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Chapter 1
Chapter 1

Patient-Physician Relationships

Building relationships of trust with patients is fundamental to ethical practice in medicine.

Responsibilities of physicians & patients

The relationship between a patient and a physician is based on trust, which gives rise to physicians’ ethical responsibility to place patients’ welfare above the physician’s own self-interest.
Opinion 1.1.1

Patient-Physician Relationships

At the heart of medicine lie relationships founded in a “covenant of trust” between patient and physician in which physicians commit themselves to responding to the needs and promoting the welfare of patients.
Opinion 1.1.2

Prospective Patients

Physicians have an ethical obligation to provide care in cases of medical emergency; Physicians must also uphold ethical responsibilities not to discriminate against prospective patients on the basis of personal or social characteristics that are not clinically relevant; Physicians are nevertheless not ethically required to accept all prospective patients.
Opinion 1.1.3

Patient Rights

The health and well-being of patients depends on a collaborative effort between patient and physician in a mutually respectful alliance.
Opinion 1.1.4

Patient Responsibilities

Successful medical care requires ongoing collaboration between patients and physicians. Their partnership requires both individuals to take an active role in the healing process.
Opinion 1.1.6


Physicians individually and collectively share the obligation to ensure that the care patients receive is safe, effective, patient centered, timely, efficient, and equitable.
Opinion 1.1.7

Physician Exercise of Conscience

Preserving opportunity for physicians to act (or to refrain from acting) in accordance with the dictates of conscience is important for preserving the integrity of the medical profession as well as the integrity of the individual physician; Physicians’ freedom to act according to conscience is not unlimited; They are expected to provide care in emergencies, honor patients’ informed decisions to refuse life-sustaining treatment, respect basic civil liberties and not discriminate against patients on the basis of arbitrary characteristics.

Special issues in patient-physician relationships

In general, physicians should not treat themselves or members of their own families. Physicians who are employed by businesses or insurance companies, or who provide their medical expertise in sports should protect the health and safety of participants.
Opinion 1.2.1

Treating Self or Family

Treating oneself or a member of one’s own family poses several challenges for physicians, including concerns about professional objectivity, patient autonomy, and informed consent.
Opinion 1.2.2

Discrimination & Disruptive Behavior by Patients

Disrespectful, derogatory, or prejudiced language or conduct, or prejudiced requests for accommodation of personal preferences on the part of either patients or physicians can undermine trust and compromise the integrity of the patient-physician relationship.
Opinion 1.2.3

Consultation, Referral & Second Opinions

Physicians’ fiduciary obligation to promote patients’ best interests and welfare can include consulting other physicians for advice in the care of the patient or referring patients to other professionals to provide care.
Opinion 1.2.4

Use of Chaperones

Efforts to provide a comfortable and considerate atmosphere for the patient and the physician are part of respecting patients’ dignity. These efforts may include providing appropriate gowns, private facilities for undressing, sensitive use of draping, and clearly explaining various components of the physical examination. They also include having chaperones available. Having chaperones present can also help prevent misunderstandings between patient and physician.
Opinion 1.2.5

Sports Medicine

Physicians who serve in a medical capacity at athletic, sporting, or other physically demanding events should protect the health and safety of participants.
Opinion 1.2.6

Work-Related & Independent Medical Examinations

Industry-employed physicians or independent medical examiners establish limited patient-physician relationships. Their relationships with patients are confined to the isolated examination; they do not monitor patients’ health over time, treat them, or carry out many other duties fulfilled by physicians in the traditional fiduciary role.
Opinion 1.2.7

Use of Restraints

At times health conditions may result in behavior that puts patients at risk of harming themselves. In such situations, it may be ethically justifiable for physicians to order the use of chemical or physical restraint to protect the patient.
Opinion 1.2.8

Gifts from Patients

Some gifts are offered to physicians as an expression of gratitude or a reflection of the patient’s cultural tradition. Accepting these gifts can enhance the patient-physician relationship; Some patients offer gifts or cash to secure or influence care or to secure preferential treatment. Such gifts can undermine physicians’ obligation to provide services fairly to all patients.
Opinion 1.2.9

Use of Remote Sensing & Monitoring Devices

Devices that transmit patient information wirelessly to remote receiving stations can offer convenience for both patients and physicians, enhance the efficiency and quality of care, and promote increased access to care, but also raise concerns about safety and the confidentiality of patient information.
Opinion 1.2.10

Political Action by Physicians

Physicians enjoy the right to advocate for change in law and policy, in the public arena, and within their institutions; Physicians have an ethical responsibility to seek change when they believe the requirements of law or policy are contrary to the best interests of patients. However, they have a responsibility to do so in ways that are not disruptive to patient care.
Opinion 1.2.11

Ethically Sound Innovation in Medical Practice

When physicians participate in developing and disseminating innovative practices, they act in accord with professional responsibilities to advance medical knowledge, improve quality of care, and promote the well-being of individual patients and the larger community.
Opinion 1.2.12

Ethical Practice in Telemedicine

Telehealth and telemedicine span a continuum of technologies; As in any mode of care, patients need to be able to trust that physicians will place patient welfare above other interests, provide competent care, provide the information patients need to make well-considered decisions about care, respect patient privacy and confidentiality, and take steps to ensure continuity of care.
Opinion 1.2.13

Medical Tourism

Medical tourists may receive excellent care, but issues of safety and quality can arise: substandard surgical care, poor infection control, inadequate screening of blood products, and falsified or outdated medications can pose greater risks than patients would face at home; Medical tourism can leave home country physicians in problematic positions since patients may need follow-up when they return and records may be unavailable.