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

2. Context of practice  The physician should not treat self, family, colleagues, or personal friends  This is an ethical, not a legal requirement  The physician should send friends and family to a colleague for care

3. 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.

4. 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.

5. 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

6. DOCTOR/ PATIENT RELATIONSHIP

7. Beginning and Ending the Relationship The relationship between a doctor and a patient is a voluntary one, entered freely on both sides. A patient can’t 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”.

8. 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.

9.  Do not get in the way of another physician- patient relationship  If a patient complains about another physician, ask if the patient has told that doctor about the concerns  If a patient tells you about inappropriate behavior, intervene  Help patient report behavior  Provide referral to alternative physician

10. 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. Valuable gifts are considered unethical, politely decline the gift when offered. For gifts from pharmaceutical companies, 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.

11. 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

12. Doctor/ Patient Sexual Contact Due to the inherent inequality of the doctor- patient relationship, romantic or sexual relationships with current or former patients are prohibited. 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.

13.  A 52 – year – old businessman establishes care with you. At the first visit, you discuss preventive measures such as exercise and 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”

14. In conclusion:  Do not go to the court  Do not go to the ethics committee  Do not seek the advice of another physician  Never leave the room  Referrals are fine medical practice, but bad exam answers