Clinician-pt relationship Flashcards
Describe a Fiduciary Relationship
- clinician has a responsibility to always act in the pt’s best interest
- requires clinician to stay UTD w/ medical knowledge, and advancements in order to provide sound clinical judgement
- requires refraining from divulging confidential PHI
What is an implied contract
when a pt and clinician enter into a therapeutic relationship
Describe the 5 Laws/Contracts that make up Clinician/Pt Contractual Rights/ Responsibilities
- implied contracts
- 1960 civil law
- Americans w/ Disabilities Act
- Emergency Medical Tx and Active Labor Act (EMTALA)
- Insurance contracts (ie employer contracts or HMOs)
What was the focus of 1960 civil law
-made it so practitioners/institutions couldn’t refuse tx based on race, religion, or ethnicity
What was the focus of EMTALA
-required EDs to medically screen every patient who sought emergency care and to stabilize or transfer those with medical emergencies, regardless of health insurance status or ability to pay
What was focus of Americans w/ Disabilities Act
prohibited discrimination against individuals with disabilities in all areas of public life
What are the 5 events that would allow for Appropriately Terminating Clinician-Pt Relationship
- tx noncompliance
- follow up non compliance
- office policy noncompliance
- verbal abuse
- nonpayment
What are the 4 events that would Restrict a Clinician from Appropriately Terminating Clinician-Pt Relationship
- in acute phase of tx
- only source of medical care
- only source of specialized medical care
- member of a prepaid health plan
What are the 3 steps a Clinician Should Take to Terminate Their Relationship w/ a Pt
- provide pt w/ adequate notice
- offer transfer of records
- arrange for continuity of care if pt has chronic medical conditions
What Elements Should be Included in a Written Termination Letter
- reason for termination
- effective date
- offer interim care
- provide suggestions for continued care
- offer copy of medical records to be sent to new provider
- express pt’s responsibility to f/u and continue medical care w/ new provider
- inform med refills end on effective date
Describe the Role of Disclosure of Clinician’s Personal Info
- controversial whether it is appropriate
- pt care should remain primary focus of clinician-pt relationship
- pt’s tend to feel more comfortable/connected when they know certain info about their providers
- in the end, up to the clinician to decide on boundaries based on what is comfortable, professional, and of best interest of the pt
Describe When it is Appropriate for a Clinician to Override/Strongly Encourage Specific Actions that are Different than a Pt’s Preferences
- when there is a high likelihood of harm and tx carries little risk
- court orders may be invoked if necessary though rare
What are Some Issues That May Arise When Caring for Several Members of the Same Family
- difficult to maintain confidentiality of each family member
- difficult to maintain impartiality
Describe Informed Consent
-provide adequate info that is comprehensible to a competent pt or pt surrogate
Describe Clinician’s Duty to Disclose
-clinician is required to disclose all relevant info regarding medical tx in order to allow the pt to make a decision about tx
Describe Conscientious Objection/Refusal of Information by Providers
- when provider beliefs disallow specific tx to be delivered
- still obligated to give informed consent
- if clinician can’t provide tx preferred to belief can refer
Describe Competence
- mental ability to understand problems/ make decisions about accepting/rejecting proposed medical tx
- presumed unless obvious via clinical observation/judicial ruling
Describe Decisional Capacity
- ability to communicate/understand info given
- ability to make logical decisions based on info given
- ability to understand current medical status
- ability to understand options for medical care
When should Decisional Capacity Assessment be performed
- abrupt changes in mental status noted
- refused recommended tx w/o adequate reasoning
- accept risky tx w/o adequate processing
- known risk of impaired decision making
How can Clinician’s Evaluate Decisional Capacity
- ask:
- does pt understand condition/tx
- can pt apply info to their condition
- reasoning consistent w/ facts/values
- can pt communicate their choices clearly
What is difference b/w Competence and Decisional Capacity
- decisional capacity is situation-specific
- incompetence is a legal determination
When Interacting w/ Pt’s w/ Differing Beliefs/Cultures, how can a clinician determine pt’s belief’s/customs
- ask:
- what do you call your problem
- what do you believe is the cause of your problem
- what course do you expect your problem to take/how serious is it
- what do you think this problem does inside your body/mind
- what do you most fear about this problem
- what do you most fear about tx
Describe Implied Medical Consent
- “presumed” consent
- only to be used in emergencies when pt is unconscious/incompetent and no surrogate decision maker is available
Describe Refusal of Care
-pt’s right to refuse care must be respected if they are a competent adult
When can a Clinician Bypass a Pt’s Refusal of Care
- pt is incompetent
- refusal of tx is a threat to others
