The Physician's Responsibilities
1. DISCUSS THOROUGHLY WITH PATIENT IN NONTECHNICAL TERMS THE
DIAGNOSIS(ES), WORK-UP, THERAPY, AND PROGNOSIS. Probably the most
common failing of physicians is to explain health problems and the
related issues thoroughly and repeatedly to the patient. First, the
doctor may be so familiar with the illness that he doesn't realize
he is skipping vital basic information. Sometimes, you may find you
have to do the reminding. Second, the doctor may feel you do not
want a lot of information; if so, ask questions or simply say, "I
need more information to understand and cope with my hepatitis."
Third, some doctors believe that patients "can't handle" the
technical information or whole truth about their problems. Such an
antiquated approach has little room in modern medical practice.
Remember, the doctor's responsibility is to the patient, and as
such it is inappropriate for other family members--children,
parents, siblings--to ask the doctor not to discus the illness with
the person affected. It is the patient's health that is at stake,
and should be only his decision if he does not wish
information.
2. PRESENT TO THE PATIENT, WHEN APPROPRIATE, ALTERNATIVE
GENERALLY ACCEPTED APPROACHES TO THERAPY OR TO REACHING A DIAGNOSIS
EVEN IF THE PHYSICIAN DOES NOT PERSONALLY ACCEPT THEM. There are
often several approaches to therapy or to establishing a diagnosis.
These will vary some among physicians, institutions, or even parts
of the country depending on philosophies, availibility of
sophisticated medical testing and therapeutic equipment, and
regional successes with therapy. The physician should present to
you the relative pros and cons of each alternative approach.
3. RECOMMEND TO THE PATIENT WHAT THE PHYSICIAN CONSIDERS THE
BEST APPROACH AND EXPLAIN WHY. While it is important for your
doctor to make you aware of alternative approaches, it is just as
important for him to recommend what he feels is best for you. To
some extent, these recommendations reflect his bias, but they also
take into account other factors which are peculiar to you. He will,
in recommending therapy, consider the disease as it is present in
you, your personality,your approach to illness, your ability to
comply with recommended treatment, your work demands, your family
support, or whatever unique factors exist in your case. If after
this has all been explained to you, you are still uncertain whether
you want to proceed with therapy, you must inform the doctor.
Either the two of you will be able to agree on an alternative, or
if not, he can refer you to another physician.
4. ALLOW ADEQUATE TIME (ON AT LEAST ONE ADDITIONAL OCCASION) TO
ANSWER PATIENT QUESTIONS AND DISCUSS PATIENT CONCERNS. Often the
initial visit to the doctor is sort of a blur. You may be nervous
and you will not remember much information. Questions will not
occur to you until you walk out the door. It is critical for you to
have time to adjust emotionally to a new diagnosis or treatment.
You will find yourself with more unanswered questions. At least a
second session, if only for talking to the doctor or counseling, is
really necessary. This is also a good way of making sure
medications are taken correctly. The doctor's failure to allow for,
or the patient's failure to take advantage of, this second session
can be a major factor in a breakdown of the relationship. It can
also lead to misconceptions about the illness, misunderstanding
about medication regimens, and other problems.
5. PROVIDE ADEQUATE FOLLOW-UP AND EMERGENCY CARE AND MAKE
PATIENTS AWARE OF THIS. Clear cut arrangements should be made for
handling emergency problems, or problems that occur during
non-office hours.
6. ASK FOR SPECIALIST CONSULTATION OR A SECOND OPINION WHEN
UNCERTAIN ABOUT A DIAGNOSIS. Every physician has had the experience
of being stumped. So much new information is generated through
medical research each year that it is impossible for the internist
to keep up on all diseases. Most doctors realize that occasionally
they will encounter difficulties in diagnosis or treating a
particular patient. The same illness never looks quite the same in
different people. Sometimes the doctor simply cannot be sure with
which illness he is dealing. At this point the internist should
arrange for a visit to a doctor whose specialty likely includes the
disease in question. For example, a person with hepatitis may be
sent to a hepatologist or a gastroenterologist.
7. ASSIST IN OBTAINING RELEVANT SOCIAL SERVICES OR
REHABILITATION SERVICES FOR THE PATIENT. The total care of the
patient, especially in chronic illness, extends far beyond the
specific treatment of the disease. Your doctor or his staff should
be able to refer you to the appropriate agencies and assist you in
obtaining these ancillary services. Other problems may occur within
the family that required psychological or psychiatric intervention.
Appropriate referral for these services should also be
available.
8. KEEP COMPLETE PATIENT RECORDS. It is both a legal and moral
obligation of a physician to keep complete care records of his
patients. This assures a smooth transition, for whatever reason, of
care from one physician to another. It also helps prevent
unfortunate errors because memory fails on exact medication or on
exactly what was decided at what visit or during what phone
conversation. Finally, it is crucial as documentation in any legal
proceeding brought for whatever reason.
9. ASSIST IN A SMOOTH TRANSITION FOR THE PATIENT TO ANOTHER
DOCTOR WHEN A RELATIONSHIP HAS BEEN ENDED. If, for whatever reason,
your care has been transferred to another doctor, your former
doctor should facilitate the move by promptly forwarding records
(at your written request), and if necessary discussing your case
with the new doctor. This is true also in situations where the
change in doctors is caused by your or his moving to a new
location.
10. MAKE AVAILABLE TO PATIENTS A LIST OF HIS CHARGES FOR THE
SERVICES HE PROVIDES. All physicians have some system for charging
their patients. Often, initial visits are one charge, follow-up
visits a somewhat lesser charge. The doctor should have available a
summary of his usual charges so you will know what sort of
financial commitment you are making when you visit him. Often,
doctors will reduce fees for patients who are not able to pay the
full charge. Also remember that physician fees do not pay for
laboratory tests or the services of other persons or equipment that
may be needed.
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