Lapses in professionalism in Sri Lankan doctors and their impact on patient outcomes

Abstract

INTRODUCTION AND OBJECTIVES: Today, the provision of optimal patient care and patient safety are the primary goals of healthcare delivery. Professionalism of doctors has an impact on achieving this goal. METHOD: This study was conducted as the Sri Lankan component of a collaborative qualitative research project with Taiwan on professionalism dilemmas faced by medical students. 64 Sri Lankan medical students described stories (narratives) of lapses in professionalism observed by them in clinical settings, at Focus Group Discussions (FGDs). The FGDs were audio-recorded and the transcripts were thematically analysed to explore the nature of lapses in professionalism and resulting patient outcomes. RESULTS: The students' narratives comprised lapses in communication, respect towards patients, accountability, integrity and probity, interprofessional relationships, compassion and care, acting within limitations, commitment to duty, managing conflicts of interests and ethical conduct in doctors in different grades. Such lapses have seemingly caused a variety of adverse patient outcomes: psychological distress, suboptimal treatment and even suicides and unwanted deaths. In almost all instances incidents were not reported, discussed or reflected upon to prevent future occurrences. Medical students appeared to suffer from high levels of moral distress due to observing such incidents but tended not to express their concerns due to their lowly status within the hierarchy. CONCLUSION: Lapses in professionalism in doctors appear to threaten patient safety and the provision of optimal patient care in Sri Lanka. The situation is unlikely to improve unless the hierarchical working culture changes to help students and doctors challenge such lapses.