Excerpt From Medical Ethics: Real-World Application By Afshin Nasser

Physician Patient Relationship

The physician-patient relationship is the core of practice of medicine and is a relationship of confidentiality and trust. The physician must honor this sacred relationship by acting in the patient’s best interests. Acceptance of all patients without discrimination, including age, disability, gender identity, language, marital and family status, medical condition, ethnic origin or political affiliations, religions, sex, sexual orientation and socioeconomic status, is necessary.

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The physician-patient relationship is the core of practice of medicine and is a relationship of confidentiality and trust. The physician must honor this sacred relationship by acting in the patient’s best interests. Acceptance of all patients without discrimination, including age, disability, gender identity, language, marital and family status, medical condition, ethnic origin or political affiliations, religions, sex, sexual orientation and socioeconomic status, is necessary.

Patients are the most important assets to a practice. Sometimes, physicians encounter difficult patients who make them and their medical staff feel upset and frustrated. In these situations, understanding the patient’s psychology and motivation is key. Staff members should also be trained on how to manage such patients. Ultimately, the physician is responsible for identifying such patients and managing them appropriately. Patient management skills include listening, providing attentiveness, expressing empathy, asking questions, making eye contact and always ending a visit on a positive note.

The way a Physician handles difficult patients will define the quality of the patient experience. Not knowing how to deal with difficult patients may lead to low staff morale, low patient volume and a damaged reputation for a practice.

Regardless of how good the service is within a practice; it is just a matter of time before the first encounter with a difficult patient. It is inevitable and unavoidable. Typically, a difficult patient will want to consume a physician’s time and focus only on his/her issue, frustrate the Physician and staff in the process, and furthermore haggle endlessly to receive more time or to acquire “freebies.”
Keep the following point in mind when dealing with difficult patients: A Physician has the right to refuse patients for legitimate reasons.

Physicians should limit self-treatment or treating family members and close friends to emergencies, and when no other physician is available. It is part of a physician’s duty to provide emergency medical care when appropriate to anyone who is in need.

Q9 A 24-year-old female friend sends you an email requesting your opinion on her medical condition. She decided to contact you after reviewing your online profile. She is not an established patient. She claims to have had lower back and abdominal pain with alternating constipation and diarrhea. She takes fiber and laxatives. She has done testing by her primary care physician and gastroenterologist, including an upper endoscopy and colonoscopy. She requests your recommendation for another test or treatment.

What is the most appropriate next step in management?
A-Ignore the email.
B-Request her medical records before any recommendation.
C-Advise the patient to be evaluated for celiac disease.
D-Advise patient to call your office to establish care.

Disclosure of Harm
When a patient suffers harm that negatively affects the patient’s health or quality of life, the responsible physician must ensure that the patient receives full disclosure of that information.

Disclosure of harm is considered a process that also addresses the patient’s immediate and future medical needs, and the investigation of the circumstances that led to the patient suffering harm, and furthermore, steps to prevent recurrence of such harm.

Disclosure must occur whether the harm is a result of disease progression, a complication of care, or an adverse event.

Disability Certification
Patients may report having been ill for one week at home, not attending work, requesting your certification for their absence, despite your lack of involvement during their illness. There are less fortunate patients with chronic debilitating illnesses, where society allows physicians to justify their illness to obtain different types of support, whether financial or otherwise. Physicians must always act honestly and be able to support decisions based on facts.

Sexual Relationships between Physician and Patient
Sexual relationships between a physician and a current patient are never ethical and constitute a violation of boundaries with severe consequences. The physician/patient relationship must cease in such a case, and the patient must be transferred to another physician, to ascertain clear boundaries.

The American Medical Association and the ACP both state that it is unethical for a physician to become sexually involved with a current patient even if the patient initiates or consents to the relationship. A lack of equality between the parties; a patient in a vulnerable and dependent state, and the physician indiscretion with confidential information and not acting in the patient’s best interest are the foundation for such ethics-based recommendations. There are sanctions against these relationships, ranging from criminal charges to sanctions by state licensing boards. Sexual contact or a romantic relationship between a physician and a former patient may also be unethical regardless of time elapsed since ending the professional relationship. Physicians should avoid such relationships with a family member or surrogate of a patient. A physician should always consult with a colleague or other professional prior to becoming sexually involved with a former patient.

It has been reported that 5% to 10% of psychiatrists have had sexual contact with a patient; the statistics remain unknown of practitioners in other specialties. Physicians aware of instances of sexual misconduct have an obligation to report them.

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State Medical Boards

The medical board’s duty is to protect the public, not the physician. State medical boards today focus on licensed physicians who violate professional ethics, and their mandate has significantly evolved to focus on disciplining physicians.

Read More »

Boundary Violation

Boundaries create a therapeutic distance between physician and patient and clarify their respective roles and expectations. Boundaries define limits of the therapeutic relationship.

Read More »

Medical Ethics: Real-World Application By Afshin Nasser

You may have acquired this book as a result of conflicts with peers, administrators, patients, or State Medical Boards, where the outcomes of those interactions have left you wondering, “…what if I had done things differently?”

In that case, I hope that this book answers some of your questions and guides you with regards to any future quandaries you may encounter.


If you are a healthcare worker seeking to understand the subject of medical ethics, then I hope this book helps you acquire the clarity you seek.
If you are an individual simply curious about medical ethics, then I raise my hat to you for your pursuit of knowledge.