The Medical Council of Hong Kong

PART III

A. Professional Responsibilities to Patients

Professional responsibilities to patients include essential basic responsibilities in professional relationship with patients, communication, use of drugs, financial arrangements, relationship with other practitioners and responsibilities in other special areas, in the course of clinical practice of a registered medical practitioner. Disregard of professional responsibilities may be taken as misconduct.

Practice falling below the standard expected of a registered medical practitioner would lead to professional review for remedial action and, if serious, disciplinary action.

1. Patient's privacy and confidentiality

1.1 Medical records

1.1.1 Medical records are notes including history, physical examination findings, investigation results and other relevant information maintained by medical practitioners on their patients. They encompass both written and electronically stored information.

1.1.2 The quality of medical records is a direct reflection on the quality of medical practice. To achieve and maintain a high standard of medical practice, proper medical documentation is essential. All doctors have a responsibility to maintain clear, accurate, adequate and contemporaneous medical records of their patients. Systematic record keeping helps in ensuring patients' problems are followed and properly looked after.

1.1.3 All medical records should be kept secure. This includes ensuring that unauthorized persons do not have access to the information contained in the records and that there are adequate procedures to prevent improper disclosure or amendment.

1.1.4 Doctors should be aware of the provisions of the Personal Data (Privacy) Ordinance (Cap. 486), and have due regard to their responsibilities and liabilities under that Ordinance. In particular they should be aware of the patient's rights of access to and correction of the information in the medical record and the circumstances when these rights may be refused.

1.2 Medical examinations and subsequential reporting

1.2.1 Whenever a doctor conducts a health check-up on a person there exists a doctor-patient relationship which should be respected at all times. The medical information should not be disclosed to a third party without the prior consent of the patient. If a consent is withdrawn, the doctor must respect this.

1.2.2 A doctor is advised to ensure that the patient fully understands what may be involved in furnishing a medical report and his contractual liabilities with the third party. A doctor should ensure that the patient understands his right of not giving consent to disclose certain part of his medical information.

1.3 Handling of medical record upon transfer or cessation of practice

1.3.1 It is the responsibility of the doctor who intends to stop practising medicine, either generally or in a particular area, to ensure that his patients' medical records are properly handled and preserved. This could be achieved either by giving the medical record or a copy of it to the relevant patient, if appropriate, or by transferring the record to another doctor who was, in his opinion, competent to look after the patient.

1.3.2
The patients should be made aware of the change of circumstances and the arrangements that have been made in respect of their medical records. Options that are available to the doctor who transfers or ceases practice include :-

making an individual announcement to each patient, whether in person or by written notification;

making a public announcement in the newspapers;

displaying notices in his office for the patients' attention.

1.3.3 The doctor who assumes custody of the medical records has a responsibility to inform the patient of the transfer of the record to him whether upon enquiry or upon the patient attending the practice. He must seek the patient's consent to his taking over the patient's medical care and his custody of the medical record. Before obtaining such consent, unless in the best interests of the patient, the succeeding doctor should not make reference to a patient's medical record under his custody.

1.3.4 A doctor who employs a locum doctor in his stead should display a notice to this effect inside the office and ensure that patients are informed about the change of doctor prior to any consultation.

1.4 Disclosure of medical information to third parties

1.4.1 A doctor should obtain consent from a patient before disclosure of medical information to a third party not involved in the medical referral.

1.4.2 In exceptional circumstances medical information about a patient may be disclosed to a third party without the patient's consent. Examples are: (i) where disclosure in the public interest or in the interests of an individual is justified because the failure to disclose the appropriate information would expose the patient, or someone else, to a risk of death or serious harm; (ii) when required by law to do so.

1.4.3 However, before making such a disclosure a doctor must weigh carefully the arguments for and against disclosure and be prepared to justify the decision. If in doubt, it would be wise to discuss the matter with an experienced colleague or to seek help from a medical defence society, a professional association or an ethics committee.

2. Consent

2.1 A medical practitioner should observe the following principles :-

Consent is part of quality care and also a legal requirement. Consent has to be informed and proper which means that patients should be properly informed about the general nature, effect and risk of medical procedures.
Consent is normally given by the patient himself or by a designated person under specific circumstances. When it is not possible for an otherwise competent patient to give consent, the views of the family members should be considered provided that such views are compatible with (i) the patient's best interests; and (ii) the patient's right of self-determination.
Consent should preferably be recorded in a document, although in law, a consent in written form is not absolutely necessary. The need for written consent becomes necessary under specific statutory provisions.
A patient has the right to refuse to give consent to treatment, provided that the patient is able to exercise his judgement clearly and freely. The refusal should be respected and preferably documented.

3. Untrue or misleading certificates and other professional documents

3.1 Medical practitioners are required to issue reports and certificates for a variety of purposes (e.g. insurance claim forms, receipts, medical reports, international vaccination certificates, incapacity to work through illness or injury certificates etc.) on the assumption that the truth of the certificates can be accepted without question. In some cases the certificates are required to include a statement that a patient has been examined on a particular date. Medical practitioners are expected to exercise care in issuing certificates and kindred documents, and should not include in them statements which the medical practitioner has not taken appropriate steps to verify. Any medical practitioner who in his professional capacity gives any certificate or similar document containing statements which are untrue, misleading or otherwise improper renders himself liable to disciplinary proceedings. In particular, medical practitioners are warned that the signing of blank certificates is prohibited by the Council.

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1.1.1	Medical records are notes including history, physical examination findings, investigation results and other relevant information maintained by medical practitioners on their patients. They encompass both written and electronically stored information.
1.1.2	The quality of medical records is a direct reflection on the quality of medical practice. To achieve and maintain a high standard of medical practice, proper medical documentation is essential. All doctors have a responsibility to maintain clear, accurate, adequate and contemporaneous medical records of their patients. Systematic record keeping helps in ensuring patients' problems are followed and properly looked after.
1.1.3	All medical records should be kept secure. This includes ensuring that unauthorized persons do not have access to the information contained in the records and that there are adequate procedures to prevent improper disclosure or amendment.
1.1.4	Doctors should be aware of the provisions of the Personal Data (Privacy) Ordinance (Cap. 486), and have due regard to their responsibilities and liabilities under that Ordinance. In particular they should be aware of the patient's rights of access to and correction of the information in the medical record and the circumstances when these rights may be refused.

1.2.1	Whenever a doctor conducts a health check-up on a person there exists a doctor-patient relationship which should be respected at all times. The medical information should not be disclosed to a third party without the prior consent of the patient. If a consent is withdrawn, the doctor must respect this.
1.2.2	A doctor is advised to ensure that the patient fully understands what may be involved in furnishing a medical report and his contractual liabilities with the third party. A doctor should ensure that the patient understands his right of not giving consent to disclose certain part of his medical information.

1.3.1	It is the responsibility of the doctor who intends to stop practising medicine, either generally or in a particular area, to ensure that his patients' medical records are properly handled and preserved. This could be achieved either by giving the medical record or a copy of it to the relevant patient, if appropriate, or by transferring the record to another doctor who was, in his opinion, competent to look after the patient.
1.3.2	The patients should be made aware of the change of circumstances and the arrangements that have been made in respect of their medical records. Options that are available to the doctor who transfers or ceases practice include :- making an individual announcement to each patient, whether in person or by written notification; making a public announcement in the newspapers; displaying notices in his office for the patients' attention.
1.3.3	The doctor who assumes custody of the medical records has a responsibility to inform the patient of the transfer of the record to him whether upon enquiry or upon the patient attending the practice. He must seek the patient's consent to his taking over the patient's medical care and his custody of the medical record. Before obtaining such consent, unless in the best interests of the patient, the succeeding doctor should not make reference to a patient's medical record under his custody.
1.3.4	A doctor who employs a locum doctor in his stead should display a notice to this effect inside the office and ensure that patients are informed about the change of doctor prior to any consultation.

1.4.1	A doctor should obtain consent from a patient before disclosure of medical information to a third party not involved in the medical referral.
1.4.2	In exceptional circumstances medical information about a patient may be disclosed to a third party without the patient's consent. Examples are: (i) where disclosure in the public interest or in the interests of an individual is justified because the failure to disclose the appropriate information would expose the patient, or someone else, to a risk of death or serious harm; (ii) when required by law to do so.
1.4.3	However, before making such a disclosure a doctor must weigh carefully the arguments for and against disclosure and be prepared to justify the decision. If in doubt, it would be wise to discuss the matter with an experienced colleague or to seek help from a medical defence society, a professional association or an ethics committee.