Professionalism, Resident Handbook www.uams.edu/gme/toc.htm

CODE OF PROFESSIONAL CONDUCT

Endorsed by the
Graduate Medical Education Committee (1996, 2006)
for all Residents/Fellows in ACGME-accredited programs

Preface
The University of Arkansas for Medical Sciences College of Medicine (UAMS-COM) and clinical departments are committed to excellence in: 1) patient care; 2) education and training of medical students, graduate students, house officers, nurses, and other health professionals; 3) continuing education of staff members; and 4) research. To further the goal of excellence, all professionals at UAMS-COM are expected to adhere to the Code of Professional Conduct in their interactions with patients, colleagues, other health professionals, students, peers, and the public.

The Code of Professional Conduct is a series of principles and their subsidiary rules that govern professional interactions. The Code consists of two complementary sections: professional obligations and professional ideals. "Obligations" refer to necessary professional behaviors that are required by the ethical foundation of medical practice, teaching, learning, and research. "Ideals" refer to desirable professional behaviors that professionals at all levels should attempt to acquire because they enhance professional excellence.

The Code applies to all professionals at UAMS-COM involved in its clinical, teaching, research, and administrative activities. Because of its broad reach, certain portions of the Code will be more directly applicable to some disciplines than to others. For example, the clinical portions apply to medical students, residents/fellows and faculty physicians, nurses, physician's assistants, nurse practitioners, and all other professionals engaged in patient care. Similarly, those portions pertaining to teaching and research apply to all professionals engaged in teaching and research regardless of discipline. The portions pertaining to students apply to Medical students and residents/fellows at all levels. The general portions of the Code discussing confidentiality, conflicts of interest, interpersonal relations, and the professional ideals apply to all UAMS-COM professionals.

A. Professional Obligations
1. Respect for persons
• Treat patients, colleagues, other health professionals, students, peers, and teachers with the same degree of respect you would wish them to show you.
• Treat patients with kindness, gentleness, and dignity.
• Do not use offensive language, verbally or in writing, when referring to patients or their illnesses.
• Respect the privacy and modesty of patients.
• Do not harass others physically, verbally, psychologically, or sexually.
• Do not discriminate on the basis of sex, religion, race, disability, age, or sexual orientation.

2. Respect for patient confidentiality
• Do not share the medical or personal details of a patient with anyone except those health care professionals integral to the well being of the patient or within the context of an educational endeavor.
• Do not discuss patients or their illnesses in public places where the conversation may be overheard.
• Do not publicly identify patients, in spoken words or in writing, without adequate justification.
• Do not invite or permit unauthorized persons into patient care areas of the institution.
• Do not share your confidential Clinic Information Systems passwords with unauthorized persons.
• Do not look up confidential data on patients without a professional "need to know".
• Do not misuse electronic mail.

3. Honesty, Integrity
• Be truthful in verbal and in written communications.
• Acknowledge your errors of omission and commission to colleagues and patients.
• Do not knowingly mislead others.
• Do not cheat, plagiarize, or otherwise act dishonestly.
• Do not abuse special privileges, e.g., making unauthorized long-distance telephone calls.

4. Responsibility for patient care
• Obtain the patient's informed consent for diagnostic tests or therapies.
• Assume 24-hour responsibility for the patients under your care; when off duty, or on vacation, assure that your patients are adequately cared for by another practitioner.
• Follow up on ordered laboratory tests and complete patient record documentation conscientiously.
• Coordinate with your team the timing of information sharing with patients and their families to present a coherent and consistent treatment plan.
• Charge patients or their insurers only for clinical services provided or supervised.
• Do not abuse alcohol or drugs that could diminish the quality of patient care or academic performance.
• Do not have romantic or sexual relationships with patients.

5. Awareness of limitations, professional growth
• Be aware of your personal limitations and deficiencies in knowledge and abilities and know when and of whom to ask for supervision, assistance, or consultation.
• Know when and for whom to provide appropriate supervision.
• Do not engage in unsupervised involvement in areas or situations where you are not adequately trained.
• Avoid patient involvement when you are ill, distraught, or overcome with personal problems.
• Students, residents and fellows should have all patient workups and orders countersigned by the appropriate supervisor.

6. Deportment as a professional
• Clearly identify yourself and your professional level to patients and staff; wear your name tag when in patient areas.
• Do not introduce medical students as "doctor" or allow yourself as a medical student to be introduced as "doctor."
• Maintain a professional composure despite the stresses of fatigue, professional pressures, or personal problems.
• Do not write offensive or judgmental comments in patients' charts.
• Dress in a neat, clean, professionally appropriate manner.

7. Avoiding conflicts of interest
• Resolve all clinical conflicts of interest in favor of the patient.
• Do not accept non-educational gifts of value from drug companies or medical equipment vendors or suppliers.
• Do not participate in incentive programs, especially when this involves prescribing drugs made by the company.
• Do not refer patients to laboratories or other agencies in which you have a direct financial stake.
• Do not accept a "kickback" for any patient referral.

8. Responsibility for peer behavior
• Take the initiative to identify and help rehabilitate impaired students, physicians, nurses, and other employees with the assistance of the UAMS or ACH Medical Staff Health Committees, the Employee Assistance Program, or the employee's supervisor.
• Report serious breaches of the Code of Professional Conduct to the appropriate person.
• Indicate disapproval or seek appropriate intervention if you observe less serious breaches.

9. Respect for personal ethics
• You are not required to perform procedures (e.g. elective abortions, termination of medical treatment) that you, personally, believe are unethical, illegal, or may be detrimental to patients.
• You have an obligation, however, to inform patients and their families of available treatment options that are consistent with acceptable standards of medical and nursing care.

10. Respect for property and laws
• Do not misappropriate, destroy, damage, or misuse property of UAMS or its component institutions.
• Adhere to the regulations and policies of UAMS, and its component institutions, such as policies governing fire safety, hazardous waste disposal, and universal precautions.
• Adhere to local, state, and federal laws, and regulations.

11. Integrity in Research
• Report research results honestly in scientific and scholarly presentations and publications.
• Give proper credit and responsibility to colleagues and others who participated in the research when publishing and presenting reports.
• Report research findings to the public and press honestly and without exaggeration.
• Avoid potential conflicts of interest in research; disclose funding sources, company ownership, and other potential conflicts of interest in written and spoken research presentations.
• Adhere to the institutional regulations governing research using human subjects and animals.

B. Professional Ideals
1. Clinical virtues
• Attempt to cultivate and practice clinical virtues, such as caring, empathy, and compassion.

2. Conscientiousness
• Fulfill your professional responsibilities with conscientiousness.
• Notify the responsible supervisor if something interferes with your ability to perform clinical tasks effectively.
• Learn from experience and grow from the knowledge gained from errors so as not to make the same mistake repeatedly.
• Dedicate yourself to lifelong learning and self-improvement by implementing a personal program of continuing education and continuous quality improvement.
• Students and residents/fellows should complete all assignments accurately, thoroughly, legibly, and in a timely manner.
• Students and residents/fellows should attend scheduled classes, laboratories, seminars, and conferences except for justified absences.

3. Collegiality
• Cooperate with other members of the health care team in clinical activities and with other members of the research team in research activities.
• Teach others at all levels of education and training.
• Be generous with your time to answer questions from residents/fellows, patients, and patients' family members.
• Shoulder a fair share of the institutional administrative burden.
• Adopt a spirit of volunteerism and altruism in teaching and patient care tasks.
• Use communal resources (equipment, supplies, and funds) responsibly and equitably.

4. Personal health
• Develop a life style of dietary habits, recreation, disease prevention, exercise, and outside interests to optimize physical and emotional health to enhance professional performance.

5. Objectivity
• Avoid providing professional care to members of your family or to persons with whom you have a romantic relationship.

6. Responsibility to society
• Avoid unnecessary patient or societal health care monetary expenditures.
• Provide services to needy patients regardless of their ability to pay.

(Adapted from Dartmouth-Hitchcock Medical Center, Code of Professional Conduct, 1996)

Patient First Philosophy
The Faculty Group Practice was founded to provide comprehensive and quality care for patients. The role of the faculty physicians and staff is to provide compassionate care for the maximum benefit of the patient. Every patient will receive all needed services in an environment where there is genuine concern for the patient.

The faculty physicians of UAMS Medical Center demonstrate professional, respectful behavior to patients at all times, consistent with the group's philosophy to put the welfare of patients first.

Outpatient Practice Statement
1. Recognizing that accessibility is a key component of excellent patient care, we, as faculty physicians will participate in the development of a reasonable and accessible scheduling mechanism for clinics, preferably through a centralized scheduling system.
2. Our goal is to make new patient appointments available with a health care provider in every clinic within 14 days or within a reasonable period of time which meets the medical needs of the patient and is acceptable to both the patient and the referring physician.
3. Patient appointments are made during the initial contact telephone call from the patient or referring physician.
4. Provisions for "overbooks" are developed for each clinic, so that arrangements can be made for seeing "urgent" patients promptly.
5. Our goal is to avoid the cancellation of clinics. When missing a clinic is unavoidable, , we try to arrange for coverage by an appropriate colleague. We plan our attendance at medical meetings, conferences, lectures, etc., as much as possible around clinic schedules and block scheduling for these clinics when a conflict is unavoidable, rather than canceling clinics after patients have been scheduled.
6. As the faculty physician, we are in the clinic on time for the first scheduled patient. When tardiness is unavoidable, we offer an apology to the patients who have been waiting. We have responsibility for the clinic schedule.
7. As faculty physicians, we are involved in all aspects of our patient’s care. We use CMS guidelines regarding the presence of faculty physicians. We inform each patient that we are responsible for each visit.
8. Before we leave the exam room, we ask each patient if there are any further questions concerning their condition or plan of treatment.
9. As faculty physicians, we communicate with appropriate physicians and services involved in our patient’s ongoing care.
10. We work with the Medical Director of the clinic, clinic management, and our fellow physicians to utilize clinic resources effectively and efficiently.

Inpatient Practice Statement
1. When on service for inpatients, we see each of our patients daily, and document our care in the patient's record. We inform each patient which faculty physician is responsible for his or her care.
2. Each service will ensure that a qualified faculty physician is available at all times.
3. Each service ensures that an attending faculty physician is accessible by telephone promptly to referring physicians, patients, colleagues, the Emergency Room, and nursing units.
4. As faculty physicians, we respond quickly to non-emergent calls from referring physicians, and we help to establish a mechanism to notify us promptly of such calls.
5. As members of the Faculty Group Practice, we collaborate in the development of a campus-wide Medical Exchange Service. We will participate in the development of a clearly designed on-call schedule that includes accurate pager and phone numbers, which is available to provide 24-hour access.
6. Inpatient consults are seen as soon as possible. We provide consultations according to the following guidelines: routine: within 24 hours; urgent: within 4 hours; emergency: immediately (less than 1 hour). When patients are seen by a resident on a consulting service, documentation of his/her discussion of the case with the attending physician will be placed in the medical record promptly. Consult attendings will provide written consult documentation in the medical record.
7. Pre-operative consultations for elective surgery are coordinated between the surgical and consulting services. When possible, consultations occur prior to hospitalization to avoid unnecessary delays in surgery or additional days in the hospital for the patient.
8. Upon completion of an operation or a procedure, we notify the family of the outcome prior to the delivery of a patient to the Recovery Room. We also notify the family of the location of the Recovery Room and tell them when they will be able to visit the patient.
9. After an operation or a procedure, we provide the family with all information pertinent to the patient's welfare, including answering questions.
10. As faculty physicians, we ensure that the discharge treatment plan, home health, and follow-up care are well planned and implemented. Each patient is given clear instructions as to whom should be contacted to discuss problems and how to make this contact. We ensure that all home health orders clearly delineate the responsible faculty or community physician.
11. As faculty physicians, we communicate with appropriate physicians and services involved in our patient's ongoing care.

On-Call & Messaging Standards
1. As clinical systems are activated, all University Hospital-based Faculty Group Practice physicians and housestaff will utilize the centralized, on line messaging system.
2. Department/division office staff or physicians will be responsible for inputting and updating schedules. All call schedules will be entered/revised/maintained in the electronic AmTelCo database.
3. All physicians will be responsible for responding to pages according to the following guidelines and indicators: -8 indicated a call from a physician, pages will be returned within 5 minutes; -1 indicates an emergency call, pages will be returned within 5 minutes. If not returned within five minutes, the next designated physician on call will be paged. All other pages will be returned within 15 minutes.
4. External referring physicians calling the Access Center will be asked if they would like to speak to a UAMS attending physician. If they would, they will be immediately routed to the attending on call for the particular service, via phone or pager. If the referring physician has no preference he/she will be directed to the physician (either resident or faculty) currently taking first call.

Patient Communication is More Than What We Say
Many patients come away from a conversation remembering more of the nonverbal messages than the spoken words. Rarely do we think about the more subtle messages that we send with our eyes, face, hands and posture; however, nonverbal cues tend to be more revealing of a speaker's true intent and attitude. Below are some nonverbal gestures that can work for physicians. Try each one as naturally as possible to see which might work for you.

Nonverbal Gesture	Translation
Sit down across from the patient when communicating.	"I'm not in a hurry, and I'll talk directly to you."
Place your hands in front of you with your fingertips, but not palms, touching.	"I'm listening carefully. I'm thinking. Let's consider all options."
Maintain eye contact with the patient.	"I see you as a person."
Briefly place your hand on the patient's shoulder, or pat his or her back.	"You're not in this alone. I'm here for you, you're going to do fine."
Slightly raise your eyebrows.	"I'm listening to what you're saying."
Lean forward in your chair to close the distance between you and the patient.	"Let's talk as specifically as possible. Let's make sure we understand each other."

Communication with words and gestures is the richest and most beneficial form of communication for helping patients understand and follow your advice and for avoiding miscommunication.