Doctor patient relationship
- 1. The Patient-Doctor Relationship Dr Umesh Bindal Senior Lecturer, School of Medicine, Faculty of Health, Taylor’s University, Malaysia
- 2. A model patient-doctor relationship • Trust • Compassion • Open and honest communication • Respect
- 3. Why is Doctor-Patient Communication Unique? • Trust – Patients on the first visit share their most personal information to someone they have never met before – They look to you for guidance when making critical health care decisions
- 4. Why is Doctor-Patient Communication Unique? • Trust – Within minutes of meeting, patients are often required to disrobe for a physical examination and are placed in a vulnerable situation
- 5. • A patient-physician relationship exists when a physician serves a patient’s medical needs • physicians’ ethical responsibility is to place patients’ welfare above the physician’s own self- interest
- 6. • relationship is entered into by mutual consent between physician and patient (or surrogate). • in certain circumstances a limited patient-physician relationship may be created without the patient’s (or surrogate’s) explicit agreement. Such circumstances include: 1. When a physician provides emergency care or provides care at the request of the patient’s treating physician. 2. When a physician provides medically appropriate care for a prisoner under court order 3. When a physician examines a patient in the context of an independent medical examination
- 7. Physicians are not ethically required to accept all prospective patients. • A physician may decline to establish a patient- physician relationship with a prospective patient in following circumstances: 1. The patient requests care that is beyond the physician’s competence or scope of practice 2. The physician lacks the resources needed to provide safe, competent, respectful care for the individual. 3. Meeting the medical needs of the prospective patient could seriously compromise the physician’s ability to provide the care needed by his or her other patients 4. The individual is abusive or threatens the physician, staff, or other patients
- 8. Patient Rights • To courtesy, respect, dignity, and timely, responsive attention to his or her needs • To receive information from their physicians and to have opportunity to discuss the benefits, risks, and costs of appropriate treatment alternatives, including the risks, benefits and costs of forgoing treatment. • To ask questions about their health status or recommended treatment when they do notfully understand what has been described and to have their questions answered. • To make decisions about the care the physician recommends and to have those decisions respected
- 9. • To have the physician and other staff respect the patient’s privacy and confidentiality. • To obtain copies or summaries of their medical records. • To obtain a second opinion. • To be advised of any conflicts of interest their physician may have in respect to their care. • To continuity of care
- 10. Patient Responsibilities • truthful and forthcoming with their physicians and strive to express their concerns clearly. • Provide as complete a medical history as they can, including providing information about past illnesses, medications, hospitalizations, family history of illness, and other matters relating to present health. • Cooperate with agreed-on treatment plans • Accept care from medical students, residents, and other trainees under appropriate supervision. But refusal of care by a trainee should be respected • Meet their financial responsibilities with regard to medical care or discuss financial hardships with their physicians. • Recognize that a healthy lifestyle can often prevent or mitigate illness
- 11. • Be aware of and refrain from behavior that unreasonably places the health of others at risk. • Refrain from being disruptive in the clinical setting. • Not knowingly initiate or participate in medical fraud. • Report illegal or unethical behavior by physicians or other health care professionals to the appropriate medical societies, licensing boards, or law enforcement authorities
- 12. A patient’s safe discharge from an inpatient unit, physicians should: • Determine that the patient is medically stable and ready for discharge from the treating facility • Collaborate with those health care professionals and others who can facilitate a patient discharge to • establish that a plan is in place for medically needed care that considers the patient’s particular needs and preferences. • If a medically stable patient refuses discharge, physicians should support the patient’s right to seek further review, including consultation with an ethics committee or other appropriate institutional resource.
- 13. Treating Self or Family • In general, physicians should not treat themselves or members of their own families. However, it may be acceptable to do so in limited circumstances: • In emergency settings or isolated settings where there is no other qualified physician available. • In such situations, physicians should not hesitate to treat themselves or family members until another physician becomes available. • For short-term, minor problems.
- 14. Special Issues in Patient-Physician Relationships • Disruptive Behavior by Patients • Consultation, Referral & Second Opinions • Use of Chaperones • Sports Medicine • Work-Related & Independent Medical Examinations • Gifts from Patients • Use of Remote Sensing & Monitoring Devices • Political Action by Physicians • Ethically Sound Innovation in Medical Practice • Ethical Practice in Telemedicine • Medical Tourism
- 15. Thank you