Doctor Patient Relationship

Question 1

What is the cornerstone of a healthcare?

Answer 1

doctor-patient relationship

Question 2

The doctor patient relationship is an act of ___

Answer 2

trust

Question 3

T/F the doctor patient relationship is a inviolable contract between the two

Answer 3

true

Question 4

What reigns supreme in a doctor/patient relationship?

Answer 4

confidentiality

Question 5

What governs the privilege and obligations of the doctor towards the patient?

Answer 5

ethics, morals, and law

Question 6

T/F the doctor patient relationship is actually a legal relationship

Answer 6

true

Question 7

What is an implicit contract?

Answer 7

implied, one not created by the explicit agreement of the parties but inferred by the law as a matter of reason and justice from their acts or conduct

Question 8

How is the doctor patient relationship manifested?

Answer 8

by the patient coming for an exam knowing you are a doctor and requesting to be seen

Question 9

What is an explicit contract?

Answer 9

a deliberate agreement between competent parties, upon a legal consideration, to do or to abstain from doing some act

Question 10

How does the doctor patient relationship begin and what does it include?

Answer 10

begins at the request of the patient for exam/tx and includes the agreement of the doctor to undertake the patient’s care

Question 11

How can you formalize the contractual relationship using printed material?

Answer 11

welcome to our office forms, agreements of financial responsibility, and consent to treat forms

Question 12

What are contract pitfalls?

Answer 12

avoid giving advice in social settings or in settings where there isn’t a complete history and exam

Question 13

What does the doctor as fiduciary mean?

Answer 13

special confidence reposed in the one who is bound to act in good faith and with due regard to the interests of the one who has reposed the confidence aka trusted to act in the interest of the patient

Question 14

What are examples of the doctor as fiduciary?

Answer 14

conform to evidence based standards of care, maintain a professional demeanor, disclose pertinent exam findings/recommend appropriate treatment, obtain informed consent

Question 15

What are ethical considerations?

Answer 15

respecting the patient’s role and keeping confidences, maintaining the standard of care and timely notice of disease, rendering care regardless of ability to pay, responding to requests for emergency are, prepared for substitutions/vacation/emergency and referrals

Question 16

What is involved in keeping the patient’s confidence?

Answer 16

no exceptions for spouse or family without explicit authorization from the patient, laws provide for disclosure of info to 1) public health official 2) individuals at risk and 3) disaster relief organizations

Question 17

What should you do if there is a breach of confidentiality?

Answer 17

get legal counsel immediately, take steps to contain potential damage

Question 18

What is informed consent?

Answer 18

full disclosure of potential risks, benefits, and alternatives of treatment

Question 19

Failure to diagnose and/or to diagnose in a timely manner can lead to ___ and ____

Answer 19

morbidity (decreased quality of life) and morality (death)

Question 20

T/F ultimately a patient cannot refuse service or treatment once a diagnosis is made

Answer 20

false, patient has the right to accept or the rejecte

Question 21

3 aspects of timely notice of disease

Answer 21

1) doctor required to disclose pertinent exam results in order to obtain informed consent 2) once treatment has started, the doctor has the legal duty to conform to the expected standard of care 3) this duty is fundamental and requires the doctor to meet reasonable standards of conduct

Question 22

Components of patient autonomy

Answer 22

patient participation, confidentiality, truthfulness, informed consent, patient records

Question 23

Components of non-maleficence

Answer 23

standards of care, professional competence, delegation of services, conflicts of interest, referral, relationships with patients, impaired optometrist?

Question 24

Components of beneficence

Answer 24

character, respect for the law, protected populations, public health, clinical research and trials

Question 25

Components of justice

Answer 25

patient selection, patient abandonment, advertising, economic interest

Question 26

Components of non-patient professional relationships

Answer 26

relationships with industry, employer-employee, harassment and relationships with subordinates, expert testimony

Question 27

What is the rule for relationships with patients?

Answer 27

optometrists should avoid intimate relationships with patients, if a relationship does develop, the professional care of the patient should be transferred to another optometrist

Question 28

Even when services are provided for free and without expectation of payment…

Answer 28

the doctor patient relationship still exists and all pursuant liabilities exist

Question 29

T/F every doctor has an obligation to be accessible when after-hours care is required

Answer 29

ture

Question 30

Urgent/emergent care must be provided…

Answer 30

during office hours and after hours

Question 31

T/F there is NOT an obligation to provide after hours or in office urgent/emergent care to individuals who are not your established patient

Answer 31

true

Question 32

What do you do if an individual who is not your patient needs urgent care?

Answer 32

you are obligated to direct the individual to an appropriate source of care

Question 33

What is true about giving advice remotely?

Answer 33

if a patient calls the office and asks advice regarding a new or recurrent condition and you or someone in the office provides a recommendation, there is a liability based on the doctor-patient relationship

Question 34

Should you gibe advice over the phone or email?

Answer 34

probably not, email must be secure and encrypted

Question 35

How do “ask the doctor” websites work?

Answer 35

the communication would NOT be considered confidential NOR would it constitute a doctor patient relationship – this does NOT apply to your own website

Question 36

How does giving advice in person work?

Answer 36

at a social event, a doctor’s advice would most likely NOT be considered confidential NOR would it establish a relationship UNLESS the person is your patient

Question 37

How do substitutions and referrals work?

Answer 37

it is advisable to have a competent doctor available to consult with your patients when you are absent

Question 38

Is a covering doctor responsible to continue care under a substitution/referral arrangement?

Answer 38

no

Question 39

If a covering doctor is negligent in the care of a patient, the absent doctor typically has no legal responsibility if…

Answer 39

due care was exercised in the selection of the substitute… does not always hold up in court

Question 40

Describe the duty to refer

Answer 40

it is the obligation of every doctor to recognize limitations in their expertise or ability to care for a patient and make appropriate referral (OD or otherwise)

Question 41

What is a true referral?

Answer 41

when the referring doctor has NO responsibility for the patient’s care while they are being treated by the new doctor

Question 42

What is a consultation/comanagement?

Answer 42

a joint undertaking of two or more doctors in the care and treatment of a patient– joint responsibility and liability

Question 43

What is NPDA?

Answer 43

national practitioner data bank

Question 44

What is the national practitioner databank?

Answer 44

used for DEA #, charges, selecting a doctor for your referrals