Our guidance and learning materials

We publish advice to doctors on the standards expected of them. All doctors must be familiar with, and follow Medical practice, and the explanatory guidance. Our learning materials show how the guidance might apply in practice.

Principles about equality and diversity are included in Medical practice and all of our guidance and learning materials because they form a key part of the duties of a doctor. These duties include the following:

  • Doctors should treat patients as individuals and respect their dignity.
  • Doctors should work in partnership with patients, listening to and responding to their concerns and preferences.
  • Doctors must never discriminate unfairly against patients or colleagues.
  • Doctors should take prompt action if they think that patient safety, dignity or comfort is being compromised.

The following summary, which is not exhaustive, explains how we have applied some of these principles to specific parts of our guidance. The summary is presented under themes in alphabetical order. More information on our ethical guidance can be found on our website.

Communication - meeting the needs of patients

Some groups of people face barriers in understanding information, and in communicating with healthcare professionals, for example, disabled people or people from black and minority ethnic groups.

Doctors should make reasonable adjustments under the Equality Act 2010 to meet the needs of disabled patients (Medical practice, paragraph 60). An example of a reasonable adjustment is to provide information in large print for someone who is visually impaired, or a sign language interpreter for someone who is deaf.

Doctors should make sure that, where possible, arrangements are made to give a patient any necessary support, and that they provide information in a way that meets patients’ communication or language needs (Medical practice, paragraphs 31-34).

This vignette illustrates the additional support that a doctor could provide to help a disabled patient make and communicate their decision.

Consent and capacity

Some patients may not have the mental capacity to make decisions, and give consent to medical treatment. This could be due, for example, to a mental health condition, a learning disability, a brain injury, or unconsciousness because of a sudden illness or accident.

Consent is not just about a patient filling in a form, it involves communication between the patient and the doctor about all aspects of the patient’s care, from examination, to investigation, and providing treatment.

Here are some examples of the guidance that we give to doctors in situations where a patient may be unable to give consent.

  • In Consent: patients and doctors making decisions together we explain to doctors what steps they need to take to plan for foreseeable changes in a patient’s capacity to make decisions. For example, discussing treatment options in a place and at a time when the patient is best able to understand and retain the information (paragraphs 18-21 and 62-70). Doctors should check whether patients need any additional support to understand information, to communicate their wishes, or to make a decision, such as using an advocate or interpreter; asking those close to the patient about the patient’s communication needs; or giving the patient a written or audio record of the discussion and any decisions that were made (paragraphs 18a, and 21-25).
  • In Confidentiality we explain to doctors what steps they need to take when they make decisions about whether to disclose information about a patient who lacks capacity (paragraphs 57-62). Disclosure without consent may be justified if it is not practicable to seek a patient’s consent – see paragraph 38 for some examples.
  • Treatment and care towards the end of life explains what doctors need to do when treating patients towards the end of life who lack capacity. For example, if a patient lacks capacity and cannot eat or drink enough to meet their nutrition or hydration needs, doctors must assess whether providing clinically assisted nutrition or hydration would be of overall benefit to them to prolong life or provide relief for their symptoms (paragraphs 118-126). This vignette is about a patient with Down's Syndrome who is terminally ill with breast cancer. It explains what steps the doctor should take to give additional support so that the patient can make and communicate their decision about their care.

Discriminating against colleagues

Doctors should treat colleagues fairly and with respect. They must not bully, harass or unfairly discriminate against them (Leadership and management for all doctors, paragraph 7). This covers all situations and all forms of interaction and communication. For example:

  • When using social media doctors should treat colleagues fairly and with respect (Doctors use of social media, paragraph 15).
  • If a doctor writes a reference for a colleague, they should be objective and fair. They should not base comments on their personal views about a candidate e.g. views about a colleague’s age, race, sexual orientation, that is not relevant to the candidate’s suitability for the role. (Writing references, paragraph 7).
  • If a doctor is acting as a witness in legal proceedings they must be honest, trustworthy and objective, and must not allow their views about a person to affect the evidence or advice that they give (Acting as a witness in legal proceedings, paragraph 4).
  • Doctors must tackle discrimination if they see it taking place and should encourage colleagues to do the same. They should be aware of their organisation’s policies on equality and diversity, and get advice on issues as they arise. Doctors should challenge the behaviour of colleagues if they are bullying, harassing or unfairly discriminating others (Leadership and management for all doctors, paragraph 7-8).

Discriminating against patients

Medical practice, paragraphs 65-64, explains what doctors should do to ensure that they treat patients and colleagues fairly and without discrimination. For example, doctors must not refuse or delay treatment because they believe that a patient’s actions or lifestyle have contributed to their condition. Doctors must not unfairly discriminate against patients or colleagues by allowing their personal views to affect their professional relationships or the treatment they provide or arrange.

Discrimination

Doctors must keep up to date with, and follow, the law, our guidance and other regulations relevant to their work (Medical practice, paragraph 12). In the context of equality and diversity, this means that doctors must meet the requirements set out in the Equality Act 2010.

Establish and maintain partnerships with patients

Doctors must work in partnership with patients, sharing the information that they need to help them make decisions about their care. Doctors must treat patients as individuals and respect their dignity and privacy. Doctors must also treat patients fairly and with respect whatever their life choices and beliefs. (Medical practice, paragraphs 46-49).

Religion and belief

All doctors have personal values that affect their day-to-day practice. We do not want to prevent doctors from practising in line with their beliefs and values, as long as they follow the guidance in Medical practice, and the law relevant to their work. Neither do we wish to prevent patients from receiving care that is consistent with or meets the requirements of their beliefs and values (Personal beliefs and medical practice, paragraph 3).

For example, patients’ personal beliefs may lead them to ask for a procedure for religious, cultural, social or emotional reasons. Personal beliefs and medical practice, paragraphs 18-23, explains what a doctor should do when providing procedures mainly for religious or cultural reasons.

Doctors must not express their personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit patients’ vulnerability or are likely to cause them distress (Medical practice, paragraph 54).  Personal beliefs and medical practice, paragraphs 29-31, provides further guidance in this area.

A doctor may choose to opt out of providing a particular procedure because of their personal beliefs and values. However in doing so, doctors must follow the guidance to ensure that they are not discriminating against a patient or groups of patients. Our guidance includes requirements such as the need for doctors to explain to patients if they have a conscientious objection to a particular procedure. They must tell patients about their right to see another doctor and make sure that arrangements are made for another suitably qualified colleague to take over the doctor’s role if the patient is unable to see another doctor. (Medical practice, paragraph 52). Conscientious objection is explained in, Personal beliefs and medical practice, paragraphs 8-16.

Vulnerable groups

Some patients are more at risk, for example, because they have a learning disability, are under the age of 18, or are elderly and frail. Doctors must take action if they think that a patient’s safety, dignity or comfort is being compromised (Medical practice, paragraph 27). These principles are explained in more detail in the relevant parts of our guidance, for example:

These pieces of guidance are brought to life using case studies which highlight and explore some of the principles. For example, the Medical practice in action case study of Mrs Giggs is about an elderly patient, who tells her doctor in the strictest confidence, that her daughter and carer has hit her. We use this case study to illustrate to doctors the steps that could be taken to ensure that Mrs Giggs confidentiality is maintained, whilst also ensuring that she is safe from harm.

Case studies for Protecting children and young people: The responsibilities of all doctors, bring to life equality and diversity issues around families’ cultural and religious practices, and a profoundly deaf patient, by focusing on how to meet the communication needs of children and young people when discussing child protection concerns.

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