PART III

E. Relationship with Other Practitioners

17.  Referrals of patients

17.1  A medical practitioner may refer a patient for diagnostic or therapeutic services to another medical practitioner, a practitioner with limited registration, or any other provider of health care services permitted by law to furnish such services, whenever he believes that this may benefit the patient. Referrals to medical specialists should be based on their individual competence and ability to perform the services needed by the patient. A medical practitioner should not so refer a patient unless he is confident that the services provided on referral will be performed competently and in accordance with accepted scientific standards and legal requirements.
17.2  A medical practitioner who refers a patient for diagnostic or therapeutic services should not receive any fees in whatever form for the referral.
18.  Financial relationships between doctors and independent organizations providing clinical, diagnostic or medical advisory services

18.1  A doctor who recommends that a patient should attend at, or be admitted to, any private hospital, nursing home or similar institution, whether for treatment by the doctor himself or by another person, must do so only in such a way as will best serve, and will be seen best to serve, the medical interest of the patient. Doctors should therefore avoid accepting any financial or other inducement from such an institution which might compromise, or be regarded by others as likely to compromise, the independent exercise of their professional judgement. Where a doctor has a financial interest in an organization to which he proposes to refer a patient for admission or treatment, he should always disclose that he has such an interest before making the referral.
19.  Depreciation of other medical practitioners

19.1  Doctors are frequently called upon to express a view about a colleague's professional practice. This may, for example, happen in the course of a medical audit or peer review procedure, or when a doctor is asked to give a reference about a colleague. It may also occur in a less direct and explicit way when a patient seeks a second opinion, specialist advice or an alternative form of treatment. Honest comment is entirely acceptable in such circumstances, provided that it is carefully considered and can be justified, that it is offered in good faith and that it is intended to promote the best interests of patients.
19.2  Further, a doctor should, where the circumstances so warrant, inform an appropriate person or body about a colleague whose professional conduct or competence or fitness to practise may be called into question. The Medical Council has procedures for rehabilitating doctors whose fitness to practise is seriously impaired by a physical or mental condition. See paragraph 24.
19.3  Gratuitous and unsustainable comment which, whether directly or by implication, undermines trust in a professional colleague's knowledge or skills is unethical and unacceptable.
20.  Association with non-qualified persons

20.1  A registered medical practitioner should not associate himself with a non-qualified person in providing any form of healing or treatment for his patients.
21.  Covering or improper delegation of medical duties to non-qualified persons

21.1  A medical practitioner who improperly delegates to a person who is not a registered medical practitioner duties or functions in connection with the medical treatment of a patient for whom the medical practitioner is responsible or who assists such a person to treat patients as though that person were a registered medical practitioner, is liable to disciplinary proceedings. The proper training of medical and other bona fide students or the proper employment of nurses, midwives and other persons trained to perform specialized functions relevant to medicine is entirely acceptable provided the medical practitioner concerned exercises effective personal supervision over any persons so employed and retains personal responsibility for the treatment of the patients.
21.2  A medical practitioner who employs or otherwise engages a person to carry out the functions of the professions listed in the Schedule of the Supplementary Medical Professions Ordinance (Cap. 359) (i.e. Medical Laboratory Technologist, Radiographer, Physiotherapist, Occupational Therapist and Optometrist) may only do so if that person is registered in accordance with the provisions of the same Ordinance. Any registered medical practitioner who employs any person to practise any profession listed in the Schedule of the Supplementary Medical Professions Ordinance when that person is not registered in respect of that profession, also commits an offence.
21.3  It is misconduct for a registered medical practitioner, by his countenance or assistance or by issuing certificates, notifications, reports or other similar documents, to enable a person who is not a registered midwife to attend a woman in childbirth other than under the direction and personal supervision of a registered medical practitioner.
22.  Complementary/alternative treatment modalities

22.1  A registered medical practitioner utilizing complementary/alternative treatment modalities should ensure that :-
(a) the modality of treatment concerned is ethical, beneficial and safe for the patient;
(b) the procedure is carried out in good faith and in the patient's best interest;
(c) informed consent has been obtained with the following :-
(i) the benefit of the procedure;
(ii) the risk of the procedure;
(iii) the fact that this is a form of complementary/alternative treatment; and
(iv) the prevailing conventional method available;
having been explained to the patient;
(d) the practitioner himself has received relevant and adequate training such that he would be clinically competent in carrying out the treatment; if necessary, he should obtain professional support from qualified persons.
22.2  A medical practitioner who utilizes complementary/alternative treatment modalities may be subject to strict review and judgement with reference to the law governing the alternative practice.
22.3  A registered medical practitioner may undertake scientific research related to complementary/alternative treatment modality, provided that the guidelines on scientific research mentioned in paragraph 9.1 are observed.
22.4  If a registered medical practitioner prescribes any health claim substance, which includes any proprietary health food product with or without herbal medicine contents, to his patient, he must make sure that :-
(a) he is not omitting the established conventional methods of treatment;
(b) the health claim substance concerned is beneficial and does not cause any harm to the patient;
(c) he is acting in good faith and in the patient's best interest;
(d) he has explained the efficacy, deficiency and uncertainty of the health claim substance fully to the patient, including but not being limited to explaining that it may contain an element for which there is no/insufficient evidence of efficacy; and
(e) he does not take advantage of his professional relationship with patients to promote the sale of any health claim substance. In any event where he or his family has a financial interest in any health claim substance, he should comply with paragraph 15.

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