• Good Occupational Medical Practice 2017
• Disclaimer

• Introduction Part 1
• Introduction Part 2
• Introduction Part 3
• Duties of a doctor
• Professionalism in action

• Develop and maintain your professional performance
• Apply knowledge and experience to practice Part 1
• Apply knowledge and experience to practice Part 2
• Apply knowledge and experience to practice Part 3
• Apply knowledge and experience to practice Part 4
• Apply knowledge and experience to practice Part 5
• Apply knowledge and experience to practice Part 6
• Apply knowledge and experience to practice Part 7
• Apply knowledge and experience to practice Part 8
• Record your work clearly, accurately and legibly

• Contribute to and comply with systems to protect patients
• Respond to risks to safety
• Protect patients and colleagues from and risk posed by your health
• Communicate effectively

• Work collaboratively with colleagues to maintain or improve patient care Part 1
• Work collaboratively with colleagues to maintain or improve patient care Part 2
• Work collaboratively with colleagues to maintain or improve patient care Part 3
• Work collaboratively with colleagues to maintain or improve patient care Part 4
• Work collaboratively with colleagues to maintain or improve patient care Part 5
• Work collaboratively with colleagues to maintain or improve patient care Part 6
• Teaching, training, supporting and assessing
• Continuity and coordination of care
• Establish and maintain partnerships with patients Part 1
• Establish and maintain partnerships with patients Part 2

• Show respect for patients

• Treat patients and colleagues fairly and without discrimination Part 1
• Treat patients and colleagues fairly and without discrimination Part 2
• Act with honesty and integrity Part 1
• Act with honesty and integrity Part 2
• Act with honesty and integrity Part 3
• Act with honesty and integrity Part 4
• Act with honesty and integrity Part 5

• Concluding remarks
• Acknowledgements

Apply knowledge and experience to practice Part 8

You should disclose only information relevant to the request for disclosure, which means you should not usually disclose a patient’s whole record. Exceptions to this general rule include benefit claims and litigation. A solicitor may need to see their client’s whole record to assess which parts are relevant, for example, to personal injury claims. If the claim goes ahead, the person the claim is made against may ask for copies of important documents, which could include records containing the patient’s medical history. Under court rules in England and Wales, they can see all the patient’s health records. The solicitor should explain this to the patient. In Scotland and Northern Ireland, you should disclose records in accordance with your patient’s wishes or as ordered by a court.

Consent (extracts from ‘Consent: patients and doctors making decisions together’ (2008))

For a relationship between doctor and patient to be effective, it should be a partnership based on openness, trust and good communication. Each person has a role to play in making decisions ….

You must work on the presumption that every adult patient has the capacity to make decisions about their care, and to decide whether to agree to, or refuse, an examination, investigation or treatment… No one else can make a decision on behalf of an adult who has capacity. If a patient asks you to make decisions on their behalf or wants to leave decisions to [others] close to them, you should explain that it is still important that they understand the options open to them …

How much information you share with patients will vary, depending on their individual circumstances. You should tailor your approach… You should explore matters with patients, listen to their concerns, ask for and respect their views, and encourage them to ask questions. …You must answer patients’ questions honestly and, as far as practical, answer as fully as they wish…. …. You must make it clear that they can change their mind about a decision at any time…  You should give information to patients in a balanced way… you must not put pressure on a patient to accept your advice. …Before accepting a patient’s consent, you must consider whether they have been given the information they want or need, and how well they understand the details and implications of what is proposed.

You should check whether the patient needs any additional support to understand information, to communicate their wishes, or to make a decision. You should bear in mind that some barriers to understanding and communication may not be obvious… You should accommodate a patient’s wishes if they want another person…to be involved in discussions or to help them make decisions.

You must explain clearly to patients the scope of any decisions to be made. …You should establish whether the patient agrees to all or only parts of the proposed plan. You must not exceed the scope of the authority given by a patient, except in an emergency.

Clear, accurate information about the risks of any proposed investigation or treatment, presented in a way patients can understand, can help them make informed decisions… you must identify the adverse outcomes that may result from the proposed options. This includes the potential outcome of taking no action. You must tell patients if an investigation or treatment might result in a serious adverse outcome, even if the likelihood is very small. You must give information about risk in a balanced way. You must use clear, simple and consistent language when discussing risks with patients. You should be aware that patients may understand information about risk differently from you. You should check that the patient understands the terms that you use…

Patients may be put under pressure by employers, insurers, relatives or others, to accept a particular investigation or treatment. You should be aware of this and of other situations in which patients may be vulnerable… You should do your best to make sure that such patients have considered the available options and reached their own decision.

Patients can give consent orally or in writing, or they may imply consent by complying with the proposed examination or treatment… In cases that involve higher risk, it is important that you get the patient’s written consent. This is so that everyone involved understands what was explained and agreed. You should also get written consent from a patient if… there may be significant consequences for the patient’s employment, or social or personal life.

Occupational physicians should discuss clearly with their patients the possible impact on their employment circumstances of an agreed action plan or agreed report (also, the possible impact of taking no action). They should not collude with employers to put inappropriate pressure on their patients to pursue or accept a given course of action.

15. You must make good use of the resources available to you.^1.