1. Component 1: Introduction to Health Care and Public Health in the U.S.
Unit 6: Regulating Health Care
Lecture 5
This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

2. Objectives of This Lecture
Explain important issues in the physician-patient relationship
Communication
Integration
Decision-making
Review legal considerations in establishing and ending a physician-patient relationship
When does the physician have a right to refuse patients?
The concept of abandonment
Describe physician rights and responsibilities
Describe patient rights and responsibilities
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

3. Health IT Workforce Curriculum Version 2.0/Spring 2011
Communication
Physician duties
Attention
Respect
Concern
Patient duties
Questions
Accurate medical history
Designate advocate or family member
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

4. Health IT Workforce Curriculum Version 2.0/Spring 2011
Integration
Facilitation/navigation
Clinicians should help patient understand the health care system
Information sharing
All treatment team members get copies of reports
Patient informs treatment team about other appointments, tests, and procedures
Health plan information
Patient should be knowledgeable about coverage
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

5. Health IT Workforce Curriculum Version 2.0/Spring 2011
Decision-Making
Physicians
Consider individual patient characteristics
Make sure patients have enough information
Reveal any actual or potential conflicts
Patients
Accurately report adherence to treatment
Execute advance directives, if desired
Reveal preferences about options and risks
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

6. Establishment of the Relationship
Contract-based approach
A patient seeks treatment
The physician accepts the patient by acts such as performing an examination, giving a medical opinion, or treating the patient
Recently, judges have accepted more limited contact as evidence of a physician-patient relationship
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

7. Limits on Physician’s Right to Refuse Patients
Medical emergencies
No right to discriminate on the basis of race, gender, sexual orientation, gender identity, HIV status
Cannot refuse to treat someone they have a contractual obligation to treat
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

8. Physician’s Right of Conscience
The patient’s right to competent, accessible care sometimes sets up a conflict with the moral convictions of individual physicians
Many physicians believe they are not obligated to provide services
Physicians have an obligation to refer the patient to someone who will provide the services
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

9. Ending the Relationship
Notice
Certified mail, return receipt requested
Explanation
For example, repeated missed appointments
Transition time
Resources or recommendations
Transfer of records
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

10. Elements of Abandonment
Terminating the physician-patient relationship in such a way that the patient does not receive needed care
Examples
Relationship was ended by the physician without the patient’s agreement
Relationship was ended without reasonable notice
Relationship was ended while there was a need for continuing patient care
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

11. Health IT Workforce Curriculum Version 2.0/Spring 2011
Kinds of Abandonment
Intentional
Inadvertent
Mix-up about who is on call
Scheduling problem
Refusal of office staff to allow patient in crisis to talk with medical staff
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

12. Abandonment and End-of Life Care
Absence of continuity in physician-patient relationship
Lack of closure for family and friends
Scarce physician resources
Drain on physician emotional resources
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

13. Declaration of Professional Responsibility
“Respect human life and the dignity of every individual”
“Refrain from supporting or committing crimes against humanity and condemn all such acts”
“Treat the sick and injured with competence and compassion and without prejudice”
“Apply our knowledge and skills when needed, though doing so may put us at risk”
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

14. Declaration of Professional Responsibility (cont’d)
“Protect the privacy and confidentiality of those for we care and breach that confidence only when keeping it would seriously threaten their health and safety or that of others”
“Work freely with colleagues to discover, develop, and promote advances in medicine and public health that ameliorate suffering and contribute to human well-being”
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

15. Declaration of Professional Responsibility (cont’d)
“Educate the public and polity about present and future threats to the health of humanity”
“Advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being”
“Teach and mentor those who follow us for they are the future of our caring profession”
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

16. Goals of Patient’s Bill of Rights
Strengthen consumer confidence
Emphasize the importance of a solid relationship between patients and their health care professionals
Highlight the essential part that individuals have in protecting their own health
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

17. Elements of Patient’s Bill of Rights
Accurate, understandable information
Help for person with disability
Language barrier
Choice of providers and plans
Access to emergency services
Participation in treatment decisions
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

18. Elements of Patient’s Bill of Rights (cont’d)
Respect and nondiscrimination
Confidentiality of health information
Procedure for complaints and appeal
Patient assumes reasonable responsibility
Refrain from activities that damage health
Treat health care providers with respect
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

19. Other Patient Bills of Rights
American Hospital Association
Adopted by member hospitals
State governments
State medical boards
Agencies of federal government
Affordable Care Act (health care reform law)
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011

20. Health IT Workforce Curriculum Version 2.0/Spring 2011
Summary
The physician-patient relationship is the foundation of the health care delivery system
There are legal implications in establishing and ending a physician-patient relationship
Once the relationship is established, both the physician and the patient have many rights and responsibilities
Good communication and mutual respect are important factors in creating an effective physician-patient relationship
Component 1/Unit 6-5
Health IT Workforce Curriculum Version 2.0/Spring 2011