The doctor–patient relationship is a central part of health care and the practice of medicine. .. 9 August ^ "Restructuring Informed Consent: Legal Therapy for the Doctor-Patient Relationship". The Yale Law Journal. 79 (8): – From USLegal, Inc (ommag.info ) The physician-patient relationship is regarded as a fiduciary relationship. Looking for online definition of physician-patient relationship in the Medical This book does not attempt to cover all of healthcare law in this country, but rather .
Abernathy treated Wendy for a pulled muscle. But a few days later, her condition worsened. After a few days more of worsening condition, she was referred to Dr. Kovaz, an internist, who immediately moved her into the intensive care unit. Unfortunately, Wendy died from beta strep septicemia.
An expert testimony was taken from Dr.
Doctor-Patient Relationships: The Distinction Between Contractual and Tortious Liability
Neal Craine and Dr. They believed that Wendy could have been saved, and countless such opportunities had been presented during the course of her unsuccessful treatment.
Thus it was stated that the treatment meted out to Wendy was well below the standard of care. This was challenged and an appeal was made. Another case which is of paramount importance is the case of Locke v. The plaintiff Locke underwent a hysterectomy at the University of Michigan hospital. The procedure was performed by Defendant, Dr. During the operation, while Defendant was beginning repair of the rectocele, the needle she was using broke.
Defendant searched unsuccessfully for the needle for over an hour. She then abandoned the search and closed the incision. Defendant informed Plaintiff afterward of the needle breakage and told her that the needle could remain inside her without causing any problems.
However, after experiencing pain, Plaintiff visited another doctor who was able to remove the broken portion of the needle. Plaintiff then sued Defendant alleging negligence on res ipsa loquitor grounds. It stated that a bad result is not sufficient to satisfy res ipsa loquitor. Something more is required, be it the common knowledge that the injury does not ordinarily occur without negligence or expert testimony to that effect. It is a subjective measure put up which will differ from person to person.
Physicians are generally judged on the principle of what is actually said to be the prevailing practice and professional consensus. Care has to be taken that these qualities must not be confused with which is the best and only way to treat a patient. Medicine is an inexact science and it is severely difficult to prove one methodology to be superior to the other. Variations could be structured around anything.
The first and foremost which comes to mind is that around schools of thought and training. There are different sets of beliefs and techniques used by the physicians that it is difficult to pinpoint a correct one. Also, the standard of care differs from one specialization and practice location to the other. For example, the level of expertise expected of a general physician and an expert in one particular field are totally different.
While the physician is assumed to know generally the conditions, the specialist will recognize even the little degrees of distinction shown in the symptoms. In the case of Jones v. Chidester [ix]Dr. Chidester performed orthopedic surgery on the leg of Mr. To obtain a bloodless field, Dr. Chidester used a tourniquet and released it at intermittent times. It was later discovered that Mr. Jones had nerve damage to his leg.
Jones contended that his nerve damage was caused by the use of the tourniquet during surgery.
Physician Patient Relationship Law and Legal Definition | USLegal, Inc.
Each side produced evidence and witnesses that supported use of tourniquets and avoidance of tourniquets. The jury was instructed that when there are two schools of thought, it is not the job of the jury to determine which school is more medically appropriate when both schools have their respective and respected advocates. Chidester was not held liable for exercising his judgment in applying a course of treatment supported by a reputable and respected body of medical experts, even if another body of experts would have performed a different treatment.
Allison [xi]deals with the locality with respect to the standard of care expected of physicians. Chapel was injured by a horse, taken to an emergency room at Livingston Memorial Hospital where he was treated by Dr. This cast was put during February of and removed in May It was noticed that Mr. The issue raised here was whether a non-board certified general practitioner could be held to a standard of care of a reasonably competent general practitioner acting in the same locality or similar community and under similar circumstances.
It was held that a non-board certified member could actually be held to the standard of reasonable care of a reasonably competent general practitioner. Qualification and examination of medical experts In Thompson v.
Carter [xii]the plaintiff contended that she developed Steven Johnson Syndrome as a result of Dr. She brought in Mr. Hughes to testify as an expert witness. But he did not have a medical degree. A question was raised as to whether a person having medical knowledge but no medical degree could be allowed to testify as an expert witness. The Supreme Court, Prather, J. The case was reversed and remanded for new trial.
It was understood that the witness who would be called in as an expert need not necessarily hold a medical degree.
Doctor–patient relationship - Wikipedia
Instead it is necessary that the person possess medical knowledge. A similar decision was given in the matter of Cornfeldt v. When applying only contractual relationships, the physician is required to provide the patient with only those services that the two of them had agreed upon.
Either a third party would be willing to pay for the services obtained by the patient or the patient themselves would delve into their own pockets for the payment of the same. This relationship between the doctor and the patient could be easily declined if the patient refuses to pay.
A patient can sue a physician for their breach of contract. A contractual approach to forming a partnership between doctor and patient is presented in both theoretical and practical terms. Four basic contractual assumptions underlie the doctor-patient relationship: Clinical examples are used to show practical implications of this model.
Although explicit contracts are not needed for all patients, a contractual analysis of doctor-patient interactions helps both participants share the responsibility for patient care. This informed consent, or lack thereof could be given after being fully aware of the risks or benefits involved in the treatment offered.
An important case which comes under the head of breach of contract is that of Sullivan v.
- Doctor–patient relationship
Sullivan, a professional entertainer who wished to change the shape of her nose to improve her appearance. She went to Dr. Photographs were taken and a line was drawn on the picture over the bridge of the nose to illustrate the intended change.
Sullivan was informed that the procedure, known as a rhinoplasty, would be completed in two operations. This disfiguration required a third operation which failed to improve the nose, but further corrective procedures were considered too precarious. Sullivan filed suit against Dr. The second count lay in negligence, alleging that Dr.
The judge then instructed the jury on the issue of damages. Thus, if the physician is to be held free to contract and to be liable on his promise, he should not then be free to provide for his own protection in advance by the simple expedient of having the patient sign a printed form, in consideration of his agreement to treat him, absolving the physician of any and all liability whether based on negligence or purported representation.
It is said that a strong public policy which pervades this field tries to uplift the contractual relationship from the level of ordinary commercial contracts.
When usually, the liability of the physicians and the surgeons is talked about, it basically always deals with malpractice. The liability of a doctor or surgeon under the ambit of contract can be broadly classified to be of two types; breach of implied contract and breach of express contracts.
Malpractice in the pertinent legal literature is inextricably bound up with the idea of breach of implied contract.
This was especially true of the older cases wherein malpractice was regarded simply as a form of breach of implied contract. The physician or surgeon was spoken of as impliedly holding himself out as possessing the degree of learning, skill and experience ordinarily possessed by the profession in similar localities.
When he failed to exercise such usual knowledge and skill, he was regarded as having breached his contractual duty to his patient. The measure of damages for breach of contract is generally expressed as one intended to put the plaintiff in as good a position as he would have been in had the defendant kept his contract, including also compensation for any consequences which were reasonably foreseeable and within the contemplation of the parties at the time the contract was entered into.
Traditionally, under this rule, physical pain and mental suffering are not proper elements of damage. Normally, only in tort actions or, more pointedly, actions for malpractice, are pain and suffering or mental anguish allowed as elements of damage.
Moreover, a tort rule of damages allows compensation also for impaired earning capacity, loss of time, and consequential damages. The breach of a contract may lead to injury and mental suffering. A few jurisdictions have indeed invoked what amounts to a tort rule of damages in cases where the action was unquestionably based on breach of contract. These cases involved failure of the defendant to perform his contract, resulting in needless pain and suffering to the plaintiff.
Thus, in Coffey v. Rubio [xxii]the appellant having breached its agreement to provide medical care and attention, the court held that damages for both mental and physical suffering were recoverable even though the damages sought were for breach of contract since the very subject matter of the contract was the health of the employee. It remains to be asked whether a contract rule of damages would not then be appropriate in a case where the issue of pain and suffering is not an essential factor.
Such a fact situation might be similar to that presented by Hawkins v. There the measure of damages was, in keeping with the contract rule, held to be the difference between the value of a perfect or good hand as promised and the value of the hand in its present condition, including any incidental consequences fairly within the contemplation of the parties when they made their contract.
Upon analysis, however, even in this fact situation the contract rule of damages appears to be not wholly appropriate. But the contracts made by physicians differ from ordinary commercial contracts under two very broad and important heads: Once the relationship is created by mutual assent, tort rules intervene to establish the standard of care owed by the physician.
In its place, the law imposes a set of non-negotiable tort and fiduciary duties on the physician as the more powerful party. The duties that the courts impose may not always achieve optimal results, but the law assumes that externally imposed terms governing the relationship are more likely to lead to an efficient result than terms negotiated by the parties themselves.
Alternative Theories of Liability As is seen previously, the liability of a doctor with respect to his patients oscillates between the spheres of contract law and tort law. More often than not, these two spheres overlap extensively and hence it is a tough task for lawyers to identify the claim under which a case can be filed. The next few sections of this paper deal with the alternate liability against physicians under tort law Res Ipsa and Negligence Per Se: The following four factors are necessary to make a res ipsa loquitor claim.
The case which has been referred to again and again when it comes to negligence is that of Locke v. The facts of the case have been briefly stated above. The plaintiff, had added that, even if the expert testimony was insufficient, her case could have proceeded to the jury on the theory of res ipsa loquitor.
Apart from this case, there are other instances that a case may be given directly to the jury without calling in an expert witness.
Such instances include leaving behind foreign objects in the body after a surgery has been performed, like a clamp or a sponge. Injury to an organ of the body which was not involved in the operation or removing of the wrong appendage or organ also comes under this. A set of laws, known as the Code of Hammurabi circa B. Carefully conscribed details were devoted to specifying the relationship between patients and practitioners, including fees and penalties.
The surgeon who dealt with physical problems, however, was accountable for both remuneration and liability to earthly courts. If a doctor performed surgery, generally with a bronze knife, and saved the life or eyesight of an upper class citizen, he was to be paid 10 shekels of silver. A similar outcome for a commoner was worth 5 shekels and only 2 shekels for a slave. If a slave died because of the surgery, the doctor had to provide a replacement but had to pay only half the value in silver if the slave was blinded.
Probably the most famous physician of all time and the founder of clinical medicine is Hippocrates circa B. Many historians question whether Hippocrates actually wrote this Oath or even the essays attributed to him. Some even question whether Hippocrates was a real person or was a composite created later by Greek and Roman scholars.
Even in antiquity there were rules, policies, and regulations on how to behave as a physician. Next to Hippocrates, Galen is probably the next most famous physician in history. His works and texts continued to be studied by medical students and scholars for hundreds of years after his death.
When Galen ventured to Rome in A. Galen did subsequently return to Rome honoring a request from Marcus Aurelius. He remained for the rest of his life. Modern Regulations and Procedures for Licensing Physicians The modern rules, policies and regulations governing the practice of medicine today are well established. In most jurisdictions — Canada, the United States, Europe — like the Code of Hammurabi, regulations govern nearly every aspect of the patient- physician relationship, clinical guidelines, best practices, evidence based medicine, fees, collegiality, and so forth.
Nearly all jurisdictions in the world nowadays require physicians to be university educated and earn an MD medical doctor degree or other approved degree e. In many jurisdictions students who have earned a medical degree are required to undergo further postgraduate supervised clinical training in the United States called residency, also called a house officer or senior house officer in the United Kingdom and several Commonwealth countries.
Depending on the medical specialty and jurisdiction, residency can be 1 to 6 years in duration. Once a doctor has passed all relevant examinations and qualifying procedures, the physician may be granted a license in a specified jurisdiction to practice medicine without direct supervision. Doctors who have earned their degrees and qualifications from other jurisdictions and come to Canada, the United States, Britain and other places, are called international medical graduates are not considered to be legally qualified to practice medicine in that jurisdiction and must go through a series of assessments, re-education, residency and further examinations.
This control about who can practice medicine in particular jurisdictions has always existed.
Physician Patient Relationship Law and Legal Definition
Leonardo Fioravanti, a Renaissance physician who held a MD degree from the University of Bologna, a preeminent medical school of that time, ran into jurisdictional difficulties in his practice of medicine. After eight days in prison, however, Fioravanti was becoming increasingly outraged by the indignity he was suffering.
The Milanese physicians had been plotting against him since his arrival from Venice in They considered him an outsider, an alien and an unwelcome intruder. They finally were able to have him incarcerated. Fioravanti was not a conventional medical charlatan hawking his nostrums in the piazza and then moving on.
Nor was he a run-of-the-mill barber-surgeon. He had a MD from the University of Bologna, had published several medical texts, had developed many medicines, and was a severe critic of much of conventional medical practice. The Milan physicians were not welcoming and considered him a foreign doctor. A paid messenger delivered the letter to the Health Office located in the Piazza del Duomo.
The health minister, Niccolo Boldoni, was responsible for overseeing every aspect of medical practice in Milan, from examining midwives, barber-surgeons, and physicians, to collecting fees, imposing fines, inspecting apothecaries, and ruling on appeals. The letter from the Doctor and Knight, Leonardo Fioravanti, claimed that the Milan physicians were in a plot to stop him from providing care and cures to the sick of Milan.
Moreover, he claimed that the Milan physicians were a menace to their patients and did more harm than good with quack treatments, poisonous medicines, and careless and arrogant behaviours. Fioravanti challenged the minister to provide 25 of the sickest patients to him and an equal number to Milan doctors that the minister selected and that he - Fioravanti - would cure his patients quicker and better than the other doctors.
It is unlikely that this early clinical trial ever occurred as there is no historical record of it, but Boldoni and the Milan court set Fioravanti free. Building a Safer Health System. Subsequent commentators have suggested that this is an underestimate and the actual mortality rate is much higher. These claims triggered international discussion, concerns and controversies about patient injuries in health care.
These errors are due to drug overdoses or interactions, misdiagnoses, botched surgeries, incorrect medications, and simple carelessness. Patient safety, a topic that had been little understood and even less discussed in health care systems, has become a public concern in most Western countries.
Notwithstanding its status as a mantra of modern medical practice, patient safety still requires investigation. Thousands of people are injured or die from medical errors and adverse events incapacitation, serious injury or death each year.
Worldwide this figure may run into the millions. Leaders in the health care systems have emphasized the need to reduce medical errors as a high priority. Doctors, as main participants have been called upon to address the underlying systems causes of medical error and harm. Unfortunately, several studies have shown that even by more than half of hospital doctors surveyed 5 had not even heard of the report, To Err Is Human.
It is not surprising then that few advances have been made in reducing medical errors and increasing patient safety in the past decade. A recent study of major adult cardiac surgical cases at three hospitals resulted in 1, reports of problems and errors for an average of 3. Nearly three-fourths of the cases A wide range of problems and errors occurs during the majority of cardiac surgery procedures.
The major factors underlying medical errors are thought to be system-based factors miscommunication on the ward as well as person factors: Failure to hold individuals accountable may contribute significantly to risk of adverse events and may lead to a focus of patient safety away from the autonomous responsibility of physicians to a systems-based approach. In the current issue of the Canadian Medical Education Journal we have included six major research contributions, two systematic review papers and three brief reports.
Each of these addresses some aspect of patient safety, medical errors, practice guidelines and evidence based medicine. Major Research Contributions Bass, Geddes, Wright, Coderre, Rikers and McLaughlin studied how experienced physicians benefit from analyzing initial diagnostic hypotheses. They began with the premise that most incorrect diagnoses involve at least one cognitive error, of which premature closure is the most prevalent.
Thus Bass et al conducted an empirical study to evaluate the effect of analytic information processing on diagnostic performance of nephrologists and nephrology residents from the University of Calgary and Glasgow University.
Participants were asked to diagnose ten nephrology cases.