1. 5 The Physician-Patient Relationship
Journal Topic: What rights does a physician have when practicing medicine and when accepting a patient.

2. Learning Objectives Define the key terms.
Describe the rights a physician has when practicing medicine and when accepting a patient.
Discuss the nine principles of medical ethics as designated by the American Medical Association (AMA).
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3. Learning Objectives Summarize “A Patient’s Bill of Rights.”
Understand standard of care and how it is applied to the practice of medicine.
Discuss three patient self-determination acts.
Describe the difference between implied consent and informed consent.

4. Physician–Patient Relationship
Both must agree to form relationship for there to be contract for services (implied contract)
Under contract for services, patient can expect doctor to provide medical service for as long as necessary
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5. Physician–Patient Relationship
Patient must confide truthfully to physician
Physician is not liable if critical information withheld
Patient information is confidential
Includes overheard or read

6. Physician's Rights Right to select patients
Right to refuse service to patients
Right to determine type of services provided
Right to be paid for services rendered
Right to withdraw from relationship
Right to vacation and time off

7. Physician's Responsibilities
AMA's Statement of Principles
Human dignity
Honesty
Responsibility to society
Confidentiality
Continued study
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8. Physician's Responsibilities
AMA's Statement of Principles
Freedom of choice
Responsibility to improve community
Responsibility to patient is paramount
Must support access to medical care for all people

9. Physician's Duties Patient welfare above financial interests
Professional courtesy
Report any unethical conduct by other physicians
Recommend second opinions when necessary
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10. Physician's Duties
Do not engage in sexual conduct with a patient during the physician-patient relationship
Do not treat family members except in emergencies

11. Professional Practice Responsibilities
Duties during a medical emergency
Cannot ethically or legally turn away patient in an emergency situation
If unable to treat patient, then must call for emergency assistance
Patients cannot be turned away if indigent or uninsured

12. Duty to Treat Indigent Patients
"Dumping crisis"
EMTALA
Requires patient stabilization in an emergency
Physician has right to select which patients to treat
Physician does not have right to drop or abandon patients once treatment is agreed upon

13. Duty Not to Abandon a Patient
Once physician agrees to take care of patient, contract may not be improperly terminated
Physician may be charged with abandonment if formal notice of withdrawal is not given
Civil wrong, or tort
Physician must allow patient time to seek service of another physician
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14. Duty Not to Abandon a Patient
Licensed healthcare providers are also subject to this principle
Dentists
Physician assistants
Nurse practitioners

15. Noncompliant and Incompetent Patients
Fails or refuses to cooperate
Incompetent
Unable to provide for own needs
Status decided by court of law

16. Duty to Treat Patients with AIDS
Unethical to refuse to treat, work with, or provide housing for person who is HIV-positive or has AIDS
Physician, by law, must make full report to state about any patient who is HIV-positive or has AIDS
Ethical dilemma
Report required regardless of consequence
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17. Duty to Treat Patients with AIDS
Ethical considerations
Persuade patient to inform his or her partner(s)
Notify authorities if concerned that patient will not inform others
As last resort, notify patient's partner(s)

18. Exposure of Health Care Workers to Patient's Blood
A 0.3 percent risk of contracting HIV after blood exposure, according to the CDC
HIV testing of patient's blood allowed in some states

19. Restrictions on HIV-Infected Healthcare Workers
Various recommendations, but no rules
AMA
American Academy of Orthopedic Surgeons
Federation of State Medical Boards
Strongest statement
Recommends names of HIV-infected healthcare workers be reported
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20. Restrictions on HIV-Infected Healthcare Workers
Various recommendations, but no rules
CDC
Testing all healthcare workers would be prohibitive
No ethical duty to disclose HIV status if no significant risk presented to patients

21. Duty to Properly Identify Patients
Identify patient both by stating his or her name and examining any other identification
Arm band
Driver's license
Use discretion with patient sign-in sheets to protect confidentiality
Have patient state name

22. Duty to Respect Confidentiality
Speak in low voice
Glass enclosure should separate front desk receptionist from waiting room
Sign-in sheet should consider protection from subsequent patients

23. Duty to Tell the Truth
Many believe principles of justice apply when dealing with truth-telling
Try to determine the "just" action for patient
Just action may be at variance with obligation of confidentiality
Confidentiality may be overridden when life or safety of patient is endangered

24. Patient's Rights Right to confidentiality
Privileged communication
Right to give informed consent
Right to privacy
Right to be informed of advantages and potential risks of treatment
Right to refuse treatment

25. Confidentiality
All information and records about treatment will be kept confidential by physician and staff unless consent to release is obtained
Breach of confidentiality is both unethical and illegal
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26. Confidentiality Medical Patients Rights Act Privileged communication
All patients are entitled to have privacy respected and medical records handled confidentially
Privileged communication
Confidential information told to a physician or attorney by a patient
HIPAA regulations must be observed (Chapter 10)

27. Patient Self-Determination Acts
Advanced directive
Living will
"Do Not Resuscitate" order
Durable power of attorney
Uniform Anatomical Gift Act
Patient may revoke these documents
Family may consent on the deceased patient's behalf

28. Definition of Minors Minor In Loco parentis Parens patriae
Person under the age of maturity (18 in most states)
In Loco parentis
Person assigned by court to stand in place of parents
Parens patriae
State takes over care for minor
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29. Definition of Minors Mature minor
Person in mid to late teens who, for health care purposes, is considered mature enough to comprehend physician recommendations and give informed consent
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30. Definition of Minors Emancipated minor
Person in mid to late teens who legally lives outside parents' or guardian's control
Proof should be included in medical record

31. The Patient's Responsibilities
Follow physician's instructions
Make follow-up appointments and monitor treatment and medication use if requested by physician
Be honest
Pay for medical services
Provide informed consent

32. Consent
Voluntary agreement by patient to allow medically trained person to touch, examine, and perform treatment
Two types
Informed (expressed) consent
Implied consent

33. Doctrine of Informed Consent
Informed or Expressed Consent
Patient agrees to course of treatment after being told consequences of having or not having certain procedures and treatments
Signature indicates patient understands limits or risks involved as explained by physician
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34. Doctrine of Informed Consent
Requires physician to explain in understandable language
Diagnosis
Nature of proposed treatment
Advantages and risks of treatment
Alternative treatments available to patient
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35. Doctrine of Informed Consent
Requires physician to explain in understandable language
Potential outcomes of treatment
What might occur—risk and benefits—if treatment is refused

36. Implied Consent
Patient indicates by behavior that he or she accepts procedure
i.e., offers arm to have blood sample drawn
Consent is assumed in medical emergencies, when patient cannot respond to give consent

37. Exceptions to Consent Need not inform of commonly known risks
Need not inform if disclosure of risks may be detrimental to patient
Need not inform if patient asks physician not to disclose risks
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38. Exceptions to Consent
Not required to restore patients to original health
Cannot elicit cure for every patient
Cannot guarantee successful results of every treatment

39. Refusal to Grant Consent
Adult patients conscious and mentally capable have right to refuse any medical or surgical treatment
Refusal must be honored no matter what patient's reasoning
Failure to respect right of refusal could result in liability for assault and battery

40. Role of Health Care Consumer
Do not self-medicate
Be honest with physician
Assist physician in prevention of medical errors