Publications and guidance

Individual Responsibilities – A Guide to Good Medical Practice for Radiologists

Ref No: BFCR(04)2

Individual Responsibilities

– A Guide to Good Medical Practice for Clinical Radiologists

---

The Royal College of Radiologists

38 Portland Place

London W1B 1JQ

 

Telephone 020 7636 4432

Fax 020 7323 3100

 

Citation details:

Faculty of Clinical Radiology

The Royal College of Radiologists (2004)

Individual Responsibilities – A Guide to Good Medical Practice for Clinical Radiologists

Royal College of Radiologists, London.

Email: enquiries@rcr.ac.uk

 

On publication this document will be made available on the College’s web site: http://www.rcr.ac.uk

 

ISBN 1872599 93 1

RCR Ref No BFCR(04)2

 

© The Royal College of Radiologists, May 2004

 

This Publication is Copyright under the Berne Convention and the International Copyright Convention.

All rights reserved.

 

This booklet was prepared and published on behalf of the Royal College of Radiologists (RCR). Whilst every attempt has been made to provide accurate and useful information, neither the RCR, the members and Fellows of the RCR nor other persons contributing to the formation of the booklet make any warranty, express or implied, with regard to accuracy, omissions and usefulness of the information contained herein. Furthermore, the same parties do not assume any liability with respect to the use, or subsequent damages resulting from the use of the information contained in the booklet.

---

Contents

          Foreword

1        Introduction

2        Professional Competence

          2.1        Outline

          2.2        Risk management – maintaining standards for 24-hour radiological services

          2.3        Adverse reactions

          2.4        Delegation

3        Professional Relationships

          3.1        Effective team working

          3.2        Consent

4        Maintaining Good Clinical Practic

          4.1        Continuing professional development

          4.2        Governance

5        Probity

          5.1        Service provision

          5.2        Financial issues

          5.3        Research

6        Teaching and Training, Appraisal and Assessin

          6.1        Developing appropriate skills

          6.2        Appraising appropriate skills

7        Health

          Reference

---

Foreword

Revalidation is a process that ensures that an individual doctor’s performance meets national professional standards. This document, Individual Responsibilities – A Guide to Good Medical Practice for Clinical Radiologists, highlights individual responsibilities that underpin revalidation of clinical radiologists, based on the guidance in the General Medical Council’s Good Medical Practice.¹ It supports but does not supplant GMC guidance, and similarly builds on, but does not replace, the RCR 1999 document A Good Practice Guide for Clinical Radiologists.²

The task of defining good practice and unacceptable practice in a medical specialty is a challenging one. Precisely how does one demonstrate that a clinical radiologist’s clinical skills are everything they should be? How can we determine that a colleague’s performance or behaviour is unacceptable? There can be no single measure or yardstick to answer these questions, but this document outlines a number of criteria against which practice may be compared. The judicious use of the criteria, it is hoped, will assist clinical radiologists and those in training to assess their professional activities. This process will contribute to the maintenance of the high professional standards our patients expect and deserve.

The professionalism of the clinical radiologist must be founded on the possession of scientific and technical knowledge and skills, as well as clear ethical values and standards. This document reflects these different aspects of the role of a clinical radiologist and highlights the duty of care that all doctors owe patients.

I am grateful to Dr Rob Manns for his work in preparing this document, to the Standards Sub-committee, under the chairmanship of Dr Jane Adam, for their comments, and to the members and Fellows who participated in the consultative process.

 

Dr Paul Dubbins

Dean of the Faculty of Clinical Radiology

Vice President of the College

---

1       Introduction

1.1      The General Medical Council (GMC) requires clinical radiologists to provide evidence of good radiology practice for revalidation. This requirement is shared by the Department of Health and Trusts as part of the annual appraisal process. Revalidation with the GMC will be based upon this appraisal process to demonstrate that doctors have maintained and developed their clinical skills since the previous revalidation episode. It is likely that revalidation will occur on a 5-yearly basis. The GMC envisages that the provision of evidence to support revalidation should be based on the duties of a doctor outlined in its’ document Good Medical Practice¹ (see Table 1).

Patients must be able to trust doctors with their lives and well being. To justify that trust, we as a profession have a duty to maintain a good standard of practice and care and to show respect for human life. In particular as a doctor you must:

• make the care of your patient your first concern
• treat every patient and their family politely and considerately
• respect patients’ dignity and privacy
• listen to patients and respect their views
• give patients information in a way they can understand
• respect the rights of patients to be fully involved in decisions about their care
• keep your professional knowledge and skills up to date
• recognise the limits of your professional competence
• be honest and trustworthy
• respect and protect confidential information
• make sure that your personal beliefs do not prejudice your patients’ care
• act quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practice
• avoid abusing your position as a doctor
• work with colleagues in the ways that best serve patients’ interests
• in all these matters you must never discriminate unfairly against your patients, their families or colleagues. You must always be prepared to justify your actions to them

Good Medical Practice, GMC, 2001.¹

1.2      Using the GMC publication¹ as a framework, this document describes a number of the principles of good radiological practice and standards of competence, care and conduct expected of clinical radiologists in aspects of their professional work. It sets key parts of the GMC guidance for all medical specialties in the context of radiological practice, highlights some of the key individual responsibilities and provides some examples of the ways in which evidence of good practice can be produced for appraisal and revalidation. It does not, however, provide an exclusive or exhaustive list covering all forms of professional practice within radiology, and all clinical radiologists are referred to the GMC document¹ for the full summary of responsibilities. A clinical radiologist must always be prepared to explain and justify his/her actions and decisions. Reference should be made to the full GMC document to inform judgement and obtain further guidance.

1.3      Ensuring patient care is central to the GMC guidance. Clinical radiologists should at all times consider what patients expect from them. In outline, this is to act in the best interests of the patient and to involve them in any decisions regarding their investigation and/or treatment. This means that the clinical radiologist should:

• be clinically competent and up to date
• listen to the patient
• respect the patient’s views
• treat the patient with kindness and consideration
• explain things clearly
• give advice without being patronising
• be honest and keep the patient’s secrets safe
• have integrity and the confidence to admit to fallibility.

1.4      For most diagnostic radiologists, investigation is more likely than treatment to be the common interaction with patients. This is obviously not the case for interventional radiologists. There are therefore several different aspects of our individual responsibilities to consider, and these are discussed in the present document, within the framework outlined by the GMC,¹ in six broad areas:

• Professional competence.
• Professional relationships.
• Maintaining good clinical practice.
• Probity.
• Teaching and training, appraisal and assessing.
• Health.

1.5      The following sections of this document:

(i)    discuss issues relating to the individual responsibilities for clinical radiologists in the six broad areas set out in Section 1.4 (above); and

(ii)    provide examples of the ways in which good radiological practice in those broad areas can be achieved, and the ways individual clinical radiologists can document their achievements to provide evidence for use in the appraisal and revalidation processes.

---

2       Professional Competence

2.1      Outline

A doctor’s first duty of care is to his/her patient. To fulfil this duty, clinical radiologists require detailed up-to-date knowledge in specialist and sub-specialty areas appropriate to the fields of clinical radiology in which they practice. There is a further requirement for clinical radiologists to discuss cases with and make appropriate referral of clinical problems to their radiological colleagues, referring clinicians and/or specialist doctors as appropriate, when needed, to ensure
that the individual patient receives the best available radiological care (Table 2).

Good Practice	Evidence
Clinical radiologists will audit their practice  against nationally agreed standards where these  are available. Guidelines for radiological practice will be established by special interest groups on  a national and local level.	Clinical radiologists should be able to demonstrate where their practice lies relative to the national/local guidelines and standards.
Within their departments, clinical radiologists  will be taking part in clinical governance schemes such as risk assessment, clinical  incident reporting, patient surveys,   discrepancy meetings or 360-degree appraisal.	Written evidence of such activity should be available, including details and evidence of change in practice as a result of participation. Clinical radiologists who are not participating in such schemes should demonstrate the reasons for this.

2.2      Risk management – maintaining standards for 24-hour radiological services

2.2.1    The need to work within the limits of professional competence is particularly relevant to out-of-hours work but applies equally to any examination or intervention undertaken during routine working, extended working hours or in an on-call emergency situation. As a consequence of progressive sub-specialisation by clinical radiologists, few will have a complete range of current skills and experience across all areas of radiological practice. Clinical radiologists should normally undertake only those procedures that they (i) have previous experience of and (ii) are competent to perform. Within the local radiological team, on-call arrangements should reflect the range of the individual interests and abilities of radiological staff.

2.2.2   In emergencies, individual clinical radiologists may be required to perform examinations or procedures outside their own specialist areas in the best interests of a patient. Such emergency case management must be undertaken when the patient’s condition demands immediate action in the form of imaging or radiological intervention. When such events occur it is important to have documented that appropriate discussion has taken place with referring clinicians and with the patient and/or the patient’s immediate family or other carers to explain and justify the actions taken. Planning for emergency radiological examinations and/or interventions should involve all of the clinical radiologists within a department. Management responsibility for such activities should be held by a named clinical radiologist, most often the clinical director. The availability of essential support staff for emergency examinations/procedures is critical in the decision making process and for carrying out the procedures.

2.2.3    The duty of the individual clinical radiologist is to the patient and therefore to make the most appropriate decision for their investigation and/or management.

2.2.4    Clinical radiologists should have an open and largely blame-free culture which encourages the reporting and discussion of adverse incidents.

2.3      Adverse reactions

Clinical radiologists have a responsibility to their patients to ensure that reasonable precautions are taken to identify and deal effectively with possible adverse reactions, particularly reactions to intravenous (i.v.) contrast agents. Such adverse events must be managed quickly and effectively. With the delegation of contrast injections to other members of staff an appropriate response to an adverse reaction requires careful planning and training to ensure satisfactory performance.

2.4  Delegation

Delegation of tasks and responsibilities such as those associated with the administration of i.v. contrast agents requires precise definition of the roles of the individuals concerned and conscientious training and monitoring. Clinical radiologists, both individually and collectively, are responsible for agreeing appropriate and effective protocols and guidelines on the clinical practices and procedures which lead to safe and useful examinations within their departments.

---

3       Professional Relationships

Clinical radiologists need to gain and maintain the respect of their patients, radiological colleagues, clinical colleagues and the other members of staff within their department and hospital. This respect will stem from their demonstration of professional competence, and from their personal attitude, manner and approach in professional relationships (Table 3).

Good Practice	Evidence
To deliver the best quality care to patients,  clinical radiologists often work in multi-disciplinary and multi-professional teams. Effective communication skills, mutual respect and a willingness to engage other professional views and contributions should be apparent.	Documented surveys of colleagues’ opinions, for example, as carried out in 360-degree appraisal, would provide evidence of an individual’s  professional relationships. This evidence, if available, should be included in the appraisal portfolio. If there are significant concerns identified from such evidence then appropriate courses of action to improve in these areas should be outlined.

3.1  Effective team working

The skills of the individual clinical radiologist must be appropriate to the task undertaken. A consequence of increasing sub-specialisation within clinical radiology is that all clinical radiologists will have particular skills, but these will not necessarily cover all areas of radiological practice.

Within most departments of clinical radiology, there will be a number of clinical radiologists sharing a range of interests and skills. In providing care, clinical radiologists must recognise and work within the limits of their professional competence. This requires a need for frequent and prompt discussion of clinical problems with radiological colleagues. An experienced clinical radiologist should be able to offer support and guidance to other clinical radiologists. Younger more recently trained consultant colleagues and specialist registrars also can offer advice and knowledge to more senior clinical radiologists.

The ultimate aim should be for high quality patient care in a supportive learning environment. The aim of the team should be to harness strengths and reduce the effects of weaknesses to the benefit of all of the patients who are referred to the team. Ineffective team working must never be permitted to compromise patient care.

3.2      Consent

Successful relationships between doctor and patient are built upon mutual trust and respect. A clinical radiologist must respect patients’ autonomy and their right to make decisions about their own health care. Patients must be given timely information in a way that they can understand in order to make informed decisions about their care. Effective communication is the key to enabling patients to make such decisions.

Information about risk and potential benefit is particularly important for interventional radiological procedures with high risk of morbidity and mortality. Techniques involving high radiation doses also require frank and open consultation with patients. The possible use of imaging modalities not involving ionising radiation should always be explored with patients.

---

4       Maintaining Good Clinical Practice

Clinical radiologists have a duty to keep their knowledge and skills up to date throughout their professional working life. By participating in continuing professional development (CPD) and audit, clinical radiologists should maintain and improve their clinical skills and competence (Table 4).

Good Practice	Evidence
Regular review of educational needs should be  undertaken and CPD directed to these needs.	Documentary evidence of the minimum required CPD hours of approved activity (50 CPD points/year)  should be available with relevant details. This CPD  should be directed to appropriate general and  specialist areas of interest.
Audit activity of general and specialist areas of interest to the individual clinical radiologist should be undertaken.	Documentation of this activity together with evidence of appropriate change in clinical practice as a result of this activity should be available.

4.1  Continuing professional development

CPD should occur both within the local clinical environment and through educational activities such as clinical meetings and clinical experience outside of the local environment. Lifelong learning and CPD are the inevitable requirements resulting from the rapid and continuing development in virtually all aspects of diagnostic and interventional radiology and the science and technology that underpins the specialty. A willingness to bring personal teaching and learning experiences back to the department for the utility of all within the department should be encouraged and undertaken personally.

CPD should also encompass maintaining the relevant and appropriate skills needed to take part in the departmental on-call rota and to deal with common emergency clinical situations, as well as acquiring skills in teaching and training, management and research.

4.2  Governance

Clinical radiologists likewise must work with colleagues to monitor, maintain and improve the quality of patient care provided. This includes actively participating in regular professional assessment and peer review, and full compliance with processes of clinical governance. In particular, these activities may include participation in:

• regular and systematic local and national audits of clinical practice
• clinical incident reporting
• risk assessment processes
• validated patient surveys
• peer review schemes
• review of complaints
• discrepancy meetings
• departmental quality and patient care.

The above activities may indeed require personal involvement and co-operation with the other clinical radiologists and health professionals in the radiology department, or from elsewhere within the Trust and/or external bodies.

---

5       Probity

All doctors must be honest and accurate in their practice (Table 5).

Good Practice	Evidence
Clinical radiologists should comply with relevant guidance from the GMC, the Royal College of Radiologists and other respected bodies including local Trust policies.	Declaration of any commercial or financial interests should be made to the Trust. 360-degree appraisal will document evidence of peer acknowledgement of good practice.
Research activities will have appropriate ethics committee approval and local Trust policies should be observed.	Relevant documentation of such.

5.1      Service provision

Clinical radiologists’ performance of and reports on radiological examinations should be timely and accurate. If there are deficiencies in local service provision which prevent good clinical radiological practice then it is the duty of clinical radiologists, both individually and collectively, usually via the local clinical director, to highlight these concerns to the local Trust management and to monitor the response.

5.2  Financial issues

Discriminatory or financial considerations should never alter the way clinical radiologists provide care for their patients. Clinical radiologists should declare to their Trust any financial or commercial interests which might influence their practice.

A clinical radiologist should provide the same high quality of care to both National Health Service and private patients. Clinical radiologists should never exploit patients for financial gain.

5.3      Research

Ethical committee approval must be obtained for research activities. The care and safety of patients must come first and never be compromised. Appropriate arrangements for fully informed consent for research procedures must be made.

---

6       Teaching and Training, Appraisal and Assessing

All clinical radiologists will be involved in the education and training of a wide and varied number of staff within their workplace. All clinical radiologists have an obligation to contribute to the education and training of other doctors, medical students and non-medical health care professionals on their team. Every clinical radiologist should be prepared to oversee the work of less experienced colleagues, and must make sure that students and junior doctors are properly supervised (Table 6).

Good Practice	Evidence
Clinical radiologists who undertake the education  and training of undergraduates, junior medical  staff and other health care professionals should  have completed appropriate training. They should evaluate the effectiveness of their teaching.	There should be documented evidence of  attendance at recognised training courses and details of teaching/training undertaken by the clinical radiologist. Feedback on these teaching sessions should be available within the personal portfolio.
Appraisal of clinical colleagues should have been undertaken after appropriate training with relevant documentation.	Attendance at an approved appraisal training course with certification. After a period of time evidence of the skills of the appraiser should become available from the individuals previously appraised.

6.1  Developing appropriate skills

There is a requirement to develop the skills and attitudes that enable effective communication in teaching and learning experiences. Personal appraisal and assessment of these skills and attitudes should be undertaken. 360-degree appraisal will aid in this process. Informal teaching is an integral part of clinical radiological practice and its importance and value should not be underestimated in any appraisal or assessment process of an individual clinical radiologist.

6.2  Appraising appropriate skills

When assessing, appraising and/or providing references for other colleagues, clinical radiologists should be objective and honest. To affirm competence inappropriately may put patients at risk, and may prevent the individual from recognising personal educational and professional development needs.

Appraisal should be undertaken in a constructive and supportive manner. Its main purpose is to identify educational needs and areas for specific action for the individual.

---

7       Health

Clinical radiologists need, as do all medical practitioners, to ensure that that their own physical and mental health does not put patients or colleagues at risk. Asking for support, for instance, when under great stress should be seen as a mature and appropriate response to the problem. Local radiological and other clinical colleagues are often well placed to provide at least initial guidance (Table 7).

Good Practice	Evidence
Clinical radiologists must ensure that their own  health does not put patients or colleagues at risk.	Documentary evidence of local employer’s standards of occupational health care being met, e.g. Hepatitis B status. 360-degree appraisal will again support this evidence.

 

Approved by the Board of the Faculty of Clinical Radiology: 31 October 2003

Approved by Council: 21 November 2003

BFCR(04)2

---

References

1    The General Medical Council (2001) Good Medical Practice. London: The General Medical Council

2    The Royal College of Radiologists (1999) Good Practice Guide for Clinical Radiologists. London: The Royal College of Radiologists

Return to Publications list