Physician Wearing Two Hats and Patient’s Best Interest

The doctor’s duty, by law, to report to authorities evidence which may be related to criminality in the patient history such as gunshot or stab wounds or other trauma or alcohol or drug blood levels is an example of a physician’s potential conflict of interest. This conflict can deny their professional goal of providing care that is in their patient’s best interest. The physician is faced with a decision of protecting his/her own self-interest by abiding by the law or following the professional ethical standards of patient confidentiality and attempting to ensure the patient’s best interest. But would the physician’s ignoring the longer-term psychosocial implications of the gunshot wound or drug level by treating the immediate problem be really in the patient’s best interest? (This again sets the question of the definition of “patient’s best interest”. Is it the goals, values and decisions of the patient or the perhaps paternalistic definition by the physician?)

One view of the work of physicians is that as part of the privileges that society has given to them is to be responsible not only to the patient but also to protect the health and safety of the greater community. The requirement of physicians to report to health officials communicable diseases is an example. Most physicians would probably not disagree with that duty. Reporting suspected child or elder abuse may pose difficulties at times since the physician may be unsure whether true abuse has really occurred and may worry about the consequences to innocents of his/her reporting.

There is, on the other hand, another view that the role of the physician as desired by society is one of healing the patient and not the simultaneous role of a policeman—“wearing of two hats”. Physicians are instructed by professional societies to avoid entering into situations where they may compromise their responsibility to the patient by the other role such as participating in the medical evaluation of prisoners scheduled for execution or in the execution process itself.

This posting provides an example of another conflict of interest that plagues physicians. I have noted others in previous postings and will likely describe others later. ..Maurice.