1. The good medical practice
Prof. MAM Ibnouf, FRCSEd
Consultant Gastro-intestinal Surgeon
The Institute for Research and Strategic Studies
Omdurman Islamic University

2. The inevitable risk All people, governments and nations look for
means of happiness, but
life curries some
hidden risk.
How do we anticipate
and minimise the risks
In all live activities?

3. The inevitable risk
In certain jobs like medicine the risks can be very serious, on both patients and health providers .
How do you become a less risky health providers?

4. 1- Competent 2- Observe dues and duties

5. 2- Observe dues and duties
1- Adopt values of medical professionalism 2- Educate health providers, and community 3- Provide good clinical care 4- Raising concerns about patient safety 5- Support self care

6. 2- Observe dues and duties
6- Avoid conflicts with patients 7-Advocate for patients and facilities 8- Care for the refused patient 10-Treatment in emergencies 11- Maintaining good medical practice 12- Teaching and training, appraising and assessing

7. 1- Good standard of practice and care 2- Respect patient dignity 3- Empathy 4- Advocacy 5- Punctuality 6- Self integrity , honesty and truthfulness 7-

8. 1- Competence The standards and competences that SHOULD
be expected to achieve depend on the:
1- Specialty
2- Grade in that specialty.

9. 2- Dues and duties All health providers MUST comply with the
Duties THAT ARE
EXPECTED TO BE
REGISTERED IN THE
Sudan Medical Council*.
*The duties are laid out in Good Medical Practice of the GMC

10. Principles of Good Medical Practice
1-Describe the values of medical professionalism.
2- Guide the health providers, and community to
know what is expect from them.

11. Principles of Good Medical Practice
It is guidance, not a legislative code, so one MUST use his/her judgement to apply the principles to the various situations he/she faces as a health provider as: 1- a- license to practice. b- One must be prepared to explain and justify his/her decisions and actions.

12. Providing good clinical care
2. Good clinical care must include:
Adequate assessment of the patient, taking history (including the symptoms, and psychological and social factors), and relevant detailed examination.
b. Providing advice, investigations or treatment or referral to another specialist where appropriate.

13. 3. In providing care you must:
1- Recognise and work within the limits of one’s
competence
2- Prescribe the appropriate drugs or
management only when one have adequate
knowledge of the patient's health condition.
3- Provide effective treatments based on the best
available evidence

14. 3. In providing care you must:
4- Take steps to alleviate pain and distress
whether or not a cure may be possible
5- Respect the patient's right to seek a second
opinion
6- keep readable records, the decisions made, the
information given to patients, including drugs
or other investigation prescribed.

15. 4- Supporting self care
The health provider SHOULD encourage patients to take an interest and actions to improve the quality of their health. This may include: A- advising patients on changes of their life stile b- Explaining the possible outcomes of their treatments.

16. 5-Avoid treating those close to you
Wherever possible, you SHOULD avoid providing medical care to anyone with whom you have a close personal relationship.   

17. 6- Raising concerns about patient safety
1- 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. 2- Otherwise, draw the attention of your senior. 3- If no adequate action is taken, you should take independent advice to take the matter further. 4- Always you MUST keep your records

18. 7- Decisions about access to medical care
1- You MUST not refuse or delay treatment because you believe that a patient's actions or behaviour is not acceptable to you or to their health status 2- You must treat your patients equally irrespective of their thoughts, ethnicity and beliefs. 3- You must not discriminate patients to affect adversely your professional relationship. 4- You should challenge colleagues if their behaviour does not comply with this guidance.

19. 8- Conflicts with patients
8- If you have a conflict with a patient you must explain to him/her and tell him/her that he/she have the right to see another doctor. If it is not practical for a patient to arrange to see another doctor, you must make the necessary arrangements for the to see another suitably qualified doctor to take over your role.

20. 9- The in adequate resources
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 number 6.

21. 10- Refusal of patients
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. m If a patient poses a risk to your health or safety, you SHOULD take all available steps to minimise the risk before providing treatment or making suitable alternative arrangements for treatment.

22. 11-Treatment in emergencies
In an emergency, wherever it arises, you: 1- MUST Offer assistance, 2- MUST Take care of your own safety, 3- MUST Not over estimate your competence, 4- Can Call for help or consider adequate referral

23. 12- Maintaining good medical practice
1- You MUST keep your knowledge and skills up to
date throughout your working life.
2- You SHOULD be familiar with relevant guidelines and
developments that affect your work.
3- You Should regularly take part in educational
activities to maintain your competence.
4- You MUST adhere to, the laws and codes of practice
relevant to your work.

24. 13- Maintaining and improving performance
1- You MUST work with colleagues to maintain and improve the quality of your work and promote patient safety. In particular,
2- You SHOULD reflect regularly on your standards of medical practice in accordance with guidance on licensing for medical practice.

25. 13- Maintaining and improving performance
3- You SHOULD take part in regular and
systematic audit
4- You SHOULD take part in systems of
quality assurance and quality improvement
5- You SHOULD respond constructively to the
outcome of audit, appraisals and performance
reviews, undertaking further training where
necessary.

26. 13- Maintaining and improving performance
6- You SHOULD contribute to confidential inquiries on adverse event recognition to help reduce risk to patients 7- You MUST record and react to suspected adverse drug reactions 8- You MUST co-operate with official requests for monitoring public health - when doing so 9- You MUST follow the guidance in with Confidentiality: Protecting and providing information.

27. 14- Teaching and training, appraising and assessing
1- You SHOULD participate on teaching, training, appraising and assessing doctors and students to improve patients care
2- If you are involved in teaching you MUST develop the skills, attitudes and practices of a competent teacher.

28. 15- Supervision 1- You MUST make sure that all staff working with
you as nurses and students, are properly
supervised.
2- You MUST be honest and objective when
appraising or assessing the performance of
colleagues, including nurses 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).

29. 16- Referencing and reporting
1- You MUST provide honest, and accurate
comments when giving references for, or
writing reports about, colleagues.
2- You MUST include all information that is
relevant to your colleague's competence,
performance or conduct.

30. GMC Good Medical Practice states: Dues and 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: 1- Make the care of your patient your first concern

31. GMC Good Medical Practice states: Dues and Duties of a doctor
2- Protect and promote the health of patients
and the public

32. 3- Provide a good standard of practice and care
Keep your professional knowledge and skills up to date
Recognise and work within the limits of your competence
Work with colleagues in the ways that best serve patients' interests

33. 4- Treat patients as individuals and respect their dignity
Treat patients politely and considerately
Respect patients' right to confidentiality

34. 5- 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

35. 6- 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.

36. 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.

37. You are personally ACCOUNTABLE for your professional practice and MUST always be prepared to justify your decisions and actions.

38. Patients Dues and Duties
While patients’ requests for treatment play a part in the care, PATIENTS SHOULD NOT override a doctor’s judgement. (i.e. the doctor SHOULD NOT go for a treatment requested by others unless he satisfies himself that the benefits outweighs the likely harms).

39. Advertisement and doctors
1- Good Medical practice has never prohibited
doctors from advertising services, provided that
the information is honest, factual, and doesn’t
exploit patients’ lack of medical knowledge.
2- The adverts MUST NOT make unjustifiable
claims about quality or outcome of service e.g.
“we will make you beautiful”.

40. GIFTS
Doctors MUST NOT ask for or accept bribe, gift or which may affect or be seen to affect their prescription or referral.

41. Financial and commercial dealings
Doctors must be honest and open in any financial arrangements with patients. In particular:
1- Doctors MUST inform patients about their fees
wherever possible before asking for their
consent to treatment.
2- Doctors MUST not exploit patients‘ vulnerability
or lack of medical knowledge when making
charges for treatment or services.

42. Doctors Fees 3- Doctors MUST NOT encourage patients to give, lend
or leave money or gifts that will directly or indirectly
affect their decision
4- Doctors MUST NOT put pressure on patients or their
families to make donations to other people or
organisations
5- Doctors MUST NOT put pressure on patients to accept
private treatment
6- If Doctors charge fees, they MUST tell patients if any
part of the fee goes to another healthcare or person.

43. General Professional Ethics
Doctors MUST be honest in financial and commercial dealings with employers, insurers and other organisations or individuals. In particular: 1- Doctors MUST declare any relevant financial or commercial interest that they or their family have in the transaction, before taking part in discussions about buying or selling goods or services.

44. General Professional Ethics
2- Doctors 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, if they are managing finances.

45. Conflicts of interest
Doctors MUST act in their patients' best interests when making referrals and when providing or arranging treatment or care.
Doctors MUST not ask for, accept or offer any bribes to colleagues.

46. Conflict of interest
If a doctor has financial or commercial interests in organisations providing healthcare or in pharmaceutical or other biomedical companies, these interests MUST NOT affect the way he/sh prescribes for, treats or refers patients.

47. Conflict of interest
If a doctor has a financial or commercial interest in an organisation to which he plans to refer a patient for treatment or investigation, The doctor must tell the patient about your interest. When treating NHS patients you must also tell the healthcare purchaser.

48. Health
A doctor MUST be registered to ensure that he/she have access to independent and objective medical care.
The doctor SHOULD NOT treat him/herself.

49. Doctors’ Health
The doctor SHOULD protect his/her patients, his/her colleagues and him/herself by being immunised against common serious communicable diseases where vaccines are available

50. Doctors’ Health
If a doctor knows that he/she has, or think that might have, a serious condition that he/she could pass on to patients, or his/her judgement or performance could be affected by a condition or its treatment, he/she MUST consult a suitably qualified colleague for investigations, treatment and changes to practice.
The Doctor MUST NOT rely on his/her own assessment of the risk posed to patients.

51. modules to help to reduce the risk:
1- Risky Business: teamwork
2- Risky Business: safe culture, openness, and
transparency
3- Manage the risks from prescription medicines 4-

52. Stroke is a medical emergency. warning signs.
EVERY MINUTE MATTERS. Know these warning signs of a stroke, and teach them to others.
Numbness or weakness of the face, arm or leg, especially on one side of the body
Confusion
Trouble speaking or understanding
Trouble seeing in one or both eyes
Difficulty walking
Dizziness
Loss of balance or coordination
Severe headache with no known cause
tPA (tissue plasminogen activator) can reduce long-term disability if it's given within three hours after an ischemic stroke starts. (Ischemic strokes are caused by clots and are by far the most common type of stroke.)

53. Stroke Risk Assessment
Age: You are a man over 45 or a woman over 55 years old.
Family History Your father or brother had a heart attack before age 55 or your mother or sister had one before age 65.
Medical History You have coronary artery disease, or you have had a heart attack. You have had a stroke. You have an abnormal heartbeat.
Tobacco Smoke: You smoke, or live or work with people who smoke every day.
Total Cholesterol and HDL Cholesterol Your total cholesterol level is 240 mg/dL or higher. Your HDL (“good”) cholesterol level is less than 40 mg/dL if you're a man or less than 50 mg/dL if you're a woman. You don't know your total cholesterol or HDL levels.
Blood Pressure Your blood pressure is 140/90 mm Hg or higher, or you've been told that your blood pressure is too high. You don't know what your blood pressure is.
Physical Inactivity You don't accumulate at least 30 minutes of physical activity on most days of the week.
Excess Body Weight: You are 20 pounds or more overweight.
Diabetes: You have diabetes or take medicine to control your blood sugar.