NTA Level 4 Semester Two

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Ethical Dilemmas in Medical Practice CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Ethical Dilemmas in Medical Practice using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Medical Ethics and Professionalism – Extended Notes – Ethical Dilemmas in Medical Practice Ethical Dilemmas in Medical Practice Learning Objectives Define the term ethical dilemmas Explain the characteristic of ethical dilemmas Explain common ethical dilemmas Identify sources of ethical dilemmas Describe strategies used to solve ethical dilemmas Definition of Ethical Dilemmas and their Characteristics An ethical dilemma is a situation having two or more undesirable alternatives. It can also be defined as a confusing problem that offers a choice between equally unsatisfactory alternatives. An ethical dilemma is a situation that will often involve a conflict that brings questions on which to obey as they may have implications on each other Ethical dilemma addresses ethical questions of right vs. wrong. Characteristics of Ethical Dilemmas In order for a problem to be an ethical dilemma it must have three characteristics The problem cannot be solved using only empirical data (empirical data is information derived from observation/experiences) The problem must be so confusing that deciding what facts and data need to be used in making decision is difficult. The results of the problem must affect more than the immediate situation; and there should be far reaching effects. Common Ethical Dilemmas Common Ethical Dilemmas identify common ethical dilemmas in medical practice Dilemmas of Beneficence Involves deciding what is good as opposed to what is harmful. Often occurs when a clinician, patients, or family members disagree about what course of action is in the best interest of the patient. Dilemmas of Non-maleficence Involves the avoidance of harm. These issues often involve a clinician’s responsibility to ‘blow the whistle’ if the clinician sees others compromising the patient’s safety. In these situations, a clinician notifies higher authorities on weaknesses in the care they provide by not following established communication channels. Dilemmas of Autonomy Involves deciding what course of action maximizes the patient’s right of self determination. Autonomy issues are related to beneficence issues, especially when individuals other than the patient must determine what is best for the patient. Dilemmas of Justice Involves issues of fairness and equality, such as dilemmas that involve dividing limited health care resources fairly. Dilemmas of Fidelity Involves issues that involve honouring promises. These may include the extent and limits of a clinician’s role and duties to patient that might conflict with other duties such as duties of the laboratory technician. Dilemmas of Veracity This is an obligation to be truthful to patients and to cultivate their understanding of relevant consideration. This may involve even delivering bad news to patients and relatives. Sources of Ethical Dilemmas Problems arise when one or more ethical principles conflict with each other. Patients and clinicians- For example human rights are involved when a patient refuses to commit herself in signing consent while the clinician believes it is ethically appropriate to get his/ her permission. The value system, beliefs and culture- For example a patient who belongs to Jehovah’s Witnesses refuses blood transfusion at the time when blood will save the life of that individual. Sources of Ethical Dilemmas cntd Dilemma may arise from justice and conflicts between clinician and other health care professionals, health care organizations, administrators or patients and family members. Example one: Quick service provided to patients who can pay extra money and leaving patients with low economical status to wait. Example two: Family members may demand the HIV results of a patient and create a difficult situation. Example three: A woman may demand abortion for her school age girl who has been raped by a school teacher. Sources of Ethical Dilemmas cntd Technology advancement- Knowledge among people is growing and patients may come to the hospital with full information of their expectations including services like DNA, such as when the clinician is asked to conduct tests to confirm if the claimed father is a true father of the child or not. Technological advancement provides challenges when we are required to extend life support services for terminally sick patients and simplifies accessibility to information. Strategies Used to Solve Ethical Dilemmas There are no clear ways of solving the dilemmas. Different strategies and ways need to be applied in solving the dilemma as described below First the medical practitioner defines his/her obligations, to patients and fellow employees which helped her to analyze ethical conflicts. He/She notes that six steps proved useful to define those obligations:- To maximize a patient’s well being.To maximize a patient’s wellbeing. To balance the patient’s need for autonomy and, in the case of a minor, his/her parents’ responsibilities for his or her wellbeing. To support each family member and enhance the family support system. To carry out the hospital’s policies. To protect the other patients’ good. To protect his or her own standards of care. After examining one’s obligations, it is usually recommended that four additional steps should be taken: Collect as much information as possible about the patient and other significant persons in the situation. Describe probable consequences of each of the courses of action being considered, for the patient and the significant others in the situations. Consider who should make the final decision in the matter. Consult other health practitioners, especially those who are prepared by practice, ethical committee and education to contribute meaningfully to solving problems of an ethical nature. Even after taking the steps described above, solutions may not necessarily be forthcoming when ethical conflicts are present. Commitment to ethical standards of practice is an essential part of medical care, as is the commitment to respecting the rights and dignity of the person receiving care. Key Points An ethical dilemma is a situation having two or more undesirable alternatives. An ethical dilemma must have three characteristics: The problem cannot

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Patient and Healthcare Provider Rights CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Patient and Healthcare Provider Rights using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Contents of This Topic Medical Ethics and Professionalism – Extended Notes – Patient and Healthcare Provider Rights Related Tasks Key Points York: Thomson. Activity: Case Study Medical Ethics and Professionalism – Extended Notes – Patient and Healthcare Provider Rights Patient Rights Learning Objectives Define the terms right, patient, culture and values Identify rights of the patient/client Identify the culture and values that influence comprehensive health care Demonstrate the application of the patient rights when providing medical service Sub-Enabling Outcome : Describe rights of patients and health care providers in the provision of health care services Related Tasks a) Define the term patient’s rights b) Identify patient rights c) Describe providers rights in the provision of health services d) Describe how to meet patients’ rights in the provision of health services e) Describe approaches to uphold human rights in health services Explanation of Patient Rights ‘What are patient rights?’ Patient rights encompass legal and ethical issues in the providerpatient relationship and include person's right to privacy; the right to quality medical care without prejudice; the right to make informed decisions about care and treatment options, and the right to refuse treatment. Many issues comprise the rights of patients in the medical system, including a person's ability to sue a health care provider; access to emergency and specialty care, diagnostic testing, and prescription of medication without prejudice; confidentiality and protection of patient’s medical information; and continuity of care.Select this paragraph to edit Besides basic rights of care and privacy, is the education of patients concerning what to expect of their health care facility and its providers. Recognition of Patient Rights The right of individuals to be treated with respect and dignity. The rights of the individual to life, liberty, and security. The right of individuals to have their religious and cultural identity respected. The right to a competent professional and quality care. The right to an appropriate standard of care to meet individual needs. The right to privacy and confidentiality, which includes access to medical records upon request. The right to personal safety self-determination. The right to be recognized as human beings who are social beings with social needs. The right to participate in the development and implementation of the plan of care. The right to be informed about condition, treatment options, and the possible results and side effects of treatment. The right to refuse treatment in accordance with the law, and receive information about the consequences of refusal. The right to quality health care without discrimination because of race, creed, gender, religion, national origin, or source of payment. The right to know the identity of the person treating the patient, as well as any relationship between professionals and agencies involved in the treatment. The right to informed consent for all procedures, including the medical records by the patient or by the patient's legally authorized representative and hospital charges. The right to consultation and communication freely without fear. The right to complain or compliment without the fear of compromising access to quality care. Together with these rights the patient has a responsibility to follow the plan of care agreed upon, and providing relevant, complete and accurate health information. The patient is further responsible for consequences of refusal of treatment, of not following the rules and regulations of a hospital, and of not being considerate of others‘ rights. Meeting Patient Rights in the Provision of Health Services ‘How can patient rights be met in the health facility during provision of health services?’ In accordance to patient rights health care providers have the obligation to adhere to these patients rights. Each provider has to adhere to ethical code of practice and has responsibilities for provision of quality of care as guided below. The Right of Individuals to be Treated with Respect and Dignity Health providers should promote an environment that engenders mutual respect including respect for the dignity and rights of all concerned. The Rights of the Individual to Life, Liberty and Security Promote emotional security, provide physical security, and enable religious and spiritual security for patients while in hospital care. Assure patients that their independence will be encouraged. Provide mechanisms that enable patients and staff to offer feedback or make complaints without fear of revenge to quality care. Provide and promote a safe working environment for patients and all staff. Respect and protect rights of staff to freedom of association, (including the right to choose whether or not to join an employee association). The Right of Individuals to Have Their Religious and Cultural Identity Respected Provide care in an environment that supports the cultural and language needs of residents and their families. Provide food and drink which meet the needs for reasonable personal, cultural and religious preferences. Provide ease of access to spiritual advisers and a place (not necessarily a dedicated place) for religious observances appropriate to the wishes of the patient. The Right of Competent Individuals to Self-determination Promote an environment that provides patients with opportunities for self-development and that maximise their potential for well-being, especially patients who stay for long time in the hospital. Respect the right of patients to their reasonable choices of care provision. Encourage patients to take responsibility for their actions and choices. Provide access to independent social, legal or other advice and help, which are relevant to patient care. Develop protocols, within the law, to assist patients with selfmedication for this type of care. The Right to an Appropriate Standard of Care to Meet Individual Needs Act in the best interests of patients in determining, particularly before admission, whether or not the hospital has the capability of providing them with care appropriate to their needs. Provide food, drink,

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Professional Values CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Professional Values using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Contents of This Topic Medical Ethics and Professionalism – Extended Notes – Professional Values 108: Key Point York: Thomson. Learning Objectives • Community Factors Own Actions Key Points Medical Ethics and Professionalism – Extended Notes – Professional Values Professional Values and Provision of Quality Health Services Learning Objectives By the end of this session, students are expected to be able to: Define the terms values and integrity Explain the link between values and a profession Describe values in the provision of quality health services Sub-Enabling Outcome: Utilize professional values in providing quality health care services a) Define the terms values and integrity b) Explain the link between values and a profession c) Describe values in the provision of quality health care services Definition of Values DISCUSS: “What is the difference between values and ethics?” Although there is a definite link between ethics and values, the two concepts are not identical. Values can be defined as relatively stable convictions about what is good or desirable. principles or standards of behaviour; one's judgement of what is important in life. " they internalize their parents' rules and values" The difference from ethics here is clearly that one can have values that are not ethical or that have nothing to do with ethics. Some values examples: Respect Transparency Fairness Justice Values and Profession The values of a profession will be reflected in their ethical code of practice. Values of a profession will be reflected through the behaviour of their professional members, who have to practice in a specific manner accepted by ethical code of practice, ethical principles and standards of the profession. Professional values include: Punctuality Commitment Respect Fairness and equality Quality of services Creativity and innovativeness For any profession to function optimally, good relations and interactions between stakeholders are required. In order to ensure such good relations and interactions occur, members of the profession need to commit themselves to specific ethical codes of practice and professional ethics. Integrity within the Profession Integrity is another concept that is closely aligned to ethics. Integrity is however a more restricted concept than ethics. It refers specifically to human character. A person is regarded as someone with integrity when she/he consistently adheres to a set of ethical standards. the quality of being honest and having strong moral principles. the state of being whole and undivided. Integrity, is often associated with concepts like Fairness Consistency Uprightness Wholeness These characteristics make a person of integrity, reliable and trustworthy. The person with integrity will always adhere to her or his values People with good moral characters can turn to unethical behaviour if they find themselves in organizations where unethical conduct is the norm. People can be restrained from unethical behaviour if they find themselves in organizations that do not tolerate unethical behaviour, but reward ethical behaviour. Ethical behaviour should not only be addressed on the individual level, but also on the system or organizational level. Characteristics of Quality Health Services Every person regardless of age or condition is afforded access to quality health care. The service is to be timely, reliable and adequate. Services to be provided to all in need guaranteeing equal access to medical services. Service that allow exercise of moral and religious freedom when receiving health care. Services where medical personal do not harm, do positive good, and respect the autonomy of persons, and adhere to principles of justice. Services that create a bond of trust between patients and health care providers which is built on shared decision-making. Services where patients or their relatives are provided with complete information in order to participate fully in their own care. Services that recognize the quality and availability of health care services for women affect the health and wellbeing of their children and families so that limitations to these services have a profound long-term effect on the public’s health. Services where medical professionals exercise their professional judgment in the best interests of their patients; and recognizing the professional obligation of medical providers to support access to medical care for all people in the interest of the public good. Services which respect and protect the dignity and autonomy of each person regardless of the person’s health issues, religious views or social status. Respecting every person’s dignity means that each person should enjoy the right to health, to health care, to direct access to health care, and to the continuation of that care, regardless of the ownership of the institution from which they seek care. Services where patient expects and has the right to expect the health care professional to employ the highest standard of care and best medical practices Services that respect transplantation of organs from living donors is permissible when such a donation will not sacrifice or seriously impair any essential bodily function of the donor Values and Provision of Quality Health Services In the provision of quality care, there are many values which result in the desired behaviour of a practitioner. These include: Good therapeutic relationship. The term ‘therapeutic relationship’ includes all professional interactions between care providers, individually or as a team, and recipients of care. Good therapeutic relationships are centered on the needs and informed choices of the person receiving care. Such relationships are based on respect and mutual giving and receiving. Good therapeutic relationships help to prevent conflicts about the goals and means of care. A good therapeutic relationship is founded on mutual trust and respect between providers and recipients of care. When care providers lose this sense of mutuality, they become mere experts and the human quality in the relationship is lost. xx When persons receiving care lose this sense of mutuality, they experience a perceived or real loss of control and increased

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Ethical Theories and Principles CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Ethical Theories and Principles using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Contents of This Topic Medical Ethics and Professionalism – Extended Notes – Ethical Theories and Principles Virtue Ethics Ethical Principle Ethical Theories Immanuel Kant. Case Study Honesty (Veracity) Other Ethical Principles Key Points University Press. Capetown: Heinemenn. Medical Ethics and Professionalism – Extended Notes – Ethical Theories and Principles Ethical Theories and Principles in Medical Practice Learning Objectives Define common terms related to ethical theories and principles in medical practice Identify major ethical theories in medical practices Identify the importance of systematic study of ethics to medicine Identify the ethical principles in medical practice Analyze ethical principles in medical practice Apply ethical principles when managing patients/clients Definition of Terms Ethics Virtue Ethics: A systematic study of what a persons’ conduct and actions ought to be with regard to himself or herself, other human beings and the environment. The word ethics originated from the Greek word ‘ethos’ meaning customs or character. It is concerned with judgement about what is right or wrong conduct. Virtue: Moral excellence, goodness and rightness. It is also defined as conformity of one’s life and conduct to moral and ethical principles, uprightness, and rectitude Virtue Ethics Refers to a virtue of character as a health practitioner rather than rules governing conduct or consequences of any action by a health practitioner. Virtue ethics demands the practitioner to exercise loyalty, devotion and trustworthiness, good temperament, compassion and integrity. Virtue ethics is a philosophy developed by Aristotle and other ancient Greeks. It is the quest to understand and live a life of moral character. This character-based approach to morality assumes that we acquire virtue through practice. Bioethics: A system of standards arising from the professional agreement to determine, sanction, and justify the interaction of biomedical professional and patient. Bioethics is the study of ethical, social, and legal issues that arise in biomedicine and biomedical research. Bioethics is both a field of study and professional practice, interested in ethical issues related to health, including those emerging from advances in biology, medicine, and technologies. Ethical Principle Is a basic concept by which behaviour can be judged. Ethical Principles help people to make decisions, because they serve as a standard with which to measure actions. Governing rules of conduct, as code of conduct by which life and action can be directed, or as generalization that provide a basis for reasoning A principle is an established rule of action to be followed in implementing a set of activities Values Is something of worth or excellence or that which is esteemed, prized, or highly regarded. Values refer to one’s evaluative judgement about what one believes is good or what makes something desirable. Values are individual beliefs that motivate people to act one way or another. They serve as a guide for human behavior. Ethical Theories Consequentialism or Utilitarianism This is a moral theory that holds that an action is judged as good or as bad in relation to the consequence, outcome or end result that is derived from it. According to the utilitarianism school of thought, right action is that which has great utility or usefulness. Utilitarianism holds that the only factors that make actions good or bad are the outcomes, or end results, that are derived from them. Consequentialism is an ethical theory that judges whether or not something is right by what its consequences are. Utilitarianism is an ethical theory that determines right from wrong by focusing on outcomes. It is a form of consequentialism. Non-Consequentialism or Deontological Ethics Deontological theories of ethics are based upon rationalistic view that rightness or wrongness of an act depends upon nature of the act rather than its consequences. The term is taken from the Geek word for duty. For example, a man needs money to feed his family. He knows that he will not be able to repay it but sees that nothing will be lent to him if he does not promise to repay it at a certain time. Deontological ethics advocates against giving wrong promises disregarding the outcome of the wrong promise, hence this man should not give the wrong promise. The most famous version of non-consequentialism is deontology, which holds that one has an absolute duty to obey certain rules. “Never kill an innocent person” or “never lie” are examples of such rules. Deontology is an ethical theory that uses rules to distinguish right from wrong. Deontology is often associated with philosopher Immanuel Kant. Importance of Systematic Study of Ethics to Medicine Helps in understanding the origin and process of ethical and moral thinking. Enables health care workers to recognize situations with ethical and moral implications and make coherent and logical ethical decisions based upon recognized ethical principles and theories. Equips medical practitioners with knowledge necessary for making right decisions in issues and situations that have element of ethical or moral uncertainty and dilemma. Types of Ethical Principles There are five types of ethical principles: The value of life principle The principle of goodness or rightness The principle of justice or fairness The principle of truth telling or honesty The principle of individual freedom The Value of Life Principle This principle requires the medical practitioner to value human life and honour the patients’/clients’ wishes regarding quality of life. It demands to recognize life as basic and important, but also life should be recognized as having an end. Yet no life should be ended without strong justification such as in the situation whereby life of a pregnant woman is threatened by the presence of the fetus. In addition, when a medical practitioner becomes negligent, he threatens the life of the patient; when life of a patient is valued, a medical practitioner will not ignore any instruction on

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics and Professionalism – Extended Notes – Introduction CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics and Professionalism – Extended Notes – Introduction using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Contents of This Topic Medical Ethics and Professionalism – Extended Notes – Introduction Continuous Assessment 40% PRACTICE • Small Group Discussion Professional Responsibility Licensing Bodies Key Points BMJ.324:838–842. Buckingham: Open University Press. Medical Ethics and Professionalism – Extended Notes – Introduction MEDICAL ETHICS AND PROFESSIONALISM 1 INTRODUCTION Sub-Enabling Outcomes (1) Describe basic concepts of ethics and professionalism in medical practice Utilize theories and principles of medical ethics in delivering health care services Demonstrate professional values in providing quality health care services Describe the relationship between clinician and society in providing quality health care servicesSub-Enabling Outcomes (2) Describe rights of patients and health care providers in the provision of health care services Manage ethical dilemmas in medical practice in improving provision of health care services Apply knowledge of medical laws in disclosing health information Apply principles of medical ethics in obtaining clients’ consent Integrated Method of Assessment Continuous Assessment 40% Written 30% Assignments 10% End of Semester Examination 60% Written 60%BASIC CONCEPTS OF ETHICS AND PROFESSIONALISM IN MEDICAL PRACTICE 6 Learning Objectives By the end of this session, students are expected to be able to: Explain professionalism in clinical medicine practice Identify the characteristics of a profession Describe the code of ethics for medical profession Recognize the roles of professional associations and licensing bodies a)Explain professionalism in medical practice b) Explain the term ethics in medical practice c) Explain characteristics of a profession d) Describe medical code of ethics e) Explain the social role of a profession f) Explain the roles of professional associations and licensing bodies What does the term Profession mean? The words ‘profession’ and ‘professional’ come from the Latin word ‘ professio’ which means a public declaration with the force of a promise. Professions are groups which declare in a public way that their members promise to work, operate and live in certain ways and that the group and the society may discipline those who fail to do so The profession presents itself to society as a social benefit and society accepts the profession, expecting it to serve some important social goal. 10Select this paragraph to edit The profession usually issues a code of ethics stating the standards by which its members can be judged. It is a vocation in which knowledge of some department of science or learning, or the practice of an art founded on it, is used in the service of others. Its members profess a commitment to competence, integrity, morality, humanity, and the promotion of the public good within their domain. These commitments form the basis of a social contract between a profession and society, which in return grants the profession autonomy in practice and the privilege of self regulation. Professions and their members are accountable to those served and to society. Medical professionalism differs from other professions in both content and motivation. 12• It is a service profession dedicated to patients, centering on the doctor-patient relationship. Medicine seeks the prevention of disease and injury, the promotion and maintenance of health, the relief of pain and suffering, the care and cure of those with illness, the avoidance of premature death, and the pursuit of a peaceful death. The true professionalism in medicine will always put in first place the well-being of the patient and the community as principal objective. Medicine is a moral endeavor which demands integrity, competence, and high ethical standards among other key attributes Medical professionalism embodies the relationship between medicine and society as it forms the basis of patient-physician trust It attempts to make tangible certain attitudes, behaviors, and characteristics that are desirable among the medical profession. Professionalism embodies the competence, skills and behaviours expected of a practitioner Characteristics of a Profession Body of knowledge Usually the knowledge is not easily understood by the public, and consequently the professions are given substantial control over its use. They acquire responsibility for its integrity, for its proper application, and for its expansion, which for medicine, means the support of science Professions have an obligation to transmit their knowledge by teaching it to future practitioners, the general public, and their patients. Service The knowledge is used in the service of others. Clinicians use their knowledge primarily to benefit individual patient. Altruism There is agreement that the trust placed in the professions and their privileged status are only justified by the expectation that they will be altruistic (Disinterested and selfless concern for the well-being of others) For clinicians this means consistently placing the interests of individual patients and society above their own. Professions must be devoted to the public good. Autonomy This is another important characteristic of a profession. Individually, clinicians are granted sufficient autonomy to act in the best interests of their patients. In the early days, autonomy was expressed in a paternalistic fashion, but modern society, recognizing patient autonomy, now views the clinicianpatient relationship as a partnership. The profession is also granted collective autonomy through self-regulation. It has the privilege and obligation to set and maintain standards for education and training, entry into practice, and the standards of practice. It must guarantee the competence of its practitioners, and has an absolute obligation to discipline unprofessional, incompetent, or unethical conduct. This means that professionals have a particularly strict duty to assure that their decisions and actions serve the welfare of their patients or clients, even at some cost to themselves. Code of ethics Professions have codes of ethics which specify the obligations arising from their duty Professionalism requires that the practitioner strive for excellence in the following areas which should be modelled by mentors and teachers and become part of the attitudes, behaviours, and skills integral to patient care: Altruism: Clinician is obligated to attend to the best interest of patients, rather than

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Medical Ethics CRT04209 · Medical Professional Ethics START READING NOTES Study Medical Ethics using the sections below. Use the topic navigation to continue through Medical Professional Ethics. Contents of This Topic Learning objectives Definition of terms Chaperone Examinations requires the presence of chaperone Patients should be offered a chaperone of their gender, present during the examination, Circumstances under which a chaperone is required during an ultrasound / x-ray examination Chaperone roles Informed consent is mandatory to all intimate/private radiological procedures Medical Ethics concepts in maintaining patient medical legal requirement; Imaging cycles phases Effects of errors in diagnostic radiography Impact of errors in radiography Category of errors Technique errors Processing errors Summary Radiology services Hierarchy MRIS Background in Tanzania Training in the field of radiology Local training programs in the field of radiology Radiology services expansion/ reforms Education in the field of radiology Academic centers around the country that provide educational opportunities in the field of radiology The Catholic University of Health and Allied Sciences (CUHAS) in Mwanza also offers a The Kilimanjaro Christian Medical Centre (KCMC) was founded in 1971 and also runs Advancement in Radiology field Service arrangement in Medical radiology and imaging section Definition of Misconduct and an abuse Misconducts Medical Ethics Examples of abuse include but not limited to; Verbal Abuse – Threats of harm, saying things to intentionally frighten a client Neglect Carelessness or neglect Professional misconduct groups Working while impaired Abusive conduct Theft 5. Failure to obtain informed consent and breach of confidentiality Failure to share information with client Inadequate documentation and record keeping Misrepresentation Failure to meet legal /professional obligations Conflict of interest; Fraud Radiographer Major duties, tasks and responsibilities of radiographer Operate complex medical instruments such as MRIs, CT scanners, X-ray, ultrasound, and several other imaging devices. Maintain proper records of patient details ensuring confidentiality of sensitive information. Explain to patients and their family the details of a procedure and ways to manage possible side effects. Ensure compliance with health and safety guidelines to minimize risk of exposure to ionizing radiation. CLINICAL RESPONSIBILITY Make an easy relationship and reduce tension in the patient Legal responsibilities Procedures in the event of an accident Is responsible for continuous improvement of current practices Medical legal concepts in administering safe radiation to the patients Qualification for Diagnostic Radiographer Licensing Professional responsibility and accountability Professional duties Practice within Scope of profession Mobile radiography – perform relevant general examinations using mobile equipment in wards, ICU’s and emergency departments C-Arm fluoroscopy unit may be operated by a diagnostic radiographer in the operating theatre and cardiovascular theatre Dental radiography Learning objectives By the end to the session the students will be able to; List the Examinations requires the presence of chaperone Outline the circumstances under which a chaperone is required during an ultrasound / x-ray examination Explain the roles of chaperone Definition of terms A healthcare practitioner; is a person who has undergone appropriate training in providing any form of healthcare. This would include but not limited to; radiographers and nurses and Chaperone Definition A chaperone is a person who stands in as a witness for a patient and a medical staff during a procedure or assessment. Typically, a chaperone should be a medical practitioner / health professional Examinations requires the presence of chaperone Many examinations, especially those affecting anatomical areas of the chest (female), pelvis and upper thigh are potentially stressful or embarrassing /uncomfortable to the patient. Examinations involving the breasts, genitalia, anus or rectum are particularly intrusive /disturbing and may make the patient feel vulnerable /defenseless. Patients should be offered a chaperone of their gender, present during the examination, The chaperone would normally be another healthcare practitioner* and, in most cases, will act as a witness to verbal consent. and this applies whether or not the examination operator is the same gender as the patient. List circumstances under which a chaperone is required Circumstances under which a chaperone is required during an ultrasound / x-ray examination Breast ultrasound Intra cavitary ultrasound HSG, Urethrography, contrast enema Testicular ultrasound Possibly, on call ultrasound Ultrasound examinations outside of normal business hours Mammography The process for obtaining chaperones. Chaperone roles Be familiar with the procedure involved Be sensitive and respect the patients dignity Reassure the patient if they show signs of distress or discomfort Stay for the whole examination and be in a position to observe the examination if practical Be prepared to raise concerns if they feel the behavior or actions of the examination operator are inappropriate Informed consent is mandatory to all intimate/private radiological procedures Verbal consent in the presence of the chaperone, are required at the time of procedure The offer of a chaperone is for the protection of both the patient and the doctor Medical Ethics concepts in maintaining patient medical legal requirement; Diagnostic errors and negligence Learning objectives By the end to the session the students will be able to; Describe errors in diagnostic radiography Explain on how to reduce errors in diagnostic radiography Imaging cycles phases The imaging cycle represents the phases involved in medical imaging care. Three procedural phases are; Pre procedural (from time an image was requested until the time when the patient presented to have the image taken) Procedural (during taking the image), and Post procedural. Effects of errors in diagnostic radiography Errors that occur in medical imaging contribute to; increased radiation dose, compromised patient safety, wrong diagnosis, delayed treatment, and decreased efficiency Impact of errors in radiography Errors have significant impact on patient outcomes, health care workers' wellbeing, and the public's trust in the health care system Category of errors The majority if errors produced can be categorized into there groups Technique and projection errors Exposure errors Processing errors – chemical errors, film handling errors Technique errors Patient preparation error Radiopaque artefacts Blurred images Technical aspects Under or overexposure, Off centering Patient rotation, The use of one only projection, The presence of artifact Errors in interpretation Projection errors Incorrect angulations Processing errors Film