PCM1: The patient-physician relationship

=The Patient-Physician Relationship=

Describe the basic ethical features of the patient-physician relationship, including the principles of beneficence, autonomy, social justice, and nonmalficience.
The patient-physician relationship is a complex professional relationship which has the goals of relieving suffering, promoting healing and preventing illness. It must be flexible enough to work in a wide variety of situations yet well defined enough to maintain patient privacy. The development of this relationship is based on earning trust, nonabandonment, continuity, empathy, and being nonjudgemental. Family and culture influence the patient-physician relationships considerably.

The patient-physician relationship evolved in the 20th century from a former paternal relationship to a model which promotes patient autonomy. Even though patients now have greater control over their own care, it is critical that the physician does not relinquish his/her duty and socially given power by the society to foster behavior changes and make therapeutic recommendations to help patient well-being.

Physicians must never abandon the patient. The physician-patient relationship includes the concept of beneficence, which means that the physician makes decisions that are best for the patient, without regard to personal gain or the interests of others. Physicians must also uphold the concept of nonmalficience, which essentially means that they must do no harm and avoid risking injury to the patient. Finally, the physician has an important role in promoting social justice. Their critical role as a healthcare provider in the community gives them the ability to assess the problems within the community and can be an effective advocate for social change, ultimately resulting in an increase in the wellbeing of the patients and the community.

Describe clear versus questionable duties of physicians
Some clear duties of the physician include being competent, communicating clearly and unambiguously, upholding standards of professionalism (which includes honesty), respecting local laws and helping to change laws in the interest of the patient, respecting the right of patients and colleagues, continuing to study and apply and advancing the science of medicine, and finally serving the needs of the patient first. Questionable duties of the physician may include treating their own family members or friends (free of charge), per the hippocratic oath.

Describe clear versus questionable duties of patients
Some clear expectations of the patients include trust that the physician will respect the patient’s secrets among other attributes of physicians listed above (patients expect these in physicians). Some questionable expectations of patients include preferential treatment for certain patients over others, or physicians providing false information for the benefit of the patient (for example false claim of disability for the patient’s financial gain).

But they forgot to say X, Y, Z

Describe laws and codes of conduct which require and encourage physicians individually to promote the welfare of their patients
The well-known codes of conduct include the Hippocratic Oath (classical vs modern version), which is a text written by Hippocrates describing his commitment as the father of Medicine to uphold certain standards and ethics. Another code of conduct is the World Medical Association Declaration of Geneva, which also delineates certain values and ethical standards physicians must uphold as they practice medicine. The house of delegates of the AMA created the “Principles of Medical Ethics”, a document which, again, describes commonly agreed to ethical standards which are primarily for the benefit of the patient. This document was created in 2001. Its 9 principles of medical ethics include: #providing competent medical care, with compassion and respect for human dignity and rights, # upholding the standard of professionalism # respecting laws and help change them when necessary # respecting the right of patients, colleagues and other healthcare professionals # continuing to study apply and advance the scientific knowledge and keep a commitment to medicine # having the freedom to choose who to provide medical care to and which environment to provide medical care in # recognizing the responsibility to participate in the improvement of public health # regarding responsibility of the patient as paramount # supporting access to medical care for all people.

Principles in Clinical Medicine Year 1