A medico-legal quick-start guide by Dr Udvitha Nandasoma (MDU Head of advisory services)

Overseas doctors and other healthcare professionals have made tremendous contribution to the NHS since it was established 75 years ago and the health service continues to depend on their skill and dedication.

The UK is a popular place to gain clinical experience and progress your career. However, it could take a while to acclimatise to your new working environment and you may find some things that are different in UK practice from where you have worked before. This is especially true of the ethical and regulatory framework.

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The NHS has developed an Induction Programme for IMGs but to help you get up to speed with the medico-legal essentials, the MDU has put together this quick-guide

Get up to speed with ethical and regulatory guidance

As the doctors’ regulator the GMC produces a wealth of guidance setting out their view of  good practice principles and professional standards. Good Medical Practice is the GMC’s core guidance document (a new version is out this year) and there are supporting documents covering important areas like consent, confidentiality, prescribing and treating children.

You don’t need to learn all the GMC guidance by heart but it’s worth reading and keeping up to date as this will help you manage your interactions with patients and colleagues. Meeting the GMC’s standards also makes you less likely to face a fitness to practise investigation.

Other guidance resources include the Royal Colleges, NICE, the Department of Health and NHS England.

Develop your communication skills

Communication is a common cause of complaint against doctors, of all backgrounds, especially in difficult interactions such as breaking bad news or where the patient is upset or angry. Effective communication skills will help you establish rapport with patients and build trust, making it easier to discuss potentially sensitive issues.

Actively considering advanced aspects of communications skill such as your tone of voice, body language and the terminology you use with patients, as well as paying attention to their signals, actively listening to what they are saying and not interrupting, can all help your day-to-day work and help avoid complaints.

Sign up to a communication skills course if you want to boost your strength and confidence in this area. Your employer should be able to arrange this, or you can check out the courses on offer from your medical defence organisation.  

Understand how to obtain informed consent and the principles of mental capacity.

In many parts of the world, what information a patient needed to give consent was a matter of professional judgment for their doctor. This used to be the case in the UK but now a patient-centred approach is enshrined in law and GMC ethical standards. That means doctors must first talk to patients and find out what matters to them so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives and ensure they have reached an informed decision.

Mental Capacity is a complex topic and you can find more information on how to assess mental capacity on our website. If a patient doesn’t have capacity, a decision must be made about what treatment is in their best interests, involving the treating doctors, those close to the patient or with legal responsibility such as the holder or a relevant power of attorney, and the patient (as far as possible). 

In the UK younger patients can also give consent – even under-16s – if they are sufficiently mature to understand what is involved and make a decision. For children who are not sufficiently mature, then authority would be needed from someone with parental responsibility.

Given the complexities, we recommend seeking specific advice from a senior colleague (and ultimately the hospital legal team) if you are unsure how to proceed. You can search for general consent guidance on the MDU website or sign up for our free webinar on Consent and decision-making (Tuesday 8 August 2023).

Respect patient confidentiality

Don’t assume that you can discuss the details of a patient’s care with their loved ones or pass information to someone not involved in their care, even if they are in authority.

In most cases, you need the patient’s consent to disclose any information or you risk losing their trust (and a complaint). The only exceptions are when you’re required to disclose information by law or under your ethical or contractual obligations, such as to comply with the coroner or to protect someone from harm.

In addition to the GMC, there is plenty of resources on confidentiality, including the NHS Code of Practice and the Government’s guidance for practitioners on safeguarding and information-sharing. You can also find an introduction to confidentiality principles on the MDU website.

Know when to offer a chaperone

It doesn’t matter what gender the patient is, you should routinely offer a chaperone before an intimate examination who should usually be a trained member of staff and ensure the patient has privacy as they undress.

It may also be sensible to offer a chaperone in other situations: some patients’ view of an intimate examination may extend to any examination where a doctor needs to touch or be very close to them; a few might refuse a chaperone altogether. You’ll only know by talking to them and using your professional judgement. Take care to document these discussions in the records. 

For more on this subject, read the GMC’s ethical guidance and the MDU’s guide to chaperones. Most employers will have a chaperones policy too.

Don’t let your guard down on social media

Social media can be an entertaining and informative resource, as long as you follow your employer’s social media policy and avoid the cyber-hazards that could jeopardise your professional registration and privacy.

The GMC’s guidance is clear that the standards expected of you don’t change because you are communicating online. It stressed the importance of maintaining professional boundaries, patient confidentiality, respect for colleagues and identifying yourself by name if you post as a doctor. 

At the same time, be cautious about how much personal information you reveal online and regularly check your privacy settings. When it comes to patient privacy, beware of jigsaw identification: this is where someone isn’t named but there is enough information in the public domain to identify them. For more information, read our guide to social media.

Be honest and open after an adverse incident

You have an ethical duty to tell patients when something has gone wrong, apologise and try to put things right but you also need to help your employer comply with its legal ‘duty of candour’ obligations following a notifiable patient safety incident, as set out in this guidance from the Care Quality Commission.

Depending on their role and seniority, a doctor’s involvement might include reporting the incident without delay through the employer’s reporting system; talking to the patient about what has happened, any possible effects and the need for further treatment; and cooperating with future investigation.

In our experience, doctors can get into real trouble if they don’t take enough care when writing a report for their employer or if they amend clinical records, even in an attempt to clarify what happened. To avoid making the situation worse, get advice and support as soon as a patient safety incident occurs.

Look after yourself

Being an NHS doctor has always been a high-pressure job but conditions have become more difficult in recent years amid growing waiting lists, acute staff shortages and workplace fatigue. You might also have to cope with problems outside work such as relationships, family, personal finances and health.

Feeling under constant stress can lead to health problems, including burnout and depression so it’s important that you are able to recognise the warning signs and seek support before you pose a risk to patients.

See your GP – the GMC requires you to register with one outside your family – or contact one of these health and wellbeing resources.

If in doubt, ask for help

Ask for help and support from senior and experienced colleagues when you feel out of your depth as this is better than struggling unsuccessfully to manage a difficult situation by yourself. Medical defence organisations provide independent and confidential medico-legal advice to members to help pre-empt difficulties. As well as our searchable guidance and advice, the MDU has a programme of free eLearning courses for members to help them navigate some of the trickier areas of medical practice such as responding to complaints, different aspects of confidentiality, learning from significant events and chaperones.

Join a medical defence organisation

You can turn to NHS indemnity in the event of a clinical negligence claim but not patient complaints, GMC referrals, ombudsman investigations, performers’ list actions, coroners’ inquests, media inquiries and criminal investigations that could put your career and livelihood at risk.

Joining one of the UK’s medical defence organisations gives you access to medico-legal advice, support and legal representation when you need it. Visit our website to find out more about the benefits of MDU membership.