The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for example, a recent version of Adobe Acrobat Reader). “Editor's Note: Doctors and patients share a legal fiduciary relationship which is contractual in nature. Due to this, a doctor owes a reasonable. Keywords: treatment contract, relationship between physician and patient, agency The legal relationship between a patient and physician is firstly a contractual .. that can be in compliance with the nature of the treatment contract is the.
It has been observed that custom-based standard of care is not something which is determined by actual practice. It is something determined by whether a certain medical practice is acceptable or not. This acceptance may differ from one school of medicine to other. Medically, both the schools of thought may not have been absolutely proven right or wrong. What matters usually is that the acceptance is derived from one of these, not from both.
The implementation of such custom-based standard of care is very difficult. It deals with an invisible average line of the skill, capacity and competence of doctors in close relations with accepted practices. But some people believe that there is no standard of care to adhere by. An important case law to be noted here is that of McCourt v. It was stated by the patient that while working with the horses a few days ago, she was injured by a horse and hyper extended her left shoulder.
She also stated that two days prior to the horse accident she had pricked her finger with a pin, but continued to work around the manure.
Abernathy and Clyde were board certified family practitioners. 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. 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.
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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. 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.
Doctor–patient relationship - Wikipedia
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. 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.
The legal nature of doctor patient relationship in Turkish medical law
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. 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. Adherence management coaching becomes necessary to provide positive reinforcement of unpleasant options. For example, according to a Scottish study,  patients want to be addressed by their first name more often than is currently the case.
In this study, most of the patients either liked or did not mind being called by their first names. Only 77 individuals disliked being called by their first name, most of whom were aged over Generally, the doctor—patient relationship is facilitated by continuity of care in regard to attending personnel.
Special strategies of integrated care may be required where multiple health care providers are involved, including horizontal integration linking similar levels of care, e. In most scenarios, a doctor will walk into the room in which the patient is being held and will ask a variety of questions involving the patient's history, examination, and diagnosis.
This can go a long way into impacting the future of the relationship throughout the patient's care. All speech acts between individuals seek to accomplish the same goal, sharing and exchanging information and meeting each participants conversational goals. A question that comes to mind considering this is if interruptions hinder or improve the condition of the patient. Constant interruptions from the patient whilst the doctor is discussing treatment options and diagnoses can be detrimental or lead to less effective efforts in patient treatment.
This is extremely important to take note of as it is something that can be addressed in quite a simple manner. This research conducted on doctor-patient interruptions also indicates that males are much more likely to interject out of turn in a conversation then women. These may provide psychological support for the patient, but in some cases it may compromise the doctor—patient confidentiality and inhibit the patient from disclosing uncomfortable or intimate subjects.
When visiting a health provider about sexual issues, having both partners of a couple present is often necessary, and is typically a good thing, but may also prevent the disclosure of certain subjects, and, according to one report, increases the stress level. Family members, in addition to the patient needing treatment may disagree on the treatment needing to be done.
This can lead to tension and discomfort for the patient and the doctor, putting further strain on the relationship. Bedside manner[ edit ] The medical doctor, with a nurse by his side, is performing a blood test at a hospital in A good bedside manner is typically one that reassures and comforts the patient while remaining honest about a diagnosis.
Vocal tones, body languageopenness, presence, honesty, and concealment of attitude may all affect bedside manner. Poor bedside manner leaves the patient feeling unsatisfied, worried, frightened, or alone.
Bedside manner becomes difficult when a healthcare professional must explain an unfavorable diagnosis to the patient, while keeping the patient from being alarmed. Rita Charon launched the narrative medicine movement in with an article in the Journal of the American Medical Association.
In the article she claimed that better understanding the patient's narrative could lead to better medical care. First, patients want their providers to provide reassurance.
Third, patients want to see their lab results and for the doctor to explain what they mean. Fourth, patients simply do not want to feel judged by their providers. And fifth, patients want to be participants in medical decision-making; they want providers to ask them what they want. Please help improve this article by adding citations to reliable sources. July Learn how and when to remove this template message Dr. Gregory House of the show House has an acerbic, insensitive bedside manner.
However, this is an extension of his normal personality. In Grey's AnatomyDr. George O'Malley 's ability to care for Dr. Bailey's baby by saying "it speaks to a good bedside manner. In LostHurley tells Jack Shephard that his bedside manner "sucks". Later in the episode, Jack is told by his father to put more hope into his sayings, which he does when operating on his future wife. The comments continue in other episodes of the series with Benjamin Linus sarcastically telling Jack that his "bedside manner leaves something to be desired" after Jack gives him a harsh negative diagnosis.
In CloserLarry, the physician tells Anna when they first meet that he is famed for his bedside manner.