Role of the doctor reviewed

A consensus statement on the role of the doctor in New Zealand advocates partnership with patients rather than the "doctor knows best" approach.

The statement, published recently in the New Zealand Medical Journal, has been developed over six months to define the role in an environment of changing societal expectations, workforce pressures, scientific and technological advancements and the increasing influence of the internet.

New Zealand Medical Association chairman Dr Paul Ockelford said there had been huge changes in health care delivery in about the last 20 years and it was essential the doctor's role reflected these changes.

The consensus statement involves eight key statements covering such issues as responsibility for medical decisions, ethical responsibility, partnership with patients, leadership, and advocacy for improved health care.

The statement says doctors are trained to support patients in understanding their condition and empower them to make informed decisions.

Reference is also made to assisting patients and their families to decide when supportive care is preferable to intervention, including in relation to end-of-life decisions.

In a section on doctors as health advocates, the statement says where the capacity to treat is growing but resources are finite, doctors have a duty to use resources wisely and to "engage in constructive debate about such use".

"As significant resources themselves, they are committed to ensuring their own and others' skills and knowledge are deployed to best effect," the statement said.

Dr Ockelford said there were ongoing challenges in meeting the increasing health care needs of society, particularly with an ageing population and more chronic illnesses.

Solutions being sought to respond to this growing demand included the creation of new health care roles, delegating tasks that were traditionally only undertaken by doctors, and a greater emphasis on health care teams.

"Doctors acknowledge and value health care delivery by a health team, including the contribution of nurses and allied health professionals. There are major benefits for patients of this integrated approach.

"However, the statement emphasises that doctors must take ultimate responsibility for medical decisions and diagnoses in situations of complexity."

The section on leadership says "as members of health care teams, doctors recognise and respect skills and attributes of other practitioners".

A section on doctors as scientists says doctors have the ability to access, interpret and assimilate new knowledge critically, have strong intellectual skills and grasp of scientific principles, and are capable of managing uncertainty, ambiguity and complexity.

"They have the capacity to work out solutions from first principles when patterns do not fit, and the ability to work outside guidelines when circumstances demand," the statement says.

The consensus statement was developed after a seminar which was hosted by the association and brought together representatives of the medical colleges, district health boards, public health organisations, nurses, medical schools and health workforce planners.

The statement has been endorsed by 12 medical organisations including the medical association, the New Zealand Rural General Practice Network, the Royal New Zealand College of General Practitioners and the New Zealand College of Public Health Medicine.

Dr Ockelford said the signatories to the statement had a shared goal to improve the health of our community.

"We would like to see the consensus statement as the foundation for further discussion among medical schools, the wider health sector, government and other groups about how we can best deliver optimal health care to New Zealanders."



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