April 2004 - Physicians and Other Health Care Professionals

In recent years increasing attention has been focused on the ethical aspects of relationships among members of the health care professions. While the traditional hierarchical relationship of physician and patient has been undergoing considerable modification in favour of the patient (cf. the WMA Declaration on the Rights of the Patient, other health care professions have been questioning the predominance of the medical profession in matters relating to the care of patients. In order to avoid competition that could be detrimental to the interests of patients, some medical associations, including the WMA, have engaged in discussions and joint activities with representatives of other health care professionals in order to establish optimal working relationships.

The WMA's principal activity in this field is its participation in the World Health Professions Alliance together with the International Council of Nurses and the International Pharmaceutical Federation. The WMA has close working relationships with other international health professional associations, notably the International Dental Federation.

The WMA's principal policy document on inter-professional relationships is the Statement on the Working Relationship between Physicians and Pharmacists in Medicinal Therapy, adopted at the Tel Aviv Assembly in October 1999.

Several National Medical Associations have participated in joint activities with other health professional associations. Here are links to reports of some such activities:

Australian Medical Association, "Doctors and nurses get together on health policy"
"Restraints for elderly a last resort: AMA and nurses develop new guidelines"

Canadian Medical Association, Canadian Nurses Association, Canadian Pharmacists Association, "Joint Statement on Scopes of Practice"
English version
Version française

Canadian Medical Association, Canadian Nurses Association, Canadian Healthcare Association, Catholic Health Association of Canada, "Joint Statement on Resuscitative Interventions"
English version
Version française

Canadian Medical Association, Canadian Nurses Association, Canadian Healthcare Association, Catholic Health Association of Canada, "Joint Statement on Preventing and Resolving Ethical Conflicts Involving Health Care Providers and Persons Receiving Care"
English version
Version française

The WMA would like to hear from other National Medical Associations about their interactions with other health professional organizations in order to publicize best practices in this area.

March 2004 - Patient Safety

It has become widely recognized in recent years that the traditional principle of medical ethics, "Above all, do no harm" (in Latin, "primum non nocere") is not observed to the extent that it should be. Both the increasing number of successful lawsuits against physicians and hospitals and studies such as the 1999 report of the U.S. Institute of Medicine, To Err is Human: Building A Safer Health System, demonstrate that much needs to be done to reduce the prevalence of adverse outcomes in health care.

The 2002 WMA General Assembly adopted a Declaration on Patient Safety that calls on National Medical Associations to initiate and promote policies and practices to reduce iatrogenic mortality and morbidity. NMA activities in this regard including the following:

• The American Medical Association was the founding sponsor of the National Patient Safety Foundation, which undertakes research and education on patient safety and related issues.
  
• The British Medical Association has produced a discussion paper on Patient Safety and Clinical Risk.
  
• The Canadian Medical Association has developed a Patient Safety Policy Framework [français - Cadre stratégique sur la sécurité des patients] and was successful in getting Canadian federal, provincial and territorial governments to establish The Canadian Patient Safety Institute.
  
• The Japan Medical Association is actively involved in promoting patient safety and improving the quality of health care. The JMA Health Care Safety Policy Committee is involved in basic research on medical risk management procedures that is compiled into an important annual report. The Committee on Development of Safe Medical Equipment collaborates with medical equipment manufacturers to develop safe equipment and instruments to prevent mistakes by medical personnel. The JMA provides educational opportunities for medical personnel aimed at disseminating knowledge on patient safety. Patient safety has been selected as a main theme for the JMA seminars, where specialists from abroad are invited as keynote speakers. In addition, a correspondence course to foster patient safety personnel, who fulfil a central role in promoting the safety of the patient at respective medical and health facilities, is offered to improve health care quality.

The World Health Organization considered reports on patient safety at its recent Executive Board and Assembly meetings and supported the creation of an International Alliance for Patient Safety in November 2003.

Cf. http://dmoz.org/Health/Public_Health_and_Safety/Patient_Safety/ for a list of web-based resources on patient safety.

The WMA would like to hear from other National Medical Associations about their patient safety initiatives in order to publicize best practices in this area.