Listening to patients and doctors: how voice strengthens good medical practice

Trust is the essential foundation of medical practice, anchoring the relationship between doctors, patients and the public. Doctors earn the trust of patients by being trustworthy—by practicing with the highest standards of professionalism and ethical conduct.

As the regulator tasked with protecting public safety, Te Kaunihera Rata o Aotearoa | Medical Council of New Zealand recognises that the standards it sets for doctors must be both clinically grounded and reflective of what patients, whānau and communities expect when they seek care. Patients’ expectations of their doctors are changing, and we need to understand that change.

That is why the Council sought feedback from both patients and doctors on the core ethical standards expected of doctors, as currently described in Good Medical Practice.¹ The feedback gives us an important opportunity to listen to the people who use, apply and experience those standards in different ways.

Patients and whānau bring an important perspective of those who place trust in doctors, often at times of uncertainty, vulnerability or distress. Integrating this with doctors’ feedback and the realities of clinical responsibility, professional judgement and the pressure of day-to-day practice provides diverse perspectives. These different perspectives can inform the standards we set, ensuring they remain relevant, fostering trust even in times of uncertainty and distress.

The patient feedback was striking in its clarity. Patients consistently emphasised the importance of being listened to, treated with respect and involved in decisions about their care. Trust, clear communication and cultural respect were recurring areas of practice that patients rated as most important. Respecting cultural background and beliefs, and the role of whānau in care, were other aspects that patients valued.^2,3

The doctor feedback brought a different, but complementary, perspective. Doctors described using Good Medical Practice to support ethical decision making, professional boundaries and supervision, reporting that it supports their practice. They also identified areas where clearer or more practical guidance would help, including on topics such as cultural safety, technology, workload pressures and team-based care.^1,2,4

Medicine has changed significantly over recent years. Digital communication, telehealth, artificial intelligence (AI), multidisciplinary models of care, workforce pressures and resource constraints all shape the environment in which doctors make decisions. The feedback from doctors shows that doctors want standards and guidance that help them navigate complexity. In many areas of practice, the challenge is knowing how to apply professional obligations in situations where clinical, cultural, organisational and technological factors intersect. Core concerns for doctors were resource constraints in the current environment, burnout and the use of AI in clinical practice.⁴

Patients and doctors concur on several areas of feedback. Patients want to be listened to and involved. Doctors want guidance that helps them communicate clearly, practice safely and make sound decisions. Patients want respect, trust and to receive culturally safe care. Doctors want standards that help them maintain those values in busy, pressured and increasingly complex environments. Both groups are pointing to the same foundation: good medical practice depends on relationships of trust.

This feedback informs how we think about standards and guidance and also about medical education and how we communicate and engage. It helps us test whether our expectations are clear. It helps identify where guidance may need more practical explanation. It helps us understand where the public sees risk, and where doctors see uncertainty. It also helps ensure that our work is shaped by the lived experience of patients and the professional experience of doctors.

This is particularly important because standards do much more than set minimum expectations. They influence our professional medical culture. They provide reference points for education, supervision and reflection. They are used by doctors, employers and educators. They also help the public understand what they can expect from doctors. For standards to serve those functions well, they must be trusted by both the profession and the public. The Council undertakes this standards work within its statutory role under the Health Practitioners Competence Assurance Act 2003 to protect public safety.⁵

Feedback is most useful when it is considered carefully and in context. Survey results, written comments and engagement with patients and doctors each offer different forms of insight. Some responses show broad areas of agreement. Others point to issues where expectations are changing, where guidance may need to be clearer or where standards are most tested in practice.

The value of hearing from both patients and doctors is that each perspective helps complete the picture. Patients describe what safe, respectful and trustworthy care feels like. Doctors describe the realities of providing that care across increasingly complex clinical, cultural, technological and organisational settings. Taken together, these perspectives help the Council understand not only what standards should say, but how they are understood and applied.

That matters in the health environment. Workload, workforce pressures and resource constraints affect both doctors and patients. They shape the context in which care is delivered, but they do not lessen the importance of honesty, respect, communication, cultural safety and sound professional judgement. Good guidance should support doctors to uphold these obligations in real-world settings while keeping the experience and safety of patients, whānau and communities at the centre.

The patient voice is especially important in this work. Regulation can become overly inward-looking if it is shaped only by professional systems and institutional processes. Patients, whānau and communities help keep the focus on what matters at the point of care: being heard, being informed, being treated with dignity and being able to trust that the doctor is acting with competence, honesty and respect. This aligns with broader expectations in Aotearoa New Zealand, including the rights of consumers to respect, effective communication, information, informed choice and support.^6,7

The doctor voice is equally important. Standards that are not understood or cannot be applied well in practice are unlikely to achieve their purpose. Doctors can tell the Council where guidance is clear, where it is ambiguous and where examples or practical explanation would help. They can also identify emerging areas of practice where ethical expectations need to be considered before problems become entrenched.

This is why engagement with both patients and doctors needs to be part of the Council’s ongoing approach to standards work. It is not an optional consultation exercise at the end of a process. It is one of the ways the Council can maintain accountability, support right-touch regulation and promote standards that are meaningful in practice. The Council’s strategic direction places emphasis on accountability, equity, right-touch regulation and using data to inform improvement.⁸ The feedback received on Good Medical Practice sits within that approach.

There is also an important equity dimension. Patients’ comments about cultural respect, Te Tiriti and whānau involvement reinforce that good medical practice in Aotearoa New Zealand must be understood in its local context. Cultural safety is not an abstract regulatory concept. Cultural safety is about how patients experience their care. Standards and guidance have a role in supporting doctors to reflect on their own practice, understand the communities they serve, and contribute to more equitable health outcomes.⁹

The publication of the patient and doctor feedback reports is therefore not simply a record of what people said. It is a reminder of how standards should be developed, communicated and used. Standards are strongest when they are informed by the people most affected by them. They need to be principled enough to support accountability, practical enough to guide doctors and clear enough to be understood by the public.

The core message from the feedback is reassuring. The values that underpin good medical practice remain sound: trust, respect, honesty, competence, communication, cultural safety and partnership. What changes is the environment in which those values must be applied. As medicine evolves, the Council’s standards work must continue to draw on both patient and doctor voice so that guidance remains current, practical and trusted.

Good medical practice is demonstrated in the quality of decisions doctors make, the way patients and whānau are treated and the trust the public can place in the profession. Listening carefully to both patients and doctors helps the Council support that trust. It also reminds us that professionalism and standards of ethical conduct are written for the moments where care is given, decisions are made and trustworthiness is demonstrated.