Are doctors allowed to discuss their personal beliefs with
patients or enquire about their patients’ beliefs?
If so, in what
circumstances?
The General Medical Council’s long-awaited revised guidance
on ‘Personal
Beliefs and Medical Practice’, published yesterday, attempts to answer these
questions.
It shows there is still scope for doctors to share their personal
beliefs within the medical consultation provided certain ground rules are
followed.
The guidance also welcomes sensitive exploration of a patient’s own beliefs, as part of history-taking, provided that they are relevant to the presenting medical problem.
The guidance also welcomes sensitive exploration of a patient’s own beliefs, as part of history-taking, provided that they are relevant to the presenting medical problem.
The new guidance has been issued
with nine
other sets of guidance on a range of issues alongside the revision of the
GMC’s core guidance to doctors, ‘Good
Medical Practice’.
All of these documents have been subject to a consultation process and I was particularly struck by how much the text has changed from the consultation draft (see below) presumably as a result of people’s feedback (See my previous articles here and here).
All of these documents have been subject to a consultation process and I was particularly struck by how much the text has changed from the consultation draft (see below) presumably as a result of people’s feedback (See my previous articles here and here).
The new (2013) edition of ‘Personal
Beliefs and Medical Practice’ comes into effect on 22 April and replaces
the first
(2008) edition. It also deals with the issue of conscientious objection
which I will come back to in a later blog.
Like its forerunner, the new 2013 version recognises that:
‘personal beliefs and
cultural practices are central in the lives of doctors and patients, and that
all doctors have personal values that affect their day-to-day practice’
This helpfully give short shrift to the myth, held by some hard-line
secularists, that only people who subscribe to a specific religious faith have
‘beliefs’ and ‘values’ and that atheists, by contrast, live their lives in a
way that is belief and value free. The
reality is very different. Everyone has a worldview
– a set of basic beliefs about the nature of reality – that profoundly affects
how they think and act. This is a good starting point.
Also, like the 2008 original, the new 2013 version
underlines the fact that personal beliefs need to be expressed in a way that is
sensitive and appropriate.
‘You must not express
your personal beliefs (including political, religious or moral beliefs) to
patients in ways that exploit their vulnerability or that are likely to cause
them distress.’
This is foundational. All doctors are, to some extent, in a
position of power over their patients who often come to them at times of great
need and crisis. I can’t see anyone wanting to disagree with this.
Absent this time, however, is any explicit statement that
knowing about a patient’s beliefs can be an important in addressing their
clinical problems. The following statement from the original 2008 edition has
now been removed:
‘For some patients,
acknowledging their beliefs or religious practices may be an important aspect
of a holistic approach to their care. Discussing personal beliefs may, when
approached sensitively, help you to work in partnership with patients to
address their particular treatment needs. You must respect patients’ right to
hold religious or other beliefs and should take those beliefs into account
where they may be relevant to treatment options.’
There is however additional text this time which partially
compensates for this omission by stressing the importance of spiritual factors
in history-taking:
‘In assessing a
patient’s conditions and taking a history, you should take account of
spiritual, religious, social and cultural factors, as well as their clinical
history and symptoms (see Good medical practice paragraph 15a). It may
therefore be appropriate to ask a patient about their personal beliefs.’
The 2008 guidance made it clear that ‘if patients do not
wish to discuss their personal beliefs with you, you must respect their wishes’
and enlarged on this at some length:
‘You should not
normally discuss your personal beliefs with patients unless those beliefs are
directly relevant to the patient’s care. You must not impose your beliefs on
patients, or cause distress by the inappropriate or insensitive expression of
religious, political or other beliefs or views. Equally, you must not put
pressure on patients to discuss or justify their beliefs (or the absence of
them).’
These last two sentences in this paragraph are reproduced
almost verbatim in the 2013 guidance, but more care is taken to unpack the
first sentence giving still, I think, scope for mutually welcomed discussion of
personal beliefs:
‘During a
consultation, you should keep the discussion relevant to the patient’s care and
treatment. If you disclose any personal information to a patient, including
talking to a patient about personal beliefs, you must be very careful not to
breach the professional boundary that exists between you… You may talk about
your own personal beliefs only if a patient asks you directly about them, or
indicates they would welcome such a discussion. You must not impose your
beliefs and values on patients, or cause distress by the inappropriate or
insensitive expression of them.’
So the key question is – ‘Has the patient either raised the
issue or indicated that they would welcome such a discussion?’ I don’t imagine
any GP with good interpersonal skills will have much difficulty reading verbal
and/or non-verbal cues to determine a clear answer to that in any given case.
Christian doctors recognise that people’s beliefs and life
choices do impact health significantly and there is a growing
literature that recognises a positive correlation between Christian faith
and health.
They will therefore not wish to exclude the possibility of discussing
personal beliefs and values with patients provided this is welcomed, is
relevant to the consultation and can be done with sensitivity, permission and
respect.
They will rather see it in the context of building a
relationship, practising holistic care, or as part of the normal social
intercourse that may take place within any other professional/client or
tradesman/customer interaction.
In other words, if you can talk to a taxi driver, hairdresser or builder about politics, morality or religion, then why should you be prevented from doing the same with your doctor if you are both up for it and have the time?
In other words, if you can talk to a taxi driver, hairdresser or builder about politics, morality or religion, then why should you be prevented from doing the same with your doctor if you are both up for it and have the time?
Good doctors will recognise when such discussions are
appropriate and will be sensitive about professional boundaries.
Of course, the real test of the new guidelines will be the
way they are interpreted and applied in practice by the GMC itself. Will we see
them applied with wisdom, discretion, flexibility and tact, or will they be
used as a stick to police and beat doctors with? I hope it will be the former.
Christian doctors need to be to continue to be as innocent
as doves and wise as serpents: innocent as doves because we are in a position
of power and patients can be needy and vulnerable, and wise as serpents because
there are those who would like to stop all faith-related discussions in the
medical consultation and others who will be only too willing to provide the
vexatious complaints.
But this is by no means a one-way street.
Secularist doctors who reveal their own anti-religious
prejudices, or who express their political or moral views in a way that
exploits vulnerability, causes distress or is otherwise inappropriate need to
realise that they too may be equally running the risk of censure, or worse.
Full wording of the
2008, 2012 and 2013 versions on discussing personal beliefs
9 For some patients,
acknowledging their beliefs or religious practices may be an important aspect
of a holistic approach to their care. Discussing personal beliefs may, when
approached sensitively, help you to work in partnership with patients to
address their particular treatment needs. You must respect patients’ right to
hold religious or other beliefs and should take those beliefs into account
where they may be relevant to treatment options. However, if patients do not
wish to discuss their personal beliefs with you, you must respect their wishes.
19 You should not
normally discuss your personal beliefs with patients unless those beliefs are
directly relevant to the patient’s care. You must not impose your beliefs on
patients, or cause distress by the inappropriate or insensitive expression of
religious, political or other beliefs or views. Equally, you must not put
pressure on patients to discuss or justify their beliefs (or the absence of
them).
12 In assessing a
patient’s conditions, it may be appropriate to ask them about their personal
beliefs. However you must not put pressure on patients to discuss or justify
their beliefs, or the absence of them.
13 During a patient
consultation, you may talk about your own personal beliefs only if a patient
asks you directly about them or if you have reason to believe† the patient
would welcome such a discussion. You must not impose your beliefs and values on
patients, or cause distress by the inappropriate or insensitive expression of
them. You should keep the discussion relevant to the patient’s care and
treatment and, as with disclosing any personal information to a patient, you
must be very careful not to breach the professional boundary‡ that exists
between you, and must continue to exist if trust is to be maintained.
29 In assessing a patient’s
conditions and taking a history, you should take account of spiritual,
religious, social and cultural factors, as well as their clinical history and
symptoms (see Good medical practice paragraph 15a). It may therefore be
appropriate to ask a patient about their personal beliefs. However, you must
not put pressure on a patient to discuss or justify their beliefs, or the
absence of them.
30 During a
consultation, you should keep the discussion relevant to the patient’s care and
treatment. If you disclose any personal information to a patient, including
talking to a patient about personal beliefs, you must be very careful not to breach
the professional boundary that exists between you. These boundaries are
essential to maintaining a relationship of trust between a doctor and a
patient.
31 You may talk about
your own personal beliefs only if a patient asks you directly about them, or
indicates they would welcome such a discussion. You must not impose your
beliefs and values on patients, or cause distress by the inappropriate or insensitive
expression of them.
Changes between
consultation draft (2012) and final (2013) edition (tracked below)
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