Doctor/patient Refationship

BEGINNING AND ENDING THE REI.ATIONSHIP The relationship betrveen a docl entered frcety on both sides. t.,:: :ti.:],.-^i…"."’-tlt is a voluntarv rclationship that is to be particurar croctor as h… ph^i;;il1il:ff1" il,.IlHl$;::ff’.1ffH: :.lfi::l]:;to accept a paticnt without his agreentent. A doctor must agr." to u.c.pt o patrent. There isno obligation on the part of thc physician ,o ,…p, u pu,iJn,.-r.i,l , ,.u" ,.,u ,.,atter what need thc patient has and whatever expertise the docto, n.,oy pnrr"rr.
For example, a patient with diabetes lives in a small town with onJy one endocrinologist. The cndocrinologist has a fulJ practice ancf is,.ro, o…prurg n._ puai.n,… The patient has very bad diabctes and has^a…,ery cornplcx ,“gin-r.r, tlrot lr., fn-ity practitioner insists is beyond.thc scope of his ,nde.rt"ndiri. .l.hc patient shows up in the office and insists to the office managcr that she b. a.l.pt.a. Wfrut st nuta bc done?
The physician is under no legal obligation to accept the patient. There is considerablc misunderstanding of this issue. The physician, by training a’nd ,”.iir",ar, , ,*.ed to aicl thc suffering However’ there is stilr no mandate for rhe piysi.io.r ,o u…p, ,r.,. patient nor can a patient force a physician to take care of her. Even .ood Sumorita., laws, which protects caregivers_from liability if they aid a sick person in ,fr" *r.", ao norinrce the cloctor to aid an injured person. you may feel a m.ral obtigation,. h"ip ;;;;;;., but there is no tegal obligation to enter into a doctor/paticnt rclationship. ffri, i, i;f…",t from a hospital! mandate to provide emergency treatment to an).one who comes to the encrgency depart_ mcnt. Hospitals cannot turn anyone aw:ry at the door of their..rg"r,.y roo, ifthey come secking care. This does not mean they must provide continuous ca’re after discharge, but it cloes mean there is a national legal mandate for all hospitals to provide energency manage’ ment and tleatment of all patients Once a patient ancl physician have entered into a care relationship there is far greater complexity in ending that relationship A physician camot suddenl,v end the relationship He must maintain the care of the patient until thc Patient can find an aPplopliate altefnate source of care and he must piive “reasonable notice”’
GIFTS FROM PATIENTS Srnall gifts trom Patlents ot nominal or modest value are acceptable on the part of th€ phyri.i t-t. This is provided that thcre is no expcctation of a different form of therapy or o tligh., 1.u"1 of care based or.r the gift’ You can accePt a cake at Christmas’ a balloon on your L,irthclay, or other tokens of esteem, trut not if the patient expects an extra’ or difterent prescription for something, in exchange for the gift’ The rules on gifts fron patients are far less rigorous’ precise’ or ctear than the rules on gifts fron.r the -pharnaceutical industry There is alr aut()matic presunlPtion that gifts from i-ndustry ahvays carry an ir.rfluence tolvard a product’ service’ or prescribing practice Gifts from industry are vierved differently becausc thcre can bc no other intention behind them except to buy influence and alter behavior’ Tberc is no such automatic presumPtion on the part of gifts received ftom Patients’
DOCTOR/PATIENT SEXUAT CONTACT Sexual contacl between a physicitrn and a patient is always inappropriate lt is unclear if there can ever be a completely acceptatrle, ethical rvay to alter the Physician/Patient rela tionship so that sexual contact is acceptabte At the vcry least’ the fhy"iciin alld patient must mutually agree to encl the fornal prof-essional relationship of a doctor ancl a patient’ It is not clear horv much time mlrst elapse between the ending of the professional doctor/ patient rclationship ar.rd the beginning of a personal relationship’‘fhc recotlmendrtion for psychiatrists is somervhat unique The American Psychiatric Associatiotr guidelines specifically state that there can never be a sexual or personally intimate private relationship between doctor and Patient even after the professional relationship has cnded ln other words, a psychiatrist should not have sexual contact even with former Palient:’’ These guidclines apPly no matter who initiates the relationship’ In other words’ it is not more alceptable tbr a doctor and patient to have sexlral relations if thc patient initiates the sexual relationship rather than the physician. These guiclelines also take no account ofgen
der or sexual orientation’ It is arways ethicalry unai-ceptabre to have a sexuar relationship between a psychiatrist and cither a current or a formcr patient. It is ethica’y unacccptable for a physician of any kind to have a sexual relationshipwith a current patient.