Gibson, Robin Margaret
This thesis investigates a perceived gap between the medical
profession’s rhetoric that the welfare of the patient is the
medical practitioner’s first priority, and the reality of
patient experience. The Medical Board of Australia’s Good
Medical Practice: A Code of Conduct for Doctors in Australia
mandates the duty of medical practitioners to make the care of
their patients their first priority. This code also confirms
that good medical practice is...[Show more] patient-centred.
Patient-centred care should therefore be central to patient
experience. However, despite promotion of this goal by medical
professional authorities, patient-centred care is not always
being achieved as well as it might in practice. This thesis is
an attempt to understand the reasons why this divergence between
rhetoric and practice is occurring, paying particular attention
to the role of the law as a potential and actual promoter of, and
barrier to, practices which are recognised components of
patient-centred care, and consequently of good medical practice.
This aim is developed through two case studies, the way valid
advance directives are observed or not, and the responses of
medical practitioners to injuries to patients sustained during
The methodology used includes analysis of hard law regulatory
processes together with the development of and increasing
reliance on the soft law documented in codes, guidelines and
other regulatory standards which reflect the evolving ideals of
medical professionalism. In turn, an examination of disciplinary
cases of tribunals and courts shows how conduct is interpreted in
accordance with what is or is not professional behaviour.
There is evidence that observance by medical practitioners of
patient-centred care is often being overwhelmed by the scientific
and technical aspects of medical practice and other pressures on
medical practitioners, such as concerns about legal liability.
The necessity for the observance of respect for the human being
who is the patient is discounted to these priorities despite
extensive evidence of improved outcomes for patients when
patient-centred principles are implemented. The reasons for this
discount are complex but a major contributor to the less than
optimum observance of patient-centred principles is medical
professionalism as fostered by the current methods of
socialisation and training of medical practitioners. Bullying
and humiliation of medical students in their training leads to
desensitisation and a consequent lack of attention by medical
practitioners to the necessity for patient-centred approaches to
An exploration of the direct and indirect impacts of the law upon
the medical profession shows the domination of medical
practitioner interests over the interests of their patients.
Therefore, this thesis considers whether the existing Australian
legislative regime can be applied to achieving the promotion of
the observance of quality, patient-centred practices by medical
practitioners to the mutual benefit of doctor and patient. It
argues that medical disciplinary authorities can use the
provisions of the Health Practitioner Regulation National Law
together with soft law regulation to more completely embed a
patient-centred culture in medical practitioner behaviour.
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