Confidentiality and Treatment Relationships Flashcards
providers may ___ to treat for any reason or for no reason
providers may refuse to treat for any reason or for no reason
list the 3 limits to refusal
- discrimination by race, religion , disability, national origin, gender, etc.
- you have already agree (e.g. Managed Care Organization contract–you agreed to be a Blue Cross network provider)
- there is another type of prior agreement (e.g. you are on call, you agreed to treat Emergency Department patients)
describe contraindications to treatment
- when common treatments serve no purpose (e.g. cataract surgery for a congenitally blind patient)
- when a patient may react badly (e.g. invasive procedures for a currently psychotic patient)
- usually involve those who cannot make their autonomous wishes known and/or terminal illness
list morally expendable treatment
- uselessness: treatment does not help the patient
- grave burden: even if the treatment serves a useful purpose, it represents a grave burden to the patient or another
- proportionality: when harms outweight benefits
AMA Ethics Code IV: a physician shall be free to choose whom to serve except _____
AMA Ethics Code IV: a physician shall be free to choose whom to serve except in emergencies
describe detrimental reliance
- when an oral promise is made, and the person reasonably relied on that promise, to their detriment
describe informal consultations
- pediatrician consults a neurologist; neurologist does not see the patient, does not see the record, does not see labs, does not bill: no treatment relationship, no liability
- treating physician retains independent judgement
- fuzzy line between formal and informal consultation; in general:
- no bill
- no patient examination
- no exposure or entry in medical record
describe the Declaration of Geneva’s stance on confidentiality
a physician will respect the secrets that are confided in him/her, even after the patient has died
describe independent medical evaluations (IME)
- IME physician is NOT in a treatment relationship with examinee
- IME is not treatment, is not consensual
- examinee does not select or pay physician
- physician reports to a 3rd party
- BUT, it can cross the line if the physician makes a recommendation directly to the patient
describe the duty of confidentiality
- physician fidelity
- patient’s right to confidentiality arises when a physician-patient relationship is formed
- both a legal and an ethical duty to protect patient information and keep it confidential
- a breach of confidentiality is a tort for which physicians can be sued
list exceptions to confidentiality
- gunshot wounds and knife wounds
- abuse or neglcy: child, elder or vulnerable/dependent adult
- communicable diseases
- neurological impairment that affects driving
- patient poses imminent danger to others: you must warn
describe the Tarasoff ruling
All health care providers are required to warn potential victims if they believe they are in danger
describe terminating physician-patient relationships
- no treatment relationship: you may refuse to treat for any reason
- existing relationship: you must continue to treat UNTIL
- relationship terminates via one of 4 valid ways
- mutual consent
- patient dismisses physician
- treatment is no longer needed
- “firing” a patient
- otherwise, termination is “tortuous abandonment”
- relationship terminates via one of 4 valid ways
describe firing a patient
- “unilateral physician withdrawal” is permitted with sufficient notice
- sufficient notice = amount of time required for patient to get another provider
- otherwise, it’s tortuous abandonment: physicians MAY NOT abandon (i.e. terminate with insufficient notice)
- abandonment: purposeful, deliberate decision for a non-medical reason
