Chapter 5 - The Physician-Patient Relationship

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Human Dignity

A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity.

Honesty

A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception

Responsibility to Society

A physician shall respect the law and recognize a responsibility to seek changes in those requirements that are contrary to the best interests of the patient.

Confidentiality

A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidence within the constraints of the law.

Continued Study

A physician shall continue to study, apply, and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals as needed.

Freedom of Choice

A physician shall, in the provision of appropriate health care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide service.

Responsibility to Improved Community

A physician shall recognize a responsibility to participate in activities contributing to an improved community.

Responsiblity to Patient

Responsiblity to patient is paramount

Patient Access to Medical Care

Must support access to medical care for all people.

Accepting Gifts

Gifts to physicians from medical companies can be accetped only if they relate to the physician's medical practice. However, drug samples from pharmaceutical companies can be accepted for patient use.

Conflict of interest

Physicians should not place their own financial interests above the patient's welfare.

Professional Courtesy

Historically, there is an unwritten practice among many physicians taht they would not charge each toher for professional services. However, this practice has lost favor because many physicians are concerned about the lack of documentation when seeing a fellow physician free of charge.

Reporting Unethical Conduct

A physician should report any unethical conduct by other physicians.

Second Opinions

Physicians should recommened that patients seek a second opinion whenever necessary.

Sexual Conduct

It is unethical for the physician to engage in sexual conduct with a patient during the physician-patient relationship.

Treating Family Members

Physicians should not treat members of their families except in an emergency.

Dumping Crisis

When a private hospital emergency room sends an indigent patient to a public hospital emergency room.

The Comprehensive Omnibus Budget Reconciliation Act (COBRA)

contains an amendment that prohibits "dumping" patients from on facility to another. It is now a federal offense to do this. This amendment does not mandate treatment, but it does require a hospital to stabilize a patient during an emergency situation.

Abandonment

withdrawing emdical care from a patient without providing sufficient notice to the patient. Considered to be a civil wrong or tort and condsidered to be a breach of contract and even negligence.

Certified Mail - Abandonment

Sending a letter by certified mail is the best method physicians can use to protect themseleves from a charge of abandoment when they have to sever a relationship with a patient.

Against Medical Advice (AMA)

when a noncompliant patient leaves a hospital without physician's permission

Acquired Immunodeficiency Syndrome (AIDS)

is a diease resulting in infections that occur as a result of exposure to the human immunodeficiency virus (HIV), which causes the immune system to break down. First documented in the US in 1980.

Americans with Disabilites Act (ADA)

A federal law, protects HIV and AIDS patients from discrimination.

Prognosis

Prediction for the course of their disease

Medical Patients Rights Act

provides that all patients have the right to have their personal privacy respected and their medical records handled with confidentiality.

Privileged Communication

refers to confidential information that has been told to a physician (or attorney) by the patient.

Patient's Bill of Rights

descrbies the physician-patient relationship

Self-Determination Documents or Advance Directives

States the patinet's intentions for healthcare-related decisions and in some cases name another person as proxy to make decisons for the patient.

Proxy or Agent

a person who acts on behalf of another person

Proxy Statement

is the written authorization given by a person so that a second person can act for him or her.

Advance Directive

is a written statement in which people state the type and amount of care they wish to receive during a terminal illness and as death approaches.

Living Will

Document that a person drafts before becoming incompetent orunable to make heathcare decisions.

Durable Power of Attorney for Healthcare

A legal doucment that empowers another person (proxy) to make healthcare decisions for an incompetent patient. It goes into effect after the person beomces incompetent and only pertains to healthcare decisons.

Uniform Anatomical Gift Act

All states have some form of this law. It allows persons 18 years or older and of sound mind to make a gift of any part of their body for purposes of medical research or transplantation.

Do not Resuscitate (DNR) Order

This is an order placed into a person's medical chart or medical record. It indicates taht the person does not wish to be resuscitated if breathing stops.

Modified Rights of Terminally Ill Act

which states that the person must be terminally ill and/or in a state of permanent unconsciousness. The patient must be in a state that is irreversible, untreatable, and incurable with the prospect of imminent death.

Patient Self-Determination Act (PSDA)

was passed in 1991 and states that congress has stongly supported a person's right to self-determination before beoming incompetent.

Minor

is a person who has not reached the age of maturity, which in most states is 18.

In loco parentis

consent of the parents or someone standing in for the parents

principle of parens patriae authority

occurs when the state takes responsiblity from the parents for the care and custody of minors under the age of 18.

mature minor

a person judged to be mature enought to understand teh physician's instructions. Such a minor may seek medical care for treatment of drug or alcohol abuse, contraception, venereal disease, and pregnancy.

Emancipated Minor

a person between the ages of 15 and 18 who is either married, in the military, or self-supporting and no longer lives under teh care of a parent. Parental consent for medical care is not required. Proof of emancipation should be included in the medical record.

Consent

is the voluntary agreement that a patient gives to allow a medically trained person the permission to touch, examine, and perform a treatment.

Informed or Expressed Consent

means taht the patient agrees to the proposed course of treatment after having been told about the possible consequences of having or not having certain procedures and treatments. The patients's signature on the consent form indicates that the patient understands the limits or risks involved in the pending treatment or surgery as explained by the physician.

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