*3.2.4 Mentoring*

A mentor can have the capacity to listen and support a colleague and is a formal professionalism arrangement. Informal collegial behaviour is important but not guaranteed, so developing a mentoring relationship over time can assist a physician who needs career advice or advice on managing conflict or clinically challenging situations. Training programs frequently assign a formal mentor to new entrants, however comfortable mentoring relationships often grow organically.

## *3.2.5 Duty of Candour*

In some countries or states, doctors have a legal obligation to disclose details of adverse clinical events to patients and their families. In most areas of clinical practice, there is an ethical duty on the physician to openly discuss significant events or information which could impact patient care. Doctors in the ICU are supported in disclosing information with the support of senior hospital management. Meetings with patients where such matters are disclosed should be documented clearly in the patient's medical record. The patient should be offered psychological support and follow up after any adverse event.

## *3.2.6 Raising concerns*

All doctors have an ethical duty to document and voice concerns, with regard to clinical resources, patient care and community care of the patient. Safeguarding of patients involves a legal mandate in many countries to formally report a concern

## *Professionalism, Teamwork and Regulation in the Intensive Care Unit DOI: http://dx.doi.org/10.5772/intechopen.105034*

that a vulnerable patient is being subjected to abuse. Patients in ICU are vulnerable because of their critical illness and sedation levels which will generally compromise their capacity to advocate for themselves. If a doctor feels that they do not have access to the resources to safely care for their patients, they should clearly articulate this deficit in writing to senior management within their institution. Risk to patient's care is an important issue in the critical care environment. There are many publications cataloguing incidences of preventable patient harm, and it is a significant cost to the healthcare system in terms of litigation.

## *3.2.7 Managing a complaint*

Patients in ICU and their families may make a complaint about the care that they have received, or their outcome. Sometimes disagreements about direction of care or interventions can occur and it is wise to invest time into resolving potential disputes as soon as they arise. There are a small number of situations that will result in a formal complaint to hospital management even in the context of good quality patient care. Learning the tools to respond compassionately to a complaint, answer questions and give further information is vital to the doctor working in the high-pressure ICU environment. Having access to specific institutional supports is useful if they exist some hospitals will have a Patient Support Unit or Complaints Department that can assist in open communication with patients and their families. When a complaint is received it is crucial to take adequate time to review the patient's medical information and clinical course in ICU before responding. A calm response with an expression of empathy is essential. If possible, offer to meet the complainant to discuss the issue to their satisfaction. Both parties should have an accompanying support person, and the meeting should be documented. Open disclosure of facts is expected by complainants and their right to information must be respected. If there has been a poor outcome, this should be acknowledged, and further support offered.

## *3.2.8 Preparation of reports*

Patients who have been in the ICU occasionally warrant a report on their course in ICU. This may be requested by insurance companies, legal representatives or the Coroner. Reports should be prepared by the senior critical care physician involved in the admission of the patient to the ICU. Adequate time should be assigned to the task, with full access to clinical records. It is wise for the report to confine itself to the facts of the case and refrain from opinion unless specifically asked for. Preparation of a report may elicit a request to attend a court hearing to present the information, and this should be allowed as part of the duties of a senior doctor working in ICU.
