Component 1- Introduction to Health Care and Public Health in the US

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

2. Objectives • Describe physician rights • Describe physician duties • Describe patient rights • Describe patient responsibilities Health IT Workforce Curriculum Version1.0/Fall 2010

3. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

4. 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 Health IT Workforce Curriculum Version1.0/Fall 2010

5. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

6. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

7. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

8. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

9. 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 Health IT Workforce Curriculum Version1.0/Fall 2010

10. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

11. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

12. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

13. 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 Health IT Workforce Curriculum Version1.0/Fall 2010

14. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

15. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

16. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

17. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

18. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

19. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

20. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

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

22. 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 Health IT Workforce Curriculum Version1.0/Fall 2010

23. 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 Health IT Workforce Curriculum Version1.0/Fall 2010

24. 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. Health IT Workforce Curriculum Version1.0/Fall 2010

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