declare any relevant financial or commercial interest that you or your family might have in the transaction
b. if you manage finances, you must make sure the funds are used for the purpose for which they were intended and are kept in a separate account from your personal finances.

Conflicts of interest

74. You must act in your patients' best interests when making referrals and when providing or arranging treatment or care. You must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients. You must not offer such inducements to colleagues.
75. If you have financial or commercial interests in organisations providing healthcare or in pharmaceutical or other biomedical companies, these interests must not affect the way you prescribe for, treat or refer patients.
76. If you have a financial or commercial interest in an organisation to which you plan to refer a patient for treatment or investigation, you must tell the patient about your interest.

Health

This is the Health section of Good Medical Practice.
77. You should be registered with a general practitioner outside your family to ensure that you have access to independent and objective medical care. You should not treat yourself.
78. You should protect your patients, your colleagues and yourself by being immunised against common serious communicable diseases where vaccines are available.
79. If you know that you have, or think that you might have, a serious condition that you could pass on to patients, or if your judgment or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague. You must ask for and follow their advice about investigations, treatment and changes to your practice that they consider necessary. You must not rely on your own assessment of the risk you pose to patients.

1. Doctors with full registration who hold a license to practice may prescribe all medicines, but not those drugs in  Misuse of Drugs . If you have provisional registration and hold a license to practice you may prescribe medicines in line with the supervisory conditions of your employment.
2. You should only prescribe drugs to meet identified needs of patients and never for your own convenience or simply because patients demand them.

3. Objectivity is essential in providing good care; independent medical care should be sought whenever you or someone with whom you have a close personal relationship requires prescription medicines.

5. When prescribing medicines you must ensure that your prescribing is appropriate and responsible and in the patient's best interests. To do this you must:
a. Ensure you are familiar with current guidance  -knowing the use, side effects and contraindications of the medicines that you prescribe.and the safe use and administration of medicines.
b. Be in possession of, or take, an adequate history from the patient, including: any previous adverse reactions to medicines; current medical conditions; and concurrent or recent use of medicines, including non-prescription medicines.
c. Reach agreement with the patient on the use of any proposed medication, and the management of the condition by exchanging information and clarifying any concerns. The amount of information you should give each patient will vary according to factors such as the nature of the patient's condition, risks and side effects of the medicine and the patient's wishes. Bearing these issues in mind, you should, where appropriate
i. Establish the patient's priorities, preferences and concerns and encourage the patient to ask questions about medicine taking and the proposed treatment
ii. Discuss other treatment options with the patient
iii. Satisfy yourself that your patient has been given appropriate information, in a way they can understand, about: any common adverse side effects; potentially serious side effects; what to do in the event of a side-effect; interactions with other medicines; and the dosage and administration of the medicine;
iv. Satisfy yourself that the patient understands how to take the medicine as prescribed
v. Satisfy yourself that the patient is able to take the medicine as prescribed. 
6. When prescribing for a patient you should:
a. Prescribe dosages appropriate for the patient and their condition
b. Agree with the patient arrangements for appropriate follow-up and monitoring where relevant. This may include: further consultations; blood tests or other investigations; processes for adjusting the dosage of medicines, changing medicines and issuing repeat prescriptions.
c. You should inform  patients with information about how to report suspected adverse reactions
d. Make a clear, accurate, legible and contemporaneous record of all medicines prescribed.
7. If you prescribe at the recommendation of a nurse or other healthcare professional who does not have prescribing rights, you must be satisfied that the prescription is appropriate for the patient concerned and that the professional is competent to have recommended the treatment.

8. If you are not the patient's general practitioner and you accept a patient for treatment without a referral from the patient's general practitioner, then you must: 
a. Explain to the patient the importance and benefits of keeping their general practitioner informed
b. Inform the patient's general practitioner unless the patient objects
c. Where possible inform the patient's general practitioner before any treatment is started, unless the patient objects to this disclosure.
9. If the patient does not want their general practitioner to be informed, or has no general practitioner, then you must:
a. Take steps to ensure that the patient is not suffering from any medical condition or receiving any other treatment that would make the prescription of any medicines unsuitable or dangerous
b. Take responsibility for providing all necessary aftercare for the patient until another doctor agrees to take over.

10. You should ensure that your patients have access to information about your own and (where known) your employers' financial or commercial interests in any pharmacy they are likely to use.
11. Patients should be free to choose from which pharmacy to have their prescribed medicines dispensed. Advice about specialist pharmacies or those that offer collection and delivery services, for example, can be helpful. It might not be practical or clinically appropriate for patients to use alternative pharmacies when in hospital or visiting clinics at which medicines are dispensed free of charge.
12. You must not allow your own or your employers' financial or commercial interests in a pharmacy to influence the way you advise patients. You should not accept any inducement which may affect or be seen to affect the advice you give patients. You must not pressurize patients to use a particular pharmacy in any event, either personally or through an agent, nor should you disparage or otherwise undermine patients' trust in a pharmacy or pharmacist by making malicious or unfounded criticisms.

13. Doctors should, wherever possible, avoid treating themselves or anyone with whom they have a close personal relationship and should be registered with a GP outside their family. Scheduled  drugs can present particular problems, occasionally resulting in a loss of objectivity leading to drug misuse and misconduct.
14. You should not prescribe a scheduled drug for yourself or someone close to you unless:
a. No other person with the legal right to prescribe is available to assess the patient's clinical condition and to prescribe without a delay which would put the patient's life or health at risk, or cause the patient unacceptable pain, and
b. That treatment is immediately necessary to:
i. Save life
ii. Avoid serious deterioration in the patient's health, or
iii. Alleviate otherwise uncontrollable pain.
15. You must be able to justify your actions and must record your relationship and the emergency circumstances that necessitated your prescribing a scheduled drug for yourself or someone close to you.
16. Scheduled drugs should be carefully prescribed

17. Your primary duty is to act in your patient's best interests; you must also make efficient use of the resources available to you; you should not prescribe in a manner those conflicts with either of these duties. You should respect patients' freedom to choose where to have their prescribed medicines dispensed. You should not prescribe differently for patients to whom you also dispense for your own or your employers' commercial or financial benefit.

18. You can prescribe unlicensed medicines but, if you decide to do so, you must:
a. Be satisfied that an alternative, medicine would not meet the patient's needs
b. Be satisfied that there is a sufficient evidence base and/or experience of using the medicine to demonstrate its safety and efficacy
c. Take responsibility for prescribing the unlicensed medicine and for overseeing the patient's care, including monitoring and any follow up treatment (see also paragraphs 25-27 on prescribing for hospital outpatients)
d. Record the medicine prescribed and, where you are not following common practice, the reasons for choosing this medicine in the patient's notes.

Prescribing medicines for use outside the terms of their license (off-label)

19. You may prescribe medicines for purposes for which they are not licensed. Although there are a number of circumstances in which this may arise, it is likely to occur most frequently in prescribing for children. Currently pharmaceutical companies do not usually test their medicines on children and as a consequence, cannot apply to license their medicines for use in the treatment of children. The use of medicines that have been licensed for adults, but not for children, is often necessary in pediatric practice.
20. When prescribing a medicine for use outside the terms of its licence you must:
a. Be satisfied that it would better serve the patient's needs than an appropriately licensed alternative
b. Be satisfied that there is a sufficient evidence base and/or experience of using the medicine to demonstrate its safety and efficacy. The manufacturer's information may be of limited help in which case the necessary information must be sought from other sources
c. Take responsibility for prescribing the medicine and for overseeing the patient's care, monitoring and any follow up treatment, or arrange for another doctor to do so (see also paragraphs 25-27 on prescribing for hospital outpatients)
d. Make a clear, accurate and legible record of all medicines prescribed and, where you are not following common practice, your reasons for prescribing the medicine.

21. You must give patients, or those authorizing treatment on their behalf, sufficient information about the proposed course of treatment including any known serious or common side effects or adverse reactions. This is to enable them to make an informed decision.
22. Some medicines are routinely used outside the scope of their license, for example in treating children. Where current practice supports the use of a medicine in this way it may not be necessary to draw attention to the license when seeking consent. However, it is good practice to give as much information as patients, or those authorizing treatment on their behalf, require or which they may see as significant. Where patients, or their carers express concern you should also explain, in broad terms, the reasons why medicines are not licensed for their proposed use. Such explanations may be supported by written information, including the leaflets on the use of unlicensed medicines or licensed medicines for unlicensed applications in pediatric practice .
23. However, you must explain the reasons for prescribing a medicine that is unlicensed or being used outside the scope of its licence where there is little research or other evidence of current practice to support its use, or the use of the medicine is innovative.
24. For specific information on prescribing medicines for children  You must refer Pharmacology.   Your   responsibility for prescribing medicines for hospital outpatients is more.
25. Where a patient's care is shared between clinicians, the doctor with the responsibility for the continuing management of the patient must be fully competent to exercise their share of clinical responsibility. They also have a duty to keep themselves informed about the medicines that are prescribed for their patient. They should take account of appropriateness, effectiveness and cost when prescribing any medicine. They should also keep up to date with any relevant guidance on the use of the medicine and on the management of the patient's condition.
26. If you are the doctor signing and issuing the prescription you bear responsibility for that treatment; it is therefore important that, as the prescriber, you understand the patient's condition as well as the treatment prescribed and can recognise any adverse side effects of the medicine should they occur.
27. There should be full consultation and agreement between general practitioners and hospital doctors about the indications and need for particular therapies. The decision about who should take responsibility for continuing care or treatment after initial diagnosis or assessment should be based on the patient's best interests rather than on the healthcare professional's convenience or the cost of the medicine.

28. The majority of clinical care should continue to be provided on an individual, patient-specific basis. The use of Patient Group Directions  should be reserved for those limited situations where this offers a distinct advantage for patient care and where it is consistent with appropriate professional relationships and accountability.
29. Patient Group Directions may be suitable for the supply and administration of some injectable medicines. However, the administration of medicines to paralyse muscles which cause wrinkles requires assessment of individual patients' suitability and (in the event that administration is delegated to a nurse or other person) patient specific directions; general directions which would apply to any patient with an appointment on a particular day are not sufficient.

30. Getting repeat prescriptions prepared by other members of the general practice healthcare team/staff or generated by computer can be an efficient way of meeting patients' needs, while reducing demands on doctors' time.
31. It is important that any system for issuing repeat prescriptions takes full account of the obligations to prescribe responsibly and safely and that the doctor who signs the prescription takes responsibility for it. Before signing a repeat prescription you must be satisfied that it is safe and appropriate to do so and that secure procedures are in place to ensure that:
a. The patient is issued with the correct prescription;
b. Each prescription is regularly reviewed so that it is not issued for a medicine that is no longer required;
c. The correct dose is prescribed for medicines where the dose varies during the course of the treatment.
32. Arrangements for issuing repeat prescriptions should include suitable provision for monitoring each patient's condition and for ensuring that patients who need a further examination or assessment do not receive repeat prescriptions without being seen by a doctor. This is particularly important in the case of medicines with potentially serious side effects.

33. Repeat dispensing can relieve pressure on doctors' time and make better use of pharmacists' professional skills, as well as being more convenient for patients.
34. You should offer repeat dispensing only to patients for whom it is appropriate, such as those with chronic conditions who are likely to remain stable for the duration of the dispensing period and who take stable, long term medication. Patients on a large number of medicines or who are likely to be hospitalised may be less suited to inclusion in a repeat dispensing scheme.
35. Patients must give consent to be included in a repeat dispensing scheme. You should satisfy yourself that patients understand the implications for confidentiality as well as the clinical and practical effects of inclusion.
36. You should make a record of the dispenser holding the original repeatable prescription form, when you know who they are, so that you can contact them as necessary.
37. As with repeat prescribing, you should ensure that secure procedures are in place to regularly review the prescription, monitor the patient's condition and for further examination or assessment of the patient as necessary.
38.  Saving time, helping patients is very much  necessary

39. From time to time it may be appropriate to use a telephone or other non face-to-face medium to prescribe medicines and treatment for patients. Such situations may occur where:
a. You have responsibility for the care of the patient
b. You are deputising for another doctor who is responsible for the continuing care of a patient or
c. You have prior knowledge and understanding of the patient's condition/s and medical history and you have authority to access the patient's records.
40. In all circumstances, you must ensure that you have an appropriate dialogue with the patient to:
a. Establish the patient's current medical conditions and history and concurrent or recent use of other medications including non-prescription medicines;
b. Carry out an adequate assessment of the patient's condition
c. Identify the likely cause of the patient's condition
d. Ensure that there is sufficient justification to prescribe the medicines/treatment proposed. Where appropriate you should discuss other treatment options with the patient
e. Ensure that the treatment and/or medicine/s are not contra-indicated for the patient
Make a clear, accurate and legible record of all medicines prescribed.
41. If you are not providing continuing care for the patient, do not have access to the patient's medical records, or are not deputising for another doctor, you must follow the advice above and, additionally you must:
a. Give an explanation to the patient of the processes involved in remote consultations and give your name and your registration  number to the patient
b. Establish a dialogue with the patient, using a questionnaire, to ensure that you have sufficient information about the patient to ensure you are prescribing safely
c. Make appropriate arrangements to follow the progress of the patient
d. Monitor the effectiveness of the treatment and/or review the diagnosis
e. Inform the patient's general practitioner or follow the advice in paragraph 9 if the patient objects to the general practitioner being informed.
42. Where you cannot satisfy all of these conditions you should not use remote means to prescribe medicine for a patient.
43. If you prescribe for patients who are overseas, you should also have regard to differences in a product's licensed name, indications and recommended dosage regimen. On import/export requirements and safety of delivery, which you might also need to consider. You should ensure that you have adequate indemnity cover for such practice. You may need to be registered with a local regulatory body in the country in which the prescribed medicines are to be dispensed.
1. Our core guidance Good Medical Practice sets out the principles which underpin good care. When doctors act as expert witnesses, they take on a different role from that of a doctor providing treatment or advice to patients. The principles set out in Good Medical Practice also apply to doctors working as expert witnesses.
2. In paragraphs 63-67 of Good Medical Practice we say

    • You must be honest and trustworthy when writing reports and when completing or signing forms, reports and other documents.
    • You must always be honest about your experience, qualifications and position, particularly when applying for posts.
    • You must do your best to make sure that any documents you write or sign are not false or misleading.  This means that you must take reasonable steps to verify the information in the documents and that you must not deliberately leave out relevant information.
    • If you have agreed to prepare a report, complete or sign a document or provide evidence, you must do so without unreasonable delay.
    • If you are asked to give evidence or act as a witness in litigation or formal inquiries, you must be honest in all your spoken and written statements. You must make clear the limits of your knowledge or competence.

3. This guidance explains how the principles set out in Good Medical Practice apply to the work of the medical expert witness. It also lists other sources of information and advice.  If you have concerns arising from an appointment as a medical expert witness, you should consider seeking advice from the MCI, your medical defense body or professional association.
4. Serious or persistent failure to follow this guidance will put your registration at risk.

5. The role of an expert witness is to assist the court on specialist or technical matters within their expertise1. The expert's duty to the court overrides any obligation to the person who is instructing or paying them2. This means that you have a duty to act independently and not be influenced by the party who retains you.

6. You must ensure that you understand exactly what questions you are being asked to answer.  If your instructions are unclear, inadequate or conflicting, you should seek clarification from those instructing you.  If you cannot obtain sufficiently clear instructions, you should not provide expert advice or opinion.
7. When giving evidence or writing reports, you must restrict your statements to areas in which you have relevant knowledge or direct experience. You should be aware of the standards and nature of practice at the time of the incident under proceedings.
8. You must only deal with matters, and express opinions, that fall within the limits of your professional competence3. If a particular question or issue falls outside your area of expertise, you should make this clear. In the event that you are ordered by the court to answer a question, regardless of your expertise, you should answer to the best of your ability but make clear that you consider the matter to be outside your competence.
9. You must give a balanced opinion, and be able to state the facts or assumptions on which it is based.  If there is a range of opinion on the question upon which you have been asked to comment, you should summarise the range of opinion and explain how you arrived at your own view. If you do not have enough information on which to reach a conclusion on a particular point, or your opinion is otherwise qualified, you must make this clear. 
10. You must make sure that any report that you write, or evidence that you give, is accurate and is not misleading. This means that you must take reasonable steps to verify any information you provide, and you must not deliberately leave out relevant information.  
11. Where you are asked to give advice or opinion about an individual without the opportunity to consult with or examine them, you should explain any limitations that this may place on your advice or opinion, and be able to justify the decision to proceed on such a basis.
12. Your advice and evidence will be relied upon for decision-making purposes by people who do not come from a medical background. Wherever it is possible to do so without being misleading, you should use language and terminology that will be readily understood by those for whom you are providing expert advice or opinion. You should explain any abbreviations and medical or other technical terminology that you use.
13. If, at any stage, you change your view on any material matter, you have a duty to ensure that those instructing you, the opposing party and the judge are made aware of this without delay.  Usually you need only inform your instructing solicitor who will communicate with the other parties. If the solicitor fails to disclose your change of view, you should inform the court. If you are unsure what to do, you should seek legal advice. 
14. You must be honest, trustworthy, objective and impartial. You must not allow your views about any individual's age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation or social or economic status to prejudice the evidence or advice that you give.

15. You must keep up to date in your specialist area of practice. You must also ensure that you understand, and adhere to, the laws and codes of practice that affect your work as an expert witness. In particular, you should make sure that you understand

    • how to construct a court-compliant report
    • how to give oral evidence
    • the specific framework of law and procedure within which you are working

16. You must take all reasonable steps to access all relevant evidence materials and maintain their integrity and security whilst in your possession. 
17. If you have reason to believe that appropriate consent for disclosure of information has not been obtained (from the patient or client, or from any third party to whom their medical records refer) you should return the information to the person instructing you and seek clarification.
18. You should not disclose confidential information other than to the parties to proceedings, unless

    • the subject consents (and there are no other restrictions or prohibitions on disclosure)
    • you are obliged to do so by law
    • you are ordered to do so by a court or tribunal
    • your overriding duty to the court and the administration of justice demands that you disclose information

19. If there is any matter that gives rise to a potential conflict of interest, such as any prior involvement with one of the parties, or a personal interest, you must follow the guidance on disclosure in paragraph 13.  You may continue to act as an expert witness only if the court decides that the conflict is not material to the case.

Continuing professional development

Doctors must remain up to date and fit to practice throughout their professional lives.
Good Medical Practice requires doctors to keep their knowledge and skills up to date throughout their working life and to maintain and improve their performance. Continuing professional development (CPD) is a key way for doctors to meet these professional standards and is one of the sources of information required for appraisal and revalidation.