A high standard is expected of professional conduct and integrity within a Doctor-patient relationship.
Written by Michael Gorton AM, Principal at Russell Kennedy Lawyers and Laura Haffenden, Law Student
The relationship is personal, with high regard to privacy and respect for a patient’s best interest and needs. Doctors work in close proximity to their patients to provide them with the adequate care they require. These relationships can evolve as treatment progresses, some long-term some short-term, creating an atmosphere where patients become reliant on the information and treatment of their doctors.
The medical industry maintains a strong moral compass with regard to what conduct towards patients is appropriate and inappropriate. However, there are circumstances where doctors are faced with predicaments in which patients actions are unacceptable, and these may be the situations where it may be necessary for doctors to terminate doctor-patient relationships.
Some patients can become vulnerable and familiar. During these times patients may misinterpret or perceive a doctors role to be beyond the ordinary boundaries, and request actions beyond their ordinary scope. This may include displaying emotions or make advancements that are not appropriate in that relationship. There must be safeguards for doctors in these situations where their service and roles within this relationship may be compromised by acts of aggression, sexual propositions and requests for relations outside common expectations. It may be necessary for doctors to assess what can be done in these circumstances to end a doctor-patient relationship.
The decision to say no to patients may be daunting and uncomfortable. Explaining and outlining the boundaries of the professional relationship must be communicated to a patient. Where these boundaries are overstepped by a patient, a doctor must endeavour to clearly communicate that the patient has overstepped, and request that those actions not be repeated.
Communicating openly and honestly may enable a doctor to avoid making the patient feel as though it is a personal affront or rejection.
In assessing how the situation can be resolved, a doctor may seek advice of senior colleagues or relevant medical defence organisations.
A formal process must be initiated where a doctor wishes to discharge their care of a patient or transfer the care to another practitioner. Contact and conduct outside of the treating relationship should be reported, and documented. Letter responses to the patient, and the date of specific conversations may also need to be factually documented. A doctors actions must adhere to the relevant Medical Code of Practice, and their conduct must follow any legal and professional obligations. Discussions of alternative practices or practitioners, between the doctor and patient may be necessary, with a list of alternatives to be provided. A reasonable deadline to make other medical treatment arrangements must be provided, and all relevant documents should be transferred. Practice staff should be advised as to the change.
Where the patient requires immediate or emergency medical attention a doctor holds a professional and ethical duty to assist. Where a patient is undergoing immediate or advanced medical treatment for a long term illness, a doctor may be required to render or continue treatment until such a time as a shift in practitioners would not negatively impact a patient’s outcome. Further a doctor should seek to keep in mind the best interest of the patient, to avoid a lapse in care and avoid negligence where a doctor-patient relationship ceases. There must be compliance with providing a patient with information in regards to follow up on any further care.
These circumstances are never easy, but are sometimes necessary and unavoidable.