Duty of Care – The Doctor-Patient Relationship
The relationship between a patient and their doctor requires mutual respect, trust, and honesty. The goal of the relationship is often to improve or maintain the health of the patient. Therefore, not only is the relationship incredibly important, but it must also be one of collaboration and provide an understanding of both the patient’s expectations and needs. The responsibilities of this relationship mean that the doctor owes a duty of care owed to the patient, representing the responsibility to act on behalf of and in the best interests of that patient. This duty of care will exist until either the doctor or the patient ends the relationship.
Why Is the Doctor-Patient Relationship Important?
Doctor-patient relationships can be profound because they require considerable levels of vulnerability and trust. Patients seeking medical assistance often share incredibly personal and sensitive information with their doctors in an effort to secure meaningful and effective medical treatment. They place an enormous amount of trust in their doctor so they are able to maintain their health or recover from an illness or injury as quickly as possible. The doctor must respect the patient’s wishes and honour their autonomy while providing a high standard of care. That standard of care must be in line with currently accepted standards of practice.
When Does the Duty of Care Begin?
Both patients and doctors have, in non-medical emergency situations, the right to choose whether or not they enter into a doctor-patient relationship. During the first meeting between the doctor and their potential patient, the doctor should try to identify the patient’s expectations and medical needs and explain to the patient their area or areas of expertise. During this initial meeting, both parties should try to determine whether the terms of the relationship are mutually acceptable.
The Canadian Medical Association Code of Ethics and Professionalism also says that a doctor must “Accept the patient without discrimination (such as on the basis of age, disability, gender identity or expression, genetic characteristics, language, marital and family status, medical condition, national or ethnic origin, political affiliation, race, religion, sex, sexual orientation, or socioeconomic status). This does not abrogate the right of the physician to refuse to accept a patient for legitimate reasons.”
A doctor-patient relationship is established when a patient who is seeking medical care and treatment finds a doctor who agrees to provide that care and treatment through an explicit agreement, by providing a diagnosis or treatment or by prescribing medication to the patient. Once they have agreed to provide medical care to the patient, they have entered into a doctor-patient relationship.
What You Should Expect from Your Doctor
Once a duty of care has been established between a patient and their doctor, the patient can reasonably expect that the physician owes an obligation to them. This may come in different forms. A patient should be able to expect a level of effective communication from their doctor. Since the core of the relationship involves the free exchange of information in order to develop a mutual understanding, communication is critical. When the patient is seen by their doctor, they should expect:
- Their doctor’s full attention
- A safe environment that respects the dignity of the patient
- Adequate instructions regarding treatment and follow-up care
- The candid exchange of information, including that which is confidential, sensitive, or intimate in nature
- To feel the doctor expresses concern for their health and wellbeing
- To feel their role as the patient is respected by the doctor
Patients should also expect that in the event their doctor is unable to provide a diagnosis or treatment or if they are not responding to the treatment provided by their doctor, they will be referred to another physician for a consultation. In addition, if a doctor is unable to provide care for a period of time, they must provide a referral or arrangements for alternative coverage for their patients.
It is important to note that a duty of care relates to a doctor’s obligation to provide a high standard of care to their patients. It does not require the doctor to provide any and all medical treatments the patient may request.
The Fundamentals of a Strong Doctor-Patient Relationship
Doctor-patient relationships are not so unlike other personal and professional relationships we have in our lives. Like other relationships, we need openness, solid communication, honesty, and trust, and we want to feel comfortable and confident in our partner. Relationships between doctors and patients must encompass four critical elements:
- Mutual trust: Both the doctor and the patient need to trust each other. The patient must trust in the doctor’s skill, ability, care, and competence. The doctor must trust in the patient’s report of their past medical history, current condition, expectations, and explanation of their beliefs.
- Mutual knowledge: The patient and doctor must share the pertinent knowledge they possess with each other in order to try and achieve optimal medical outcomes.
- Loyalty: Even the strongest doctor-patient relationships are not perfect. Both patients and doctors ought to be able to navigate issues like scheduling errors or minor inconveniences while remaining loyal and committed to the relationship.
- Regard: Patients need to feel like their doctor is on their side and respects who they are. In the same way, doctors thrive when their patients appreciate the work they do and respect their skill, knowledge, and competence.
If a doctor-patient relationship is lacking these fundamental elements, it’s very difficult for the doctor to adequately address the patient’s healthcare needs. Doctors sometimes meet patients at a difficult time in their lives when they may be struggling with an injury or illness. The doctor-patient relationship should serve to help the patient not only in identifying what ails them but also help them deal with the implications of needed treatments and provide encouragement and support to navigate the process of assessment, diagnosis, treatment, and recovery.
Doctor-patient relationships can be negatively affected by a variety of factors. Generally speaking, those factors are either dependent on the patient, provider, or health system, or related to a poor patient-provider match. As with any other relationship, if one party fails to uphold their responsibilities within the relationship or if the match is simply not a good one, the relationship will not work or will, at the very least, be a source of stress and frustration.
Patients can help strengthen the quality of their communication with their physicians by doing some preparatory work in advance of their medical visits. This may include:
- Preparing a list of questions they want to ask their doctor
- Providing any and all information regarding their past medical history
- Deciding who should act as their patient advocate and defining what their role should be
How the Doctor-Patient Relationship Can Influence Patient Satisfaction
Patients derive satisfaction from their doctor-patient relationship when they feel the services rendered by their physician were useful or beneficial or the treatment they received proved effective. Each of the four critical elements of a doctor-patient relationship can serve to influence how satisfied the patient ultimately is with their experience. Even patients who receive a poor prognosis often feel a higher level of satisfaction with their doctor if they trust and respect them. Those levels are even higher when a patient feels like their doctor provides emotional support in a caring and friendly way. Patients also feel more satisfied when they feel like their doctor has taken the time to listen to their concerns and address their expectations of the medical care they are to receive.
How Health Outcomes Can Be Affected by the Doctor-Patient Relationship
The complex nature of medicine and the human body means that a huge variety of factors can influence the overall health of the patient. One of those factors is actually the quality of the doctor-patient relationship. Poor medical outcomes can be the result of a problematic doctor-patient relationship. When patients feel like their doctors aren’t listening to them, are treating them disrespectfully, or aren’t fulfilling the basic fundamentals of a doctor-patient relationship, a poor outcome may occur.
Ending a Doctor-Patient Relationship
A doctor or a patient can end a doctor-patient relationship. The patient may end the relationship at any time for any reason. A doctor typically ends a doctor-patient relationship for reasons like:
- A leave of absence
Doctors are, however, permitted to end their relationship with a patient for other reasons as long as their patient does not need emergency medical care. Some jurisdictions in Canada do require a physician to have a reasonable cause to end the relationship. Additionally, some medical regulatory authorities require doctors to thoroughly document the reasons the doctor chose to terminate their relationship with their patient within the respective patient’s medical record. Typically, when doctors and patients choose to end their relationship for reasons other than those listed above, the doctor-patient relationship has broken down irreconcilably.
The Role of Duty of Care in Medical Malpractice Cases
In medical malpractice cases, the doctor-patient relationship and the owed duty of care can play a central role and require close examination and evaluation during the case. In order for a patient (plaintiff) to prove medical negligence, they must demonstrate that the doctor (defendant) owed them a duty of care, breached the standard of care, and that the impugned actions and/or omissions of the doctor resulted in an injury or loss to the patient. The doctor’s duty of care arises from the establishment of the doctor-patient relationship. As a result of this relationship, the doctor has a fiduciary duty to act for the benefit of, and in the best interests of their patient.
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