Prof Development: Concept Checklist

Concepts covered across the module lectures, grouped by lecture. Tick each once you can explain it from memory.

L1 Introduction to Medical Law in New Zealand (25 Mar) L1 Prof Development Introduction to Medical Law in New Zealand

• Sources of NZ law: Acts, regulations, common law, tikanga Māori, court decisions
• Levels of law relevant to medicine, and the four key health-related Acts and whom each targets
• Health Practitioners Competence Assurance Act 2003: functions of responsible authorities, reporting of competence and impairment concerns, HPDT
• Origins and purpose of the Health and Disability Commissioner Act 1994 (Cartwright Inquiry background)
• Code of Rights overview and Right 4: services of an appropriate standard
• What gives doctors permission to treat
• Three avenues when things go wrong: ACC, complaints (HDC and others), professional conduct/HPDT, with upsides and downsides of each
• Applying Right 4 to a medication error case, and system-level responses such as HQSC medication alerts

L2 Professional Boundaries 1 (27 Mar) L2 Prof Development Professional Boundaries 1

• Definition and purposes of professional boundaries; the continuum from under-involvement to boundary violation
• Inappropriate patient sexual behaviour: definition, prevalence, risk factors, unintentional and intentional causes, repercussions
• Passive, aggressive and assertive responses, and yellow-orange-red escalation for verbal vs physical behaviour
• Strategies for keeping yourself safe, and reporting a professional concern (Behavioural Assessment Committee)
• Factors that make a gift appropriate or inappropriate, and MCNZ guidance on gifts and financial dealings
• Advantages and disadvantages of treating yourself or those close to you
• MCNZ guidance on treating those close to you, including situations where you must not
• Sexual boundaries: rules for current and former patients, and circumstances where a relationship is never acceptable
• Why sexual boundary breaches are harmful: power imbalance, trust, clinical judgement; Gabbard’s view in psychiatry
• Slippery slope of boundary crossings to violations, and professional supports and self-checks

L4 Patient Rights (30 Mar) L4 Prof Development Patient Rights

• Distinguish rights, legal rights, human rights and patient rights; sources of patient rights in NZ
• History of the Code: the “unfortunate experiment” at National Women’s Hospital, 1988 Committee of Inquiry, HDC Act 1994
• Structure of the Code, including the reasonable actions defence and where the onus lies
• The ten rights of the Code, and Rights 1 to 3 as the attitudinal umbrella
• Applying the Code to a case of inadequate follow-up of results and referral (Rights 4 and 6)
• HDC complaints process: preliminary assessment and four possible outcomes
• HDC statistics: volume, outcomes, most common complaint issues, and most frequently complained-about providers

L5 Suicide panel discussion (17 Apr) L5 Prof Development Suicide panel discussion

• Professional and ethical issues raised when a patient dies by suicide (Huntington’s disease and long-term psychiatric patient vignettes)
• Self-care strategies for doctors after a patient suicide
• Managing pressure and distress from family members after a patient suicide
• Support services available to medical students and doctors

L6 Privacy and Confidentiality (3 Jun) L6 Prof Development Privacy and Confidentiality

• Distinguish privacy from confidentiality, and the ethical principles underpinning them
• Professional sources of the duty of confidentiality: Hippocratic Oath, Declaration of Geneva, Code of Rights, MCNZ, medical student code of conduct
• Privacy Act 2020 and the Health Information Privacy Code: scope and who counts as a health agency
• The 13 rules of the Health Information Privacy Code
• Lawful use of health information (Rule 10) and examples of unauthorised access to records
• Lawful disclosure (Rule 11): permitted recipients, and exceptions where consent cannot or should not be obtained (serious threat, required by law)
• Examples of legally required disclosure: notifiable diseases, notifying the NZ Transport Agency about unsafe drivers

L7 Health of doctors (17 Jul) L7 Prof Development Health of doctors

• Scale of doctor impairment and the four Ds (depression, drugs, dimming, disruptive behaviour); doctor suicide rate
• Burnout: definition, onset, symptoms and associated work factors
• Compassion fatigue: definition as secondary traumatic stress, onset, emotional effects and symptoms; how it differs from burnout
• Personal characteristics that put doctors at risk, including maladaptive vs adaptive perfectionism
• Strategies for treating burnout and compassion fatigue
• Why doctors should not treat themselves or those close to them, and the expectation of having your own GP
• HPCAA 2003 section 45: duty to notify when a practitioner or student may be unable to perform due to a mental or physical condition, and protection from civil or disciplinary proceedings for notification

L8 Personal values in professional life (17 Jul) L8 Prof Development Personal values in professional life

• Distinguish personal values from professional values, and the values intrinsic to being a good doctor
• Giving a professional rather than personal recommendation when asked (Right 6), and the authority a doctor’s views carry
• Legitimate vs illegitimate reasons for refusing to care for a patient
• Why doctors should not impose personal beliefs such as religion on patients
• Conscientious objection: definition, conscience, and ethical debate about CO in healthcare
• Conscientious objection in NZ law, including the Abortion Legislation Act 2020 duties to inform and provide emergency care, and employer accommodation
• MCNZ Good Medical Practice guidance on personal beliefs and the patient

L9 Responding to suffering (changed 9_7) (24 Jul) L9 Prof Development Responding to suffering (changed 9_7)

• Personal health risks to doctors from exposure to suffering: impairment prevalence and the four Ds
• Burnout: definition and symptoms
• Compassion fatigue: definition, onset and effects
• Moral distress: definition and causes
• Identifying and responding to patient suffering, and coping with the distress it causes clinicians