THE topic of religious beliefs and medical practice has been hotly debated in recent months, thanks largely to a high-profile General Medical Council case that made many media headlines.
It is likely you will have read reports about the Christian GP who was issued a warning by the GMC for causing a patient distress by discussing religion with him. It sparked a furious debate, with the regulator concluding that the GP had breached its guidelines that forbid doctors from imposing their own beliefs onto patients.
While this case might suggest religion has no place in the consulting room, the fact is that many practices across the UK operate quite successfully within a religious or spiritual ethos – whether it be Christian, Muslim, Jewish or another faith. In some instances the practice as a whole operates within a religious framework or often one or more GPs within a practice treat patients in line with their personal beliefs.
What this means in practice is that religious doctors may occasionally choose not to provide certain treatments such as contraception, abortion or sometimes fertility treatment, choosing instead to refer to another physician. Religious doctors may also, where appropriate, broach the subject of faith with a patient during a consultation and in some cases offer to pray with them.
So how does this impact on the role of practice manager?
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In the good management of any practice it is important to have appropriate policies in place to deal with the many issues that arise and the same applies for faith-related matters.
Where one or more of your GPs practise in line with their faith, and may therefore occasionally choose not to provide certain treatments, it is important to have an appropriate policy in place for dealing with such a situation. This policy should include measures to ensure patient treatment is not adversely affected, it should be in line with the GMC’s guidance Personal Beliefs and Medical Practice and all staff should be familiar with it.
An updated version of the guidance is currently out for consultation and states that doctors should be free to practise medicine in accordance with their beliefs, provided that in doing so they are not denying patients access to appropriate medical treatment or services, or causing distress to patients.
It also makes it clear that doctors must not express their personal beliefs to patients “in ways that exploit their vulnerability or that are likely to cause them distress.” It takes a firmer line on faith discussions, stating: “You may talk about your own personal beliefs only if a patient asks you directly about them or the patient indicates they would welcome such a discussion.”
Dr Peter Saunders is chief executive of the Christian Medical Fellowship, an organisation that supports 4,000 practising Christian doctors across the UK, around half of whom are GPs.
He says faith discussions should be based around the principles of “sensitivity, permission and respect”. “We would certainly not encourage a doctor to continue a faith discussion if the patient has said they are not interested,” he says. “It would only take place if the patient welcomed it.”
The GMC’s guidance goes on to state that doctors “must explain to patients if you have a conscientious objection... You must tell them of their right to see another doctor and make sure they have enough information to exercise that right.” In some faith practices, the manager can play an important role in ensuring patients seeking certain treatments are seen by a doctor who will not object to providing those treatments.
Retired GP Dr Kenneth Collins is a former chair of the Scottish Council of Jewish Communities. He says managers in faith practices have a variety of issues to consider.
He says: “In a practice which is solely guided by faith, the practice manager would clearly have an important role in policy issues. There may also be a need to operate a dierent timetable; for example a religious Jewish practice which will have been closed from before the onset of the Sabbath on a Friday afternoon in December might be expected to have consulting on a Sunday morning.”
Faith practices sometimes choose to offer a chaplaincy service and the way this is administered should also be set out in a practice policy. Some practices will include information about the service on their website or in practice literature while reception staff may offer patients the option of meeting with the chaplain when they contact the surgery.
It is possible chaplains may request full access to the records of patients they meet and clearly this must be done with the patients’ express consent, with the relevant measures in place to protect confidentiality.
In any faith-related practice it is important that non-religious patients and staff do not feel excluded in any way. This is another important duty for the practice manager.
Dr Collins says non-religious patients must be assured that their care will be of an equally high standard to other patients and that due care will be given to their own value systems, adding: “Where there is a variety of faiths within a practice the practice manager will have to ensure that the sensitivities of each group are catered for.”
Where a chaplaincy service is provided, it should be clear that it is available to everyone, regardless of their beliefs. Chaplains will typically be given a room within the practice where they can talk to patients in confidence and offer support in the form of prayer or provide information on church or community support groups.
Similarly, non-religious staff working in faith practices should not be treated differently to their religious colleagues. To show favouritism towards or bias against any member of staff risks falling foul of the Equality Act or other employment laws. And where your practice consists of a mix of religious and non-religious doctors, you should be alert to any potential religious discrimination between colleagues as this is expressly prohibited under the GMC guidance.
If in doubt on any issues regarding personal beliefs and medical practice, contact MDDUS for more specific advice.
Joanne Curran is an associate editor of Practice Manager