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Stronger sections on discharge and follow-up included in new ethical guide

By Catherine Reilly - 05th Nov 2023

discharge

Specific guidance for doctors regarding discharge summaries and follow-up of investigations has been included in the latest version of the Medical Council’s guide to professional conduct and ethics. 

The ninth edition of the guide, which was published this month, states that discharge of a patient from care “must” be accompanied by a “timely and prompt” discharge summary.

This summary must include at least the minimum basic information, including a summary of relevant medical and treatment history; medication and any medication changes; any planned follow-up by the discharging service; action required by primary care/community services (if involved); and action required by the receiving GP clearly documented.

When discharging care to the patient’s GP, the doctor who orders diagnostic tests or investigations “must follow up on the results to ensure these investigations have taken place, results are followed up and appropriate action taken, including communication to the GP”.

While the previous edition had sections on continuity and transfer of care, the language and detail in the new guide is much more explicit.

As previously reported in the Medical Independent (MI), communication breakdowns at the interface of hospital and primary care have been a concern for the Medical Council and a source of inter-professional tensions among doctors. The issue has been especially highlighted by GPs, who have also objected to the transfer of hospital workload into general practice. The pressure on hospital teams and lack of joined-up IT have also been raised.

Elsewhere, the new guide emphasises that doctors “must practise, promote, and support a culture of open disclosure”. It states doctors must comply with any applicable legislation and national policies regarding open disclosure, including the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023.

While the previous edition stated that doctors had a duty to promote a “culture of candour”, the language suggested that engaging in open disclosure following an adverse event was optional.

Other new or revised areas include a broadening of guidance on communicating with the public, including via social media, and guidance on acting as expert witnesses.

The ethical guide was updated by the Council following a consultation with the public, doctors, and partner organisations.

One of the significant additions was clarification around use of the words ‘must’, ‘should,’ and ‘judgement’ in the guidance.

“The guide reflects international guidance and will be supported by position statements in certain specialty areas, for example, telehealth and prescribing,” according to the Council.

Council President Dr Suzanne Crowe told MI the overall tone of the guide had moved towards “positive role modelling and showing what is good professional practice”. “Not perfect [practice],” she added, “because it is not possible to be perfect in your interaction with a patient every single day, every minute, every hour, but what we are saying is, if you follow the basic principles in this guide, that is a very safe harbour to navigate from.”

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