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Responsibility and Accountability


Responsibility and accountability are a part of a doctors life. With greater independence and authority comes greater responsibility. Understanding this and developing the skills necessary to deal with it is an important part of the transition from medical student to doctor. Some of the steps that ease this transition are given below.
  •  Find out what is expected regarding an interns duties and responsibilities. They must be discharged in the best possible manner. 
  •  Responsibilities must not be delegated to others - particularly to untrained/unqualified personnel.
  • Negligence of responsibilities towards patients may result in the postponement or revocation of the SLMC registration.
  • It is essential to develop an understanding of personal limitations and when to summon help. Do not overreach beyond what is within an intern's jurisdiction.
    Ensure that you have a means by which to contact the relevant members of the hospital staff and other services.
  • Ensure that proper documentation is maintained for the each patient. It facilitates in the treatment of the patient and provides evidence that duties have been properly discharged.

For detailed information regarding the responsibilities of an intern please refer to the ‘Handbook for Medical Interns’

An intern’s behaviour towards patients and co-workers must be governed by ethical consideration. Some of the main things that need to be taken into account are as follows -

  • The patients’ right to confidentiality
  • The patients’ right of informed consent
  • The intention to do good
  • The intention to avoid harm
  • Maintaining justice

 The Ten Commandments

 1. Shall owe a duty of care to all the patients in the unit where IMO is attached to. Privacy, dignity and the rights of the patient and the confidentiality of the information must be respected to the utmost even after the death of the patient.
 
 2. Shall mange having obtained a valid consent all the patients in the unit, promptly, appropriately and effectively exercising a reasonable degree of medical care that is expected of a newly passed out medical graduate. In the case of a minor or a patient with unsound mind, the consent may be obtained from the next of kin. Only exception would be to save the life of the patient where taking of a valid consent cannot be done as in the case of an unconscious patient.   

 3. Shall record all the relevant findings (positive as well as negative) during the course of medical management of the patient legibly, adequately and appropriately in an orderly manner in the clinical record (BHT / clinic notes). All reports of investigations must be secured.

 4. Shall record all necessary information/findings which are medico-legally important in the same manner. This includes but is not limited to date and time of examination, investigation and therapy, level of consciousness, injuries observed externally and internally, any therapeutic intervention to injuries or health condition, whether breath is smelling of alcohol and/or whether the patient is under influence of alcohol or drugs and under what circumstances and in what manner injuries were sustained. 

 5. Shall inform the Police if it appears that there had been a possible criminal act associated with the illness and must ensure that medico legal examination is done prior to discharge or transfer of such patient. Also to ensure that proper endorsements are made in the Bed Head Ticket to that effect and it is kept in safe custody. The IMO shall assist the JMO /MO who will be visiting to examine the patient for medico legal purpose.  

6. Shall recognize, identify, collect, preserve and record all relevant and important physical evidence (e.g. vomit/gastric leverage in a case of suspected deliberate poisoning, clothing in a suspected homicide case, missiles such as bullets/pallets recovered from body, foreign body in the case of suspected criminal abortion and to hand over them to the relevant investigator by maintaining proper chain of custody. 

 7. Shall inform police to arrange for an Inquest in all unnatural and suspicious and sudden deaths and also in situations where medical cause of death is not known irrespective of the duration of stay in the hospital. Death occurring while in police or prison custody, mental and leprosy hospital also requires an Inquest irrespective of the circumstances, manner and cause of death. It is the sole responsibility of the Medical Officer (including IMO) certifying the death to request for an Inquest. When an inquest is requested it is best that establishment of the cause of death is left to be done during the Inquest procedure and the IMO shall not issue the Declaration of Death form (DC).  

8. Shall record or arrange for recording of a dying declaration where appropriate.  

9. Shall take utmost care when issuing medical certificates/reports to courts recommending that the patient is unfit to attend and also stating the medical status of the patient.  

10.Shall consult the supervising specialist before giving statement regarding patients to police or at administrative or disciplinary inquiries. However IMO shall attend, appropriately dressed, when summoned by courts or when informed to appear at an Inquest and shall get prepared to give evidence.

 Dr.Ananda Samarasekera

 MD, MBBS, DLM, DMJ (London), Dip.F.M (Glas.), MFFLM (UK)

 Chief Consultant JMO, Institute of Legal Medicine & Toxicology

 Colombo