Bioethics Discussion Blog: Physician's Right to Choose and Duty Not to Neglect

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Friday, August 24, 2007

Physician's Right to Choose and Duty Not to Neglect

The responsibilities of a physician include not to abandon his or her patient. A patient can abandon their physician as desired but the physician cannot abandon the patient. Abandoning a patient means halting the attention and care of a patient without referral and establishment to another source of care. Physicians do have the right not to accept a patient who comes to a physician when no life or death emergency exists. Physicians also have the right to terminate a doctor-patient relationship for a number of ethical reasons including problems with personality issues, inability to follow patient requests either based on moral reasons or standards of medical practice and perhaps some others including a beginning non-professional interest between the two parties. Reasons to terminate the relationship that are not ethical might include inability of the patient to fully pay for the services rendered. Another would be to terminate care simply because the patient failed to respond to treatment and that the physician might not want an unsuccessful result to be part of his or her medical record which might discourage further aquisition of patients.

There is a whole history regarding the right of physicians to choose patients and the duty not to neglect as written in the American Medical Association's Code of Medical Ethics. The story of the Code and its revisions is presented by Faith Lagay in the September 2001 issue of Virtual Mentor. Read the article.

It would be interesting to read my visitors experiences regarding termination of relationships with their physicians or about physicians who refused to start a relationship with a visitor. Remember, no names please! ..Maurice.

2 Comments:

At Wednesday, September 05, 2007 9:55:00 AM, Anonymous middle aged engineer said...

I usually get along pretty well with health care providers, but I think a lot of that is because I'm pretty proactive in letting them know what I expect in term of communications. That said, in my 50+ years on this planet, I've twice terminated my relationship with a provider.

As a preface, I'm a member of a large HMO. Primary care is provided through your chosen PCP,h a cadre of specialists to handle issues outside their scope of practice.

The first instance was 12 years ago. I sustained a rather serious fracture to my ankle (two spiral fractures of the lower fib & 2 cracks in the joint itself.) My Orthopod was great - ex army Doc & very experienced. Based on the xrays, he determined that the bones were well aligned, there was no separation in the joint, and recommended letting it heal naturally without surgical intervention, with follow up xrays every couple weeks the first month or so to make sure ther was no change in alignment. During the first xray followup I saw a PA that kept pushing me to have surgery. I told him The Doc recommended otherwise & I wasn't interested. During the 2nd xray followup I got the same PA, same basic conversation, only this time he told me the doctor was obviously wrong, I was stupid not to have surgery & that I would never have full use of the leg again if I didn't. I filed a formal complaint with membership services & let them know in no uncertain terms I would never accept care from this PA again under any circumstances. Leg healed just fine BTW......

The 2nd instance was about 5 years ago. I have primary hypertension that is well controlled by medication. Even though he meds I was takiong were doing the job, and all my labs were right where they should be, My PCP arbitrarily decided he wanted to change me to a different medication (beta blocker), the common side effects of which I had serious concerns with. When I expressed those concerns, he basically blew me off & became very insistent. I told him that I'd think about it, then immediately called membership services & requested a new PCP based on philosophical differences in approach to health care that made a continued relationship with the PCP in question impossible.

 
At Wednesday, September 05, 2007 1:27:00 PM, Blogger Maurice Bernstein, M.D. said...

Good examples. In the second instance, was there any attempt by the doctor to explain in terms of pharmacology or otherwise this abrupt and to you seemingly unnecessary change of medication? This sounds like a problem with communication. Had you been with him over a period of time and experienced satisfactory communication? What I was getting at is whether the doctor was simply having a "bad" day or were there other ongoing "philosophical differences"?

To me, the first example is a bit worrisome. The PA should be acting under the diagnostic and therapeutic oversight of the attending physician and shouldn't be giving advice contrary to that of the physician. However, if such advice was given, I would try to understand the PA's rationale and then report to the physician what has occurred and listen to the physician's response. Since a physician is "only human", it is possible for a physician to overlook some important issue and that a trained PA but with "different eyes" pick up that issue. But it would seem to me more appropriate for the PA to confront the physician rather than first speaking to the patient about it, there being no instant emergency decision to be made. What do you think? ..Maurice.

 

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