DOCTOR / DOCTOR AND DOCTOR PATIENT RELATIONSHIPS Idara C.E,

Reporting Impaired Physicians Physicians have as much a duty to report an impaired physician as they do to report child abuse. Although it is enormously confrontational, there is no discretion in terms of avoiding reporting an impaired physician when the impairment is clear. If a physician is not functioning normally and may be a danger to patients, his or her privacy is less important than the safety of his/ her patients.

Report physicians and students in training to their local supervisor first; Report a resident to his program director or department chair; Report a medical student to his dean or course director; Report an attending physician to the department chair or division head e.t.c. The key is to go to whoever might have authority over that physician The key is to go to whoever might have authority over that physician.

You are a fourth year medical student on a subinternship in obstetrics. You notice that the resident has come in with alcohol on his breath and some abnormal behavior. No one except you seems to notice. What should you do? a. Nothing; you are surbodinate to the resident b. Talk to the resident directly alone but don’t mention it to the program director c. Tell the dean of students d. Report him to the chairperson or program director of his department

Physician Disagreements If an attending physician disagrees with a resident’s improper management, there is little problem because the attending physician has the authority to overrule the resident. It becomes a problem when the resident disagrees with the attending physician. If the resident finds an error in management with the attending physician, the resident should discuss or confer with the attending physician. If these discussions are not satisfactory, bring the issue to whatever is the version of a higher authority locally. Confer with the division head or departmental chair, not the state licensing board Confer with the division head or departmental chair, not the state licensing board.

DOCTOR/ PATIENT RELATIONSHIP

Beginning and Ending the Relationship The relationship between a doctor and a patient is a voluntary one, entered freely on both sides. A patient cant be compelled to accept a particular doctor without his/ her agreement. A doctor must agree to accept a patient. A physician cant be compelled to accept a patient without his agreement. Once a patient and physician have entered into a care relationship, a physician cannot suddenly end the relationship. He/ she must maintain care of the patient until the patient can find an appropriate alternative source of care and he must give “ reasonable notice”.

Note: On the examination, a physician is not to abandon a patient, whether a patient doesn’t pay up or not. Even if a patient behaves badly, you cannot abandon your patient.

Gifts from Patients Small gifts of modest or minimal value are acceptable on the part of the physician as long as the patient doesn’t expect a higher level of care or a different form of therapy based on the gift. For gifts from pharmaceutical company, there is an automatic presumption that those gifts always carry an influence towards a product, service, or prescribing practice so do not accept such gifts.

You are a resident invited to dinner given by a pharmaceutical company. In addition to the dinner, there is a lecture given on a medical subject as well as a $500 gift certificate to a department store for attending the presentation. What is most appropriate? a. Refuse everything b. It is ethical to attend the lecture c. Do not accept the money, but the dinner and the lecture are ethically acceptable d. Accept all three components

Doctor/ Patient Sexual Contact Sexual contact between a physician and a patient is always inappropriate. THE PHYSICIAN AND PATIENT MUST MUTUALLY AGREE TO END THE PROFESSIONAL RELATIONSHIP AS DOCTOR AND A PATIENT. The American Psychiatric Association states that there can NEVER be a sexual or personally intimate private relationship between doctor and patient even after the professional relationship has ended.

 A 52 – year – old businessman establishes care with you. At the first visit, you discuss preventive measures such as exercise diet. The next week the businessman offers you tickets to the opera opening gala night. What is your appropriate response? a. “ I am so grateful and touched by your gift, but I’m so sorry I can’t accept it” b. “ Thank you so much for the gift” c. “ thanks a lot, I will also give the tickets to the resident”