Physicians & the Health of the Community

Routine universal screening of adult patients for HIV helps promote the welfare of individual patients, avoid injury to third parties, and protect public health. Nonetheless, physicians must continue to seek patients’ informed consent, including informed refusal of HIV testing.

Those who operate a vehicle when impaired by a medical condition pose threats to both public safety and their own well-being. In deciding whether or how to intervene when a patient’s medical condition may impair driving, physicians must balance dual responsibilities to promote the welfare and confidentiality of the individual patient and to protect public safety.

Due to their commitment to care for the sick and injured, individual physicians have an obligation to provide urgent medical care during disasters. However, physicians also have an obligation to evaluate the risks of providing care to individual patients in the present versus the need to be available to provide care in the future.

In the context of infectious disease, physicians’ public health responsibility may include the use of quarantine and isolation to reduce the transmission of disease and protect the health of the public. They also have an obligation to protect their own health. In such situations, these obligations may conflict with patients’ rights of self-determination and with physicians’ duty to advocate for the best interests of individual patients.

Differences in treatment that are not directly related to differences in individual patients’ clinical needs or preferences constitute inappropriate variations in health care. Such variations may contribute to health outcomes that are considerably worse in marginalized populations. Physicians ethically are called on to provide the same quality of care to all patients without regard to medically irrelevant personal characteristics.

Patients have a right to know their past and present medical status, including conditions that may have resulted from medical error. Open communication is fundamental to the trust that underlies the patient-physician relationship, and physicians have an obligation to deal honestly with patients at all times.

In the context of a highly transmissible disease that poses significant medical risk for vulnerable patients or colleagues, or threatens the availability of the health care workforce, and for which there is an available, safe, and effective vaccine, physicians have a responsibility to accept immunization absent a recognized medical contraindication or when a specific vaccine would pose a significant risk to the physician’s patients.

A physician who suspects that an adverse reaction to a drug or medical device has occurred has an ethical responsibility to promptly report that information to the professional community and to the appropriate regulatory agency.

Expedited partner therapy seeks to increase the rate of treatment for partners of patients with sexually transmitted infections through patient-delivered therapy without the partner receiving a medical evaluation or professional prevention counseling. However, expedited partner therapy potentially abrogates the standard informed consent process, compromises continuity of care for patients’ partners, encroaches upon the privacy of patients and their partners, increases the possibility of harm by a medical or allergic reaction, leaves other diseases or complications undiagnosed, and may violate state practice laws.

In light of their obligation to promote the well-being of patients, physicians have an ethical obligation to take appropriate action to avert the harms caused by violence and abuse.

Health promotion should be a collaborative, patient-centered process that promotes trust and recognizes patients’ self-directed roles and responsibilities in maintaining health. Effective elements of this process may include educating and motivating patients regarding healthy lifestyle, helping patients by assessing their needs, preferences, and readiness for change, and recommending appropriate preventive care measures.

In the context of the media marketplace, understanding the role as a physician being distinct from a journalist, commentator, or media personality is imperative. Physicians involved in the media environment should be aware of their ethical obligations to patients, the public, and the medical profession; and that their conduct can affect their medical colleagues, other health care professionals, as well as institutions with which they are affiliated.

As an ethical responsibility, competence encompasses more than medical knowledge and skill. It requires physicians to understand that as a practical matter in the care of actual patients, competence is fluid and dependent on context. Physicians at all stages of their professional lives need to be able to recognize when they are and when they are not able to provide appropriate care for patients.