Healthcare Provider–Patient Relationship

Chapter Objectives

• To understand the roles of healthcare professionals as both providers and consumers
• To define the patient using the acronym DEAR: Dignity, Empathy, Autonomy, Respect
• To learn about The Patient's Bill of Rights
• To understand the healthcare provider–patient relationship, including contracts and consent
• To know how to handle transference (boundaries)
• To understand the healthcare consumer
• To know the reasons a patient could be released from care

Key Terms

• Autonomy: self-governance
• Consent: permission for something to happen or agreement to do something
• Contract for care: An agreement that creates a relationship where the healthcare provider is to provide care to the patient
• Countertransference: redirection of a therapist’s feelings toward a patient
• Dignity: the state or quality of being worthy of honor or respect
• Empathy: the ability to understand and share the feelings of another
• Good Samaritan law: offers legal protection to people who give reasonable assistance to those who are, or who they believe to be, injured, ill, in peril, or otherwise incapacitated
• Healthcare consumer: is someone seeking professional care or treatment for health
• Implied consent: occurs when a patient's behavior suggests compliance
• Informed consent: giving permission based upon a clear appreciation and understanding of the facts, implications, and future consequences of an action
• Noncompliance: Failure to act in accordance with a wish or command
• Patient Care Partnership: informs patients about what they should expect during their hospital stay with regard to their rights and responsibilities
• Patient's Bill of Rights (PBOR): list of guarantees for those receiving medical care
• Respect: a feeling of deep admiration for someone or something elicited by their abilities, qualities, or achievements
• Standard of care: refers to the attention given to a task (with a patient) that would reasonably be expected to be given by anyone in a similar situation
• Transference: the redirection to a substitute, usually a therapist, of emotions that were originally felt in childhood

Establishing Ethical Standards

• Dr. William Mayo, founder of the Mayo Clinic, stated the best interest of the patient is the only interest to be considered
• The patient should be seen as an individual to provide the best healthcare
• A foundation of trust should exist in every healthcare provider-patient relationship
• Healthcare professionals must uphold high ethical standards to earn the patient's trust

High Ethical Standards

• Avoid personal relationships or greed to keep the patient's best interest first
• Use resources appropriately to avoid contributing to higher medical bills

The Patient is DEAR

• The patient is DEAR: Dignity, Empathy, Autonomy, and Respect
• Personal and professional lives should be separate
• A wise healthcare professional knows the worth of putting the patient first to provide the best care

D-Dignity

• Dignity is the result of showing regard for another person
• Showing a patient respect empowers them to feel dignity
• Dignity varies depending on the receiver and is an issue in vulnerable populations like the elderly

E-Empathy

• Remembering how you would want to be treated as a patient and understanding patient needs will enhance how you serve patient
• Empathy is the mark of a top-notch healthcare professional

A-Autonomy

• Autonomy is a necessary consideration concerning a patient’s rights
• Autonomy is the act of the patient making his/her own decisions, in partnership with the medical staff, without influence of the medical staff
• Patients have the autonomy to request extra tests to be sure about a proposed treatment plan

R-Respect

• Respect is necessary for quality health care
• When respecting someone, you show them attention and regard their feelings
• Show respect regardless of a person's characteristics (age or economic status)
• Present the highest standard of professionalism to maintain a spirit of helpfulness, knowledge, and regard for the other person’s condition
• Avoid taking it personally when a patient lashes out because they are likely not at their best

Robert Sidakis Case Study

• First response to an agitated patient should be one of empathy and concern
• Put your feelings aside and attend to his or her needs, because you are called on through professionalism

The Healthcare Consumer

• A healthcare professional will experience the roles of provider and healthcare consumer
• Anyone seeking professional care or treatment for health is considered a healthcare consumer
• It is good to be an informed patient
• Ask questions and stay informed without hindering healthcare providers from serving you

Healthcare Costs

• Healthcare is one of the most expensive purchases
• The average daily cost of a hospital stay in the United States is a minimum of $5,000
• The west coast averages more than $7,000
• A patient expects to get the highest standard of care

Ethical Considerations in Healthcare Provider–Patient Relationships

• The patient relationship is a fragile one so you want to provide the highest standard of care
• Standard of care refers to the attention given to a task (with a patient) that would reasonably be expected to be given by anyone in a similar situation
• In a professional relationship, special attention is given to the patient as an individual, and lines are clearly drawn about what is and is not appropriate behavior

Maintaining a Professional Relationship

• Care is built on trust so deliver high-quality care
• Leave the room when a patient is undressing for an examination unless the patient needs assistance, and in that case, have at least one other healthcare professional present
• Avoid using inappropriate language, such as telling jokes with sexual content, and never use racial slurs
• When a physician conducts an intimate examination, there should be at least one other healthcare professional present
• Conversations should be limited to informing the patient of what is being done during these types of examinations or treatments
• Listen to the patient without judging because It is a problem if the patient thinks it is a problem, regardless of opinions
• Be careful not to overstep personal boundaries and avoid questions about marital status, sexual orientation, religion, and other highly sensitive areas unless they directly relate to the medical concern
• Sexual contact (even flirting) is unprofessional and unethical, and should be completely avoided even outside of the healthcare setting
• It is highly unethical to visit with a patient outside of the healthcare setting
• Never make promises to a patient as that is unethical and illegal; for example, promising to fix cancer

Transference

• The healthcare provider–patient relationship can come in different forms,
• A patient may even retain feelings or attitudes associated with childhood, which may surface during treatment and may be transferred onto the healthcare provider
• This phenomenon is known as transference
• Although transference is usually associated with the patient developing feelings of love or sexual attraction to the professional, it can involve other feelings
• Countertransference is when the healthcare provider experiences feelings for the patient that are out of the norm, such as love, anger, or any other emotion
• A healthcare provider should never engage in a personal relationship with a patient

Susan Walters and Dr. Henson Case Study

• Susan Walters had been raped as a child

Contracts and Consent

• The healthcare provider-patient relationship is a type of contract
• A contract for care is an agreement that creates a relationship where the healthcare provider is to provide care to the patient
• Consent is a patient’s agreement to treatment
• Consent is for specific healthcare, such as a consultation or an injection
• Consent comes in two forms: (1) informed (also known as express) and (2) implied
• Informed consent is an important factor in the autonomy of the patient and brings the patient into the decision-making process of his/her care

Informed Consent

• Informed consent occurs when the physician explains a treatment or procedure(s) and the patient or patient representative agrees to have them performed
• The consent can be verbal, but it is usually written, and this type of consent is most protective of the physician’s liability
• Another term for informed consent is express consent
• Informed consent could be in the form of a written statement signed by the patient that is declaring understanding
• Even if a patient signs a consent form, that does not necessarily mean fully comprehends what is being explained
• The medical caregiver should be sure before concluding the meeting that the patient or patient representative does understand what is being proposed

Barriers to Understanding Medical Treatments

• There are many barriers that contribute to a lack of understanding on the part of the patient
• Barriers include a lack of basic information on the consent form, and ineffective provider–patient communication
• Lack of consideration of health literacy of patients and cultural issues of patients when developing informed consent communication forms are also barriers

Implied Consent

• Implied consent occurs when a patient’s behavior suggests compliance
• For example, rolling up a sleeve to accept the shot after being told the doctor has ordered a shot for sinus infection
• Consent is implied in emergency situations, such as a car wreck
• The Good Samaritan law protects the healthcare provider from being sued when performing medical care in good faith

The Good Samaritan Law

• The law protects healthcare providers and even, in some cases, other providers, such as those who provide free medical services at clinics and got its name from the Bible (Luke 10:25–37)
• Every state in the U.S. now has some version and some of these include a "duty to assist” statute, making it a crime for a healthcare professional to see an accident and not stop to offer assistance

Can a Physician “Fire” a Patient?

• A physician also has the legal and moral right to “fire” (release) a patient
• Patients can only be fired because contracts that are violated may be terminated
• Patients may be dismissed from a certain physician’s care due to noncompliance, insurance plan participation, and patient’s failure to keep appointments.

The Patient Care Partnership

• The Patient Care Partnership was a developed as a guide for patients to better understand their rights and responsibilities when receiving medical care during a hospital stay
• The document also addresses financial aspects of patient care, confidentiality, and the fact that patients have choices in their own medical care

Rights of Patients

• The patient has certain rights, including respect, empathy, and dignity (RED)
• Other rights can be reviewed in the U.S. Government Bill of Rights under the Affordable Care Act
• Included under ethical and legal considerations are the issues of consent and contract