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ccountability has recently been added as the ninth ethical principle of the FPI Code of Ethics. The following narrative is grounded in true events. Picture the consulting rooms of a medical practitioner.
“The test indicates diabetes,” says the clinician, the tone sympathetic. “I have often recommended changing your lifestyle, and now it is too late for preventative interventions.”
The patient retorts, “But why was diabetes never tested for during any of our prior consultations? For the past seven years, you have prescribed medication for three other lifestyle-related illnesses, and we have conducted health reviews every six months.”
The clinician replies, “You should have requested a diabetes test. It is your responsibility to inform me about possible symptoms that would indicate the need for testing. I cannot assume you are in a condition warranting a glucose test.” [End of scene]
Evaluation
What emerges from this scenario is the undeniable importance of preventative care and early intervention. Retrospectively, we often see that better outcomes are possible if action is taken sooner. However, life does not permit us to rely on hindsight or to conduct ourselves based on a series of “you should haves”. The real challenge, therefore, lies in establishing mechanisms of accountability before outcomes are known and before the need for intervention becomes urgent.
Further, what could reasonably be expected from a seven-year doctor-patient relationship? Should the standard be determined by the competence, training and practical experience of the healthcare professional? Is it instead shaped by the clearly expressed needs and self-advocacy of the adult patient? Or is there a third party to consider – the medical aid scheme – an external actor whose influence ensures that the healthcare professional does not oversell services or perform unnecessary procedures?
Each of these perspectives reveals different facets of accountability. The healthcare professional, by virtue of their training and ethical obligations, is expected to act in the patient’s best interests, anticipating potential conditions based on observed risk factors. The patient, meanwhile, is expected to take an active role in their own wellbeing by communicating openly about symptoms, concerns and lifestyle habits. The medical aid scheme, for its part, introduces a regulatory element, potentially designed to prevent over-servicing but often limiting the scope of care and the autonomy of both patient and practitioner.
What results is a complex interplay of responsibilities and expectations, all of which influence the ultimate outcome. This scenario prompts a vital question: in cases such as these, who is responsible for ensuring the best possible outcome for the patient or client? Too often, the enquiry focuses on identifying culpability for unfavourable results. Paradoxically, our usual approach is to regard accountability as the state of being answerable specifically for adverse impacts, rather than for the creation of positive outcomes.
Defining accountability
Accountability, however, should be understood more broadly. It is the explicit acknowledgement of responsibility for actions, decisions, services rendered and products delivered.
Responsibility in the professional context can be legal or moral (ethical) in nature. For accountability to be meaningful, there must be a clear and mutual understanding of the underlying relationships and expectations. It cannot exist in a vacuum, for in the absence of defined boundaries and roles, responsibility becomes limitless and, ultimately, unmanageable.
Accountability should be understood more broadly.
Therefore, context is paramount. The dynamics of accountability are shaped by the specific circumstances surrounding the interaction – be it in healthcare or any other professional setting. Each actor must understand both their own obligations and those of the other parties involved. Accountability becomes an active process, anchored in communication, clarity of expectations and a shared commitment to achieving the best possible outcomes.
In conclusion, this case study illustrates that accountability is not about retrospective blame, but rather about proactive ownership of outcomes. It demands explicit dialogue, clear role definition and an appreciation of the broader context in which professional relationships operate. Only then can individuals and institutions create environments where accountability leads not just to avoidance of negative consequences, but to the realisation of positive, tangible benefits for all involved.
