Transcript Document

Pearson's Comprehensive
Medical Assisting
Administrative and Clinical Competencies
Second Edition
CHAPTER
CHAPTER
3
Medical Law and Ethics
Lesson 2:
Patient/Physician Relationship
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Lesson Objectives
Lesson Objectives
Upon completion of this lesson, students
should be able to …
• Discuss informed consent.
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Physician Rights
• A physician and patient form a contract
when there is a service and fee that is paid
• The patient must confide truthfully in the
physician in order to receive proper
treatment
• If the physician does not know all the
facts, there could be serious
consequences
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Critical Thinking Questions
1. Does a physician have to treat every
patient that comes into the office?
2. When might the physician choose not to
treat a patient?
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Physician Rights
• Physicians have the right to:
– Select the patients they wish to treat
– State the types of services they will provide
– State the hours their offices will be open
– Determine where their offices will be located
– Expect payment for the treatment given
– Take vacations and time off from practices
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Patient Rights
• Patients have the right to:
– Approve or give consent for all treatment
– Expect the standard of care
– Expect confidentiality by the physician and
employees
– Privacy
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Patient Obligations
• Patients have an obligation to:
– Follow instructions given by the physician
– Pay the physician for the services
– Truthfully give the physician all information
required
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Informed Consent
• Involves informing the
patient about the
possible consequences
of both having and not
having certain
procedures and
treatments
– The physician must
carefully explain that, in
some cases, the
treatment may even
make the patient’s
condition worse
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Doctrine of Informed Consent
• Explanation of advantages and risks to the
treatment
• Alternatives available to the patient
• Potential outcomes to the treatment
• What might occur if there is no treatment
• The use of understandable language
There are exceptions to the Doctrine of Informed
Consent that are unique to each state.
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Common Exceptions to Informed
Consent
• A physician does not have to inform a
patient about risks that are commonly
known
• If the physician feels the disclosure of risks
may be detrimental to the patient, then he
or she is not responsible for disclosing
them
• If the patient requests the physician to not
disclose the risks, then the physician is not
responsible for failing to do so
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Implied Consent
• When a patient is seen for a routine
examination for medical treatment, there is
implied consent that the physician will
touch the person during the examination
– Battery: touching someone without the
person’s consent
– In a routine examination, there is no crime,
since there is implied consent
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Implied Consent
• Also occurs when there is an emergency
situation and the patient cannot
understand the explanation or sign a
consent form
– The physician is protected by law when
providing emergency care
– The physician may not delegate gaining
informed consent to another, except in an
emergency
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
How Protective is an Informed
Consent?
• Anyone can sue anyone if they want
• However, if….
– the physician has carefully explained the
treatment,
– the patient acknowledges understanding the
explanation and risks involved, and
– the patient signs the consent form
….there is some protection.
• Still, patients sue physicians when the
treatment fails
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Refusal of Treatment
• Patients have the right to refuse treatment
• Reasons for refusing treatment include:
– Religion
– Personal beliefs
– Personal choice
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Rights of Minors
• Minor: Under 18 in most states (though this
varies in some states)
• Minors are unable to give consent for treatment
• Exceptions
–
–
–
–
Pregnancy
Request for birth control information
Abortion
Testing and treatment for sexually transmitted
diseases
– Problems with substance abuse
– Need for psychiatric care
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Categories of Minors Who Can
Give Consent
• Mature minors: A young person who possesses
a maturity to understand the nature and
consequences of the treatment in spite of young
age
• Emancipated minors that
–
–
–
–
–
live on their own
are married
are self-supporting
are in the armed forces
any combination of the above conditions
• Rules vary from state to state
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Legal Implications to Consider
When Treating a Minor
• When does a minor have the right to
confidentiality?
• Who is financially responsible?
• Who is the minor’s legal guardian?
For more information on the rights of emancipated
minors by state, click here or go to
http://www.jlc.org/factsheets/emancipationus
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Think About It!
Situation #1
Situation #1
• A teenager is seeking birth control. She
has the right to confidentiality.
• The girl cannot pay for services.
• How does your office get payment?
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Think About It!
Situation #2
• A teenager living with her mother needs
treatment for an STI.
• The patient has a right to confidentiality.
• The parents are divorced and the father
has financial responsibility for care and
treatment.
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Patient Self-Determination Act
• Documents that
provide protection to
both the patient and
physician
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Requirements of Health Care
Institutions
• Provide patients a written summary of their
health care decision-making rights
• Give written policy with respect to recognizing
advance directives
• Ask and document if patients have an
advance directive
• Educate staff and community about advance
directives
• Never discriminate based on whether
patients have advance directives
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Living Will
• Allows patients to request that life-sustaining
treatments and nutritional support not be
used to prolong their life
• Gives patients the legal right to direct the
type of care they wish to receive when death
is imminent
• Protects physicians and hospitals when they
follow the patient’s wishes
• Copy of living will should be kept with the
patient’s records
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Durable Power of Attorney
(DPOA)
• Allows an agent or
representative to act
on behalf of the
patient
• Can be for health
care only or other
legal things
• Agent may be a
spouse, grown child,
friend, or an attorney
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Durable Power of Attorney
(DPOA)
• Used when a patient becomes mentally
incapacitated
• Document is in effect until the patient
cancels it or until the patient is able to
make their own decisions again
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Critical Thinking Questions
1. What are the potential implications of not
having a DPOA?
2. Are there disadvantages to having a
DPOA?
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Uniform Anatomical Gift Act
• Allows a person 18 years or older and of sound
mind to make a gift of any or all parts of their
body for the purposes of organ transplantation
or medical research
• A physician who is not involved in the transplant
will determine the time of death
• No money is allowed to change hands for organ
donations
• Donor carries a card signed by 2 witnesses
• The family can make this decision in some
cases
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Uniform Anatomical Gift Act
• Each day about 19 people die for lack of
an organ donation
• There about 95,000 individuals waiting on
the organ donation list
For information on organ transplants click here or
visit www.organdonor.gov
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Critical Thinking Question
1. What are the potential controversies to
organ donation?
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Questions?
Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e
Beaman • Fleming-McPhillips • Routh • Gohsman • Reagan
Copyright ©2011 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.