PART III

B. Communication in Professional Practice

4. Communication in professional practice

4.1 The need for good communication and information

4.1.1  Good communication between doctors and patients, and between doctors, is fundamental to the provision of good patient care.
4.1.2  A key aspect of good communication in professional practice is to provide appropriate information to users of a doctor's service and to enable those who need such information to have ready access to it. Patients need such information in order to make an informed choice of medical practitioner and to make the best use of the services the medical practitioner offers. Doctors, for their part, need information about the services of their professional colleagues. Medical practitioners in particular need information about specialist services so that they may advise patients and refer them, where appropriate, for further investigations and/or treatment.
4.1.3  Persons seeking medical attention for themselves or their families can nevertheless be particularly vulnerable to persuasive influence, and patients are entitled to protection from misleading advertisements. Practice promotion of doctors' medical services as if the provision of medical care were no more than a commercial activity is likely both to undermine public trust in the medical profession and, over time, to diminish the standard of medical care.

4.2 Principles and rules of good communication and information

4.2.1 

Information refers to information of any forms, computer-related information, internet modalities, telemedicine related items and any other forms of electronic transmission. Any information provided by a doctor to the public or a patient :-

  1. shall be legal, decent, honest, truthful, factual, accurate, and not exaggerated; and
  2. shall not claim superiority over or disparage other doctors or their work.
4.2.2  Practice promotion
4.2.2.1  Practice promotion means the promotion of a doctor, his work, his practice or his group, by himself or others, and includes the provision of information, advertising and publicising to both the public and patients. Self advertisement, canvassing or publicity to enhance or promote a professional reputation for the purpose of attracting patients would constitute professional misconduct.
4.2.2.2  Practice promotion by individual practitioners, or by anybody acting on their behalf or with their forbearance, on people who are not their patients is not permitted except to the extent permitted by paragraph 4.2.3.
4.2.3  Dissemination of information about professional services to the public

A doctor, whether in private or public service, may provide information about his professional services to the public only in the following ways :-

4.2.3.1  Signs

A doctor may exhibit in connection with his practice any sign which, in relation to its nature, position, size and wording, is reasonably necessary to indicate the location of, and entrance to the premises concerned.

Signboards

The word 'signboard' includes any composite notice(s) exhibited by a registered medical practitioner to identify his practice to the public.

Not more than two signboards may be exhibited and only on the premises at which the practice to which they refer is conducted. They should not be ornate or illuminated (except at night or where situated in a dark place). Any such illumination must be the minimum necessary to allow the content to be read and must not flash. Details of permitted sizes and measurements are given in Appendix A.

The only particulars which may appear on signboards are :-
  1. The name of the registered medical practitioner (or the name by which the practice is known), in Chinese and English, with the prefix Dr. (西醫) or the Chinese suffix "醫生 "or "醫師" .
  2. The term "registered medical practitioner" (註冊醫生或註冊西醫).
  3. Qualifications recognized by the Council in the approved Chinese and English abbreviated forms.
  4. An indication of the location in the building of the medical practitioner's office.
  5. The hours of attendance at such office
  6. The specialist title as approved by the Medical Council.
4.2.3.2  Stationery

Stationery (visiting cards, letterheads, envelopes, prescription slips, notices etc.) may carry the following information :-
  1. the practitioner's name, and (where appropriate) the name of the partnership, and the names of partners, assistants or associates in the practice;
  2. specialist title, qualifications and appointments approved by the Council in their Chinese and English forms;
  3. address(es) of the practice;
  4. telephone, fax, pager numbers, e-mail address; and
  5. consultation hours.
4.2.3.3  Announcements by media

Commencement and Altered Conditions of Practice

Announcements of commencement of practice or altered conditions of practice (e.g. change of address, partnership etc.) are permissible only in newspapers provided that all announcements are completed within two weeks of the commencement/change taking place AND comply with paragraph 4.2.1 of this Code. The size of the announcement must not exceed 100cm2 and the announcement may contain only the information specified in paragraph 4.2.3.2 together with the date of the commencement or alteration of the conditions of practice. Examples of permitted announcements are given in Appendix B.

Similar announcement via other media including printing, mailing, broadcasting and electronic means is not permitted. Photographs are not allowed.

Other announcements

Letters of gratitude or announcements of appreciation from grateful patients or related persons identifying the practitioner concerned should not be published in the media or made available to members of the public. A practitioner should take all practical steps to discourage any such publications.
4.2.3.4  Telephone directories
Telephone directory entries may be listed under the appropriate descriptive title e.g. medical practitioners, physicians and surgeons. Doctors registered under the Specialist Register of the Medical Council may have their names listed under the appropriate specialty.

Telephone directory entries should only carry the following information :-
  1. the practitioner's name, and (where appropriate) the name of the partnership, and the names of partners, assistants or associates in the practice;
  2. specialist title, qualifications and appointments approved by the Council in their Chinese and English forms;
  3. address(es) of the practice;
  4. telephone, fax, pager numbers, e-mail address; and
  5. consultation hours.

The characters of all the entries should be uniform, i.e. of the same size, not bold-type, and not in italic etc.
4.2.3.5 Internet homepages

4.2.3.5.1 Doctor's practice homepage

An internet homepage may carry only the following information in relation to the practice : -

    1. the practitioner's name, and (where appropriate) the name of the partnership, and the names of partners, assistants or associates in the practice;
    2. specialist title, qualifications and appointments approved by the Council in their Chinese and English forms;
    3. address(es) of the practice;
    4. telephone, fax, pager numbers, e-mail address; and
    5. consultation hours.
No other information should be included.
4.2.3.5.2 Other homepages

Other homepages should observe the principles laid down under paragraph 4.
4.2.4 Dissemination of information about professional services to patients
No attempt should be made to put pressure on patients and there should be no abuse of the trust of patients in the dissemination of information.

4.2.4.1  A patient is someone who has, at any time, consulted that doctor, a partner in his practice, or a doctor in a practice which that doctor has taken over, and whose name appears in the records of the practice.
4.2.4.2  A doctor may provide information about his service to his patients provided that such information :-
  1. is not disseminated in such a way as to constitute practice promotion to non-patients;
  2. conforms with paragraph 4.2.1;
  3. does not involve intrusive visits, telephone calls, fax or e-mails by himself or by people acting on his behalf;
  4. does not abuse the patient's trust or exploit his lack of knowledge;
  5. does not put him under undue pressure; and
  6. does not offer guarantees to cure particular complaints.
4.2.4.3  Doctors in private practice as well as those in public organizations are bound by the same rules.
4.2.4.4  A doctor may provide information about the acceptance of credit facilities inside his office.
4.2.4.5  A doctor may provide information about medical or ancillary services inside his office.
4.2.4.6  A doctor should not take advantage of his professional capacity in the promotion and sale of medical products and health claim substance.
4.2.5  Unsolicited visits or telephone calls
Doctors' services may not be promoted by means of unsolicited visits, telephone calls, fax, e-mails or leaflets by doctors or persons acting on their behalf or with their forbearance.


5. Books, lectures, mass media appearances, electronic publications

 
5.1  Doctors in their capacity as registered medical practitioners may give public lectures, participate in radio or television programmes, or publish in print or electronically for the fulfilment of public health education. Doctors' full names, identifiable photographs, together with the specialist title, qualifications, and appointments approved by the Council, may be used. However, doctors should ensure that reference is not made to the doctor's experience, skills and reputation, or practice, in a manner which can be construed as promotional.
5.2  Doctors should ensure the material in whatever form does not imply that he is especially recommended for patients to consult.
5.3  Difficulties may arise when material included in articles, books or broadcasts by doctors, or the manner in which it is referred to, is likely to imply that the doctor is especially recommended for patients to consult. Doctors should ensure that no such implication is given. Where a doctor in clinical practice writes articles or columns which offer advice to the public on medical conditions or problems, or offers telephone or other recorded advice on such subjects, or broadcasts about them, it should not imply that the doctor can offer individual advice or see individual patients as a result.
5.4  Information given to the public should be authoritative, appropriate and in accordance with general experience. It should be factual, lucid and expressed in simple terms. It should not cause unnecessary public concern, or personal distress, or arouse unrealistic expectations. (Unsubstantiated claims for the efficacy of therapeutic regimes, or undue emphasis on the hazards of necessary procedures are examples which may cause distress to patients or their relatives.) Doctors must never give the impression that they, or the institutions to which they are attached, have unique or special skills or solutions to health problems. Information should never be presented in such a way that it furthers the professional interests of the doctors concerned, or appears to attract patients to their care.


6. Information about specialists practising in a particular field

 
6.1  Lists of doctors other than those available in the Specialist Register should not be made available to the public. Enquiries relating to the Specialist Register can be made to the Secretariat of the Medical Council. It may be viewed on the Council's homepage. Doctors seeking information in addition to what is available in the Specialist Register about specialists should approach the Hong Kong Academy of Medicine.


7. Information about medical innovations

 
7.1  Medical practitioners who directly or indirectly release information to the public on new discoveries, inventions, procedures, or improvements should ensure beforehand that :-
  1. the relevant medical innovation has been adequately tested;
  2. the value of the innovation is evidence-based;
  3. the evidence-based research has been properly documented and completed with peer approval. It is the duty of the author to seek peer approval from the relevant professional or academic bodies;
  4. the ethical guidelines under paragraph 4.2.1 and 8 are observed; and
  5. it is not implied that the doctor may be consulted by individual patients as a result.


8. New medical procedures

 
8.1  Medical practitioners in public institutions or in the private sector may apply new method of treatment for appropriate patients under appropriate circumstances. In this respect, innovative ideas, new appliances and medications are expected and are encouraged. Nevertheless, the medical practitioner must be reminded that the human rights of the patient must be protected and his dignity respected.
8.2  New medical procedures should be conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki, and that are consistent with good clinical practice and the applicable regulatory requirement(s).
8.3  Medical practitioners when using NEW surgical procedures, grafts, implants or medications on patients should take due consideration of the following :-
  1. Such new surgical procedures, grafts, implants or medications should be primarily for the benefit of the patient.
  2. The medical practitioner has good grounds, supported where necessary by experimental or trial results, to expect that such surgical procedures, grafts, implants or medications would yield equal or better results than alternative methods of available treatment.
  3. The medical practitioner has made adequate preparations and facilities to meet the undertaking, and its expected complications arising from such an undertaking.
  4. The medical practitioner has clearly explained to the patient the nature of the surgical procedure, graft, implant or medication, as well as alternative methods of available treatment. Informed consent from the patient is required for invasive procedures.
  5. The medical practitioner should consult and obtain approval from the relevant ethical committee or mechanism of similar standing for the use of such surgical procedures, grafts, implants or medications.
8.4  Medical practitioners should familiarize themselves with the guidelines issued by the Medical Council from time to time.
8.5  Medical practitioners are reminded that they may be asked to justify their action. Failure to adhere to the above principles may result in disciplinary action.


9. Clinical research practice

 
9.1.  The practice of good clinical research should follow the principles of good clinical practice. (These principles are adopted from the International Conference of Harmonization on Harmonised Tripartite Guideline and other references.)

9.1.1  Clinical trials should be conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki, and that are consistent with good clinical practice and the applicable regulatory requirement(s).
9.1.2  Before a trial is initiated, foreseeable risks and inconveniences should be weighed against the anticipated benefit for the individual trial subject and society. A trial should be initiated and continued only if the anticipated benefits justify the risks.
9.1.3  The rights, safety, and well being of the trial subjects are the most important considerations and should prevail over interests of science and society.
9.1.4  The available non-clinical and clinical information on an investigation product should be adequate to support the proposed clinical trial.
9.1.5  Clinical trials should be scientifically sound, and described in a clear, detailed protocol.
9.1.6  A trial should be conducted in compliance with the protocol that has received prior approval from an appropriate ethics committee or mechanism of similar standing.
9.1.7  The formation of an ethics committee in all institutions where researches on humans are undertaken should be encouraged.
9.1.8  The medical care given to, and medical decisions made on behalf of, subjects should always be the responsibility of a qualified physician or, when appropriate, of a qualified dentist.
9.1.9  Each individual involved in conducting a trial should be qualified by education, training, and experience to perform his respective task(s).
9.1.10  Freely given informed consent should be obtained from every subject prior to clinical trial participation.
9.1.11  All clinical trial information should be recorded, handled and stored in a way that allows its accurate reporting, interpretation and verification.
9.1.12  The confidentiality of records that could identify subjects should be protected, respecting the privacy and confidentiality rules in accordance with the applicable regulatory requirement(s).
9.1.13  Investigation products should be manufactured, handled, and stored in accordance with applicable good manufacturing practice. They should be used in accordance with the approval protocol.
9.1.14  Systems with procedures that assure the quality of every aspect of the trial should be implemented.
9.1.15  Fraudulent practice of clinical research could be regarded as professional misconduct.

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