Component 1- Introduction to Health Care and Public Health in the US Unit 6- Regulating Health Care Lecture e- The Physician Patient Relationship

Objectives Describe physician rights Describe physician duties Describe patient rights Describe patient responsibilities Component 1/Unit 6e2 Health IT Workforce Curriculum Version1.0/Fall 2010

The Physician-Patient Relationship The relationship between the physician and patient is the pivotal relationship in healthcare. The physician and the patients have rights and responsibilities. Health care professionals (excluding physicians) have responsibilities to the physician and to the patient. Component 1/Unit 6e3 Health IT Workforce Curriculum Version1.0/Fall 2010

The Physician-Patient Relationship (continued) Physician rights –Select patients to treat –Refuse to treat patients –Location of office –Hours of availability –Expect payment for services rendered –Take vacation and be unavailable to care for patients during this time Component 1/Unit 6e4 Health IT Workforce Curriculum Version1.0/Fall 2010

The Physician-Patient Relationship (continued) Physicians’ Declaration of Personal Responsibility –We, the members of the world community of physicians, solemnly commit ourselves to: I. Respect human life and the dignity of every individual. II. Refrain from supporting or committing crimes against humanity and condemn all such acts. III. Treat the sick and injured with competence and compassion and without prejudice. Component 1/Unit 6e5 Health IT Workforce Curriculum Version1.0/Fall 2010

The Physician-Patient Relationship (continued) IV. Apply our knowledge and skills when needed, though doing so may put us at risk. V. Protect the privacy and confidentiality of those for whom we care and breach that confidence only when keeping it would seriously threaten their health and safety or that of others. VI. 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 6e6 Health IT Workforce Curriculum Version1.0/Fall 2010

The Physician-Patient Relationship (continued) VII. Educate the public and polity about present and future threats to the health of humanity. VIII. Advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being. IX. Teach and mentor those who follow us for they are the future of our caring profession. We make these promises solemnly, freely, and upon our personal and professional honor. Component 1/Unit 6e7 Health IT Workforce Curriculum Version1.0/Fall 2010

The Physician-Patient Relationship (continued) Physician Duties (usually required by law) –Duty during a medical emergency Cannot turn away a patient who needs emergency treatment, is indigent or uninsured –Duty not to abandon a patient When a physician takes a patient under his/her care, there is an implied contract between the two. If the physician does not want to continue treating the patient, he/she must tell the patient and give them time to find another provider. If not, this is considered abandonment. Component 1/Unit 6e8 Health IT Workforce Curriculum Version1.0/Fall 2010

The Physician-Patient Relationship (continued) –Abandonment is a civil wrong or a tort. It is considered breach of contract and even negligence. For example, if a physician would not schedule a patient for post-operative care because the patient or the insurance company did not pay the bill for the surgery, this would be negligence and abandonment Component 1/Unit 6e9 Health IT Workforce Curriculum Version1.0/Fall 2010

The Physician-Patient Relationship (continued) –A physician would not be liable if a competent, hospitalized patient signed him-or herself out of a hospital against medical advice (AMA). The patient is noncompliant and the physician is not legally responsible –A physician may get a judge’s order to hospitalize an incompetent patient. A hearing will occur within 72 hours of admission to determine if the patient will remain hospitalized. Component 1/Unit 6e10 Health IT Workforce Curriculum Version1.0/Fall 2010

The Physician-Patient Relationship (continued) –Duty to treat patients with AIDS Physicians have an ethical dilemma when treating AIDS patient to maintain confidentiality and risk the possibility of a lawsuit if the person’s contacts contracts the disease. –Duty to properly identify patients To ensure patient safety and prevent medical errors, the patient needs to be identified by stating their name and checking at least one additional source of identification, such as a wrist band. Component 1/Unit 6e11 Health IT Workforce Curriculum Version1.0/Fall 2010

The Physician-Patient Relationship (continued) –Duty to tell the truth The physician faces an ethically dilemma to tell a terminally ill patient the truth about the projected course of their disease. The news can be disturbing and unsettling for some patients. This news can also be a call to action to empower the patient to take control of the remaining time on this earth. Component 1/Unit 6e12 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Rights Just like a health care professional, patient have rights, too. These rights include –The right to considerate and respectful care –The right to and is encouraged to obtain from the physicians and other direct caregivers relevant, current, understandable information concerning diagnosis, treatment, and prognosis Component 1/Unit 6e13 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Rights (continued) –The right to make decision about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the consequences of this action. Component 1/Unit 6e14 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Rights (continued) –The right to have an advance directive (such as a living will, healthcare proxy, or durable power of attorney for healthcare) concerning treatment or designating a surrogate decision maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy. Component 1/Unit 6e15 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Rights (continued) –The right to every consideration of privacy. –The right to expect that all communications and records pertaining to his/her care will be treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. Component 1/Unit 6e16 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Rights (continued) –The right to review the records pertaining to his/her medical care and to have the information explained or interpreted as necessary, except when restricted by law. –The right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and service. Component 1/Unit 6e17 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Rights (continued) –The right to ask and be informed of the existence of business relationships among the hospital, education institutions, other healthcare providers, or payers that may influence the patient’s treatment or care. –The right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities. Component 1/Unit 6e18 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Rights (continued) –The right to consent to or decline to participate in proposed research studies or human experimentation affecting care and treatment or requiring direct patient involvement, and to have those studies fully explained prior to consent. Component 1/Unit 6e19 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Rights (continued) –The right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate. –These patient rights were developed by the American Hospital Association. Component 1/Unit 6e20 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Rights –Advanced directives refer to living wills, durable power of attorney for healthcare, uniform anatomical gift act, and do not resuscitate (DNR) order Component 1/Unit 6e21 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Responsibilities Patients are responsible for following their physician’s instructions Patients must be absolutely honest with physicians about past medical history, family medical history, and substance abuse history. Patients are responsible for paying their physicians Component 1/Unit 6e22 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Responsibilities (continued) Patients consent to physicians to examine, touch, and administer a treatment. Informed consent –When a patient consents to a treatment after being informed about what the consequences of having or not having a procedure Component 1/Unit 6e23 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Responsibilities (continued) Implied consent- –When a patient indicates by his/her behavior that they are consenting to a treatment. –There are exceptions to this law, but they vary from state to state Refusal to consent –Adult patients can refuse any procedure. –Must be honored, no matter what. Component 1/Unit 6e24 Health IT Workforce Curriculum Version1.0/Fall 2010

Patient Responsibilities (continued) Health care professionals have a duty to make sure that patients understand all the medically terms and the procedure. Component 1/Unit 6e25 Health IT Workforce Curriculum Version1.0/Fall 2010