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Chapter 10 Medical Staff Organization and Malpractice Principles of Medical Ethics

▸ PRINCIPLES OF MEDICAL ETHICS The medical profession has long subscribed to a body of ethical guidelines

developed primarily for the benefit of the patient. As a member of this profession, a

physician must recognize responsibility to patients first and foremost, as well as to

society, to other health professionals, and to self.

The following principles adopted by the American Medical Association are not laws,

but rather standards of conduct that define the essentials of honorable behavior for

the physician.

Code of Medical Ethics I. A physician shall be dedicated to providing competent medical care, with

compassion and respect for human dignity and rights.

II. A physician shall uphold the standards of professionalism, be honest in all

professional interactions, and strive to report physicians deficient in character or

competence, or engaging in fraud or deception, to appropriate entities.

III. A physician shall respect the law and also recognize a responsibility to seek changes

in those requirements that are contrary to the best interests of the patient.

V. A physician shall respect the rights of patients, colleagues, and other health

professionals, and shall safeguard patient confidences and privacy within the

constraints of the law.

V. A physician shall continue to study, apply, and advance scientific knowledge;

maintain a commitment to medical education; make relevant information available

to patients, colleagues, and the public; obtain consultation; and use the talents of

other health professionals when indicated.

VI. A physician shall, in the provision of appropriate patient care, except in emergencies,

be free to choose whom to serve, with whom to associate, and the environment in

which to provide medical care.

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VII. A physician shall recognize a responsibility to participate in activities contributing to

the improvement of the community and the betterment of public health.

III. A physician shall, while caring for a patient, regard responsibility to the patient as

paramount.

IX. A physician shall support access to medical care for all people.

The following correspondence in the form of a reality check describes one episode of a frustrated patient’s journey of being passed from physician to physician,

eventually finding one she thought would help her find the answers to her

mysterious disease.

What happened to the first principle in the code of medical ethics for physicians?

I. A physician shall be dedicated to providing competent medical care, with

compassion and respect for human dignity and rights.

The physician failed to respond. The patient considered contacting the hospital

governing body as well as regulatory and accreditation agencies but never pursued

the option because her painful disease consumed her life.

98

MY HOPES FOR HELP CRUMBLE

“When I went to your office, it was with great hopes that someone was finally going to piece together all of the bizarre symptoms I have been experiencing over the last several months and get to the cause of my pain.

I was quite frankly shocked by how I was treated as a patient—especially one experiencing a health crisis. A medical student examined me. He wrote my history and current health problems on a small “yellow sticky pad.” You were not in the room when he examined me, and then I saw you for approximately 10 minutes. You took the business card of my New York doctor and said you were going to call him, and then call me regarding what you thought the next steps should be.

I called you on Friday because my local doctor said that you had not called, and I was told you were on vacation until yesterday. I had asked that you call me. You never did. I called you yesterday again, but you did not answer nor did you return my call. On Monday, I received a letter from a medical student, I assume. Although I empathize with the demands on your time, I have never seen a handwritten letter,

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The patient’s hope for answers and possible treatment in this reality check were dashed. The patient began to lose trust in the medical profession. I listened as she

explained to me, “I was troubled as I stood looking at the code of medical ethics that hung so prominently in the physician’s waiting room. All the right words were there,

only one thing was missing.” I asked her what was missing. She looked at me and

emphatically said, “practice.”

which I received, informing me of test results I provided to you prior to my appointment with you. You never mentioned the liver enzyme elevations or my February test from New York. Moreover, no mention was made regarding any plan to help me alleviate immediate problems.

Doctor, I am not a complainer or a person with a low pain tolerance. Since moving here, I’ve had fainting episodes, severe chest pain and pressure, leg and arm pain and stiffness, congestion on the left side when the pain kicks in, and by 3 o’clock I have to go home and lie down because I’m so weak and tired. I cannot continue to exist like this. It is not normal. If you’re too busy and don’t want to take me as a patient, you will not offend me. Frankly, I need attention now to get these things resolved. Testing my cholesterol in a month will not address the problem. I’ve been treated for that for three years.

Please call or write to me so I can get another doctor if I have to.”

—Anonymous