1. Doctor – Patient Contract Dr Hidayathulla Shaikh, Lecturer, College of Dentistry, Majmaah University.

2. Objectives At the end of the lecture students should be able to Define contract Explain implied contract Explain expressed contract Discuss privilege communication.

3. Doctor – Patient Contract Contract - “is defined as an agreement between two or more persons which creates an obligation to do or not to do a particular thing”. A contract can be a) Implied & b) Expressed.

4. a) Implied Contract Is one inferred from the conduct of the parties and arises, where one person renders services under circumstances indicating that he expects to be paid there for, And the other person knowing such circumstances, avails himself of the benefits of those services.

5. Implied Duties owed by the Doctor In accepting a patient for care the Dentist warrants that he/she will do the following – 1.Use reasonable care and methods which are of high standards. 2.Be properly licensed and registered. 3.Maintain level of knowledge with current advances in the profession. 4.Obtain informed consent from the patient before examination or treatment.

6. 5.Charge reasonable fee based on community standards. 6.Keep the patient informed of his or her progress. 7.Not undertake any procedures for which the practitioner is not qualified. 8.Keep accurate records of patients information and complete the care within time. 9.Maintain confidentiality of the patient.

7. 10. Inform the patient about any untoward occurrence in the course of treatment. 11.Make appropriate referrals and request necessary consultation. 12.Comply with all the laws regulating the practice of dentistry. 13.Practice in a manner consistent with the code of Ethics of the profession.

8. Implied duties owed by the patient When a patient hires or avails the services of the doctor for treatment, he has the following duties – 1.He must disclose all information that may be necessary for proper diagnosis and treatment. 2.He must co operate with the doctor for any relevant investigations required to diagnose and treat him. 3.He must carry out all the instructions as regards to drugs, food, rest, exercise or any other necessary aspects.

9. 4.He should notify the dentist of a change in health status. 5.In case of a private medical practitioner he must compensate the doctor in terms of money. If patient breaches any of these duties, it will enable the doctor to end the doctor-patient contract and he will be free from his legal responsibilities.

10. b) Express Contract It is an actual agreement of the parties, The terms of which are openly uttered or declared at the time of making it, Being stated in the distinct and explicit language either orally (oral agreement) or in writing (written agreement).

11. A doctor-patient contract requires that. a doctor must continue to treat the patient with reasonable care, skill and responsibility. Not to take any procedure/treatment beyond his skill and must not divulge in professional secrets. Responsibilities towards the patient begins the moment a doctor agrees to examine the patient.

12. A Doctor must not abandon his patient except under the following circumstances The patient has recovered from illness, for which the treatment was initiated. The patient / attendant does not pay the doctors fees. The patient / attendant consults another doctor without the knowledge of first attending doctor. The patient / attendant do not co operate and do not follow the instructions given by doctor. The doctor has given due notice for discontinuing the treatment. The doctor is convinced that the illness is fictitious one.

13. Responsibilities towards Doctor He must use clean and proper instruments. Provide his patients suitable medicines if he dispenses them himself, if not He should write the prescriptions properly, using standard abbreviations and mentions instructions for the pharmacist in full. He should give full instruction to the patients regarding administration of drugs, diet, rest, exercise etc in the local written language.

14. A Doctor can consult the Specialist under the following circumstances When the case is complicated. When the question arises about performing an operation which may be life threatening to the patient. Operating on the criminally assaulted cases. The cases where suspicion of poisoning or other criminal act has been found. When desired by the patient / attendants.

15. When it appears that the quality of the medical services to be enhanced. When there is no one from whom the consent can be obtained. At the same time the doctor should not take any procedure / treatment beyond his skill. Should not divulge in the professional secrets except under special circumstances like – a)A witness in court of law, b)Warning partners and spouses of HIV, AIDS patients c)Informing public health authorities of food poisoning from a hotel, any source etc And all these circumstances are called as Privileged Communication.

16. Privileged Communication is defined as communication made by the doctor to a proper authority who has corresponding legal, social and moral duties to protect public. The doctors – Patient relationship ends when,  Both parties agree to end it.  Either patient or dentist dies.  The patient ends it by act or statement.  The dentist unilaterally decide to end the treatment.  There has been breakdown in the inter relationship between the two.