Healthcare Provider – Patient Relationship

Chapter Objectives

• The chapter highlights the importance of healthcare professionals as both providers and consumers.
• Discusses the DEAR principles: Dignity, Empathy, Autonomy, and Respect in patient care.
• Outlines The Patient’s Bill of Rights.
• Describes the healthcare provider–patient relationship including contracts, consent, and boundaries like transference.
• Defines the healthcare consumer.
• Explains the reasons for which a patient could be released from care.

Key Terms

• Autonomy: A patient's right to self-determination and decision-making.
• Consent: Permission given for a specific treatment or procedure.
• Contract for Care: An agreement establishing a healthcare provider-patient relationship.
• Countertransference: A provider's emotional reactions towards a patient.
• Dignity: Respect and regard shown to a person.
• Empathy: Understanding and sharing the feelings of another.
• Good Samaritan Law: Provides legal protection to someone who offers assistance in an emergency.
• Healthcare Consumer: Anyone seeking professional health care or treatment.
• Implied Consent: Consent suggested by a patient's actions.
• Informed (or Express) Consent: Permission given after full disclosure of the facts needed to make an intelligent decision.
• Noncompliance: A patient's failure to follow a doctor's advice or treatment plan.
• Patient Care Partnership: Guidelines for patients' rights and responsibilities.
• Patient's Bill of Rights (PBOR): A list of rights for patients receiving medical care.
• Respect: Showing attention and regard for a person's feelings.
• Standard of Care: The level of attention reasonably expected to be given in a similar situation.
• Transference: A patient's unconscious redirection of feelings onto a healthcare provider.

Establishing Ethical Standards

• Dr. William Mayo, Mayo Clinic founder, emphasized prioritizing patient interests.
• Patients should be seen as individuals, not just a collection of parts.
• A foundation of trust is vital in the healthcare provider-patient relationship.
• Always research to ensure the accuracy of information given to the patient.
• Maintain high ethical standards, prioritize patient interests over company influence or personal gain.
• Avoid wasting resources, which can increase medical bills.

The Patient is DEAR (Dignity, Empathy, Autonomy, and Respect)

• Personal values influence thoughts and actions, even in a professional setting.
• Prioritizing the patient and providing the best care, regardless of differences, is crucial.
• This approach is seen as both professionally wise and ethically sound.

D - Dignity

• Dignity arises when one person shows regard for another.
• Showing a patient respect can empower them to feel dignity.
• The concept of dignity can vary individually.
• Dignity is especially important for vulnerable populations like the elderly.
• Dignity differs from empathy and respect, but can result from them.

E - Empathy

• Empathy involves understanding patient needs and wanting to be treated well.
• It is a hallmark of a top-notch healthcare professional.

A - Autonomy

• Autonomy is a necessary consideration concerning a patient’s rights.
• The act of the patient making his/her own decisions, in partnership with the medical staff, without influence of the medical staff.
• Patients can request extra tests for reassurance.
• Physicians should respect patient requests if there are no dangers.

R - Respect

• An important addition is respect for quality health care.
• Consideration for the person's feelings can be shown by respect.
• Regardless of status, respect can be given.
• Be aware that patients may be at their worst when seeking care.
• Healthcare professionals should maintain professionalism, helpfulness, and knowledge.
• Professionalism requires practice and determination.
• It is important not to take it personally if a patient lashes out.
• Focus on making a positive impact on the patient.

The Healthcare Consumer

• Healthcare professionals fill the roles of provider and consumer at different times.
• Seeking professional health care or treatment makes someone a healthcare consumer.
• Being informed is vital.
• Consumers should ask questions but avoid hindering providers.
• Remembering what it is like to be a patient helps professionals give better care.
• Patient satisfaction involves both health and financial concerns.
• Healthcare is expensive; the average daily hospital cost in the United States is at least $5,000.
• In the Western United States, hospital cost is more than $7,000.
• Consumers rightly expect the highest standard of care.

Ethical Considerations in Healthcare Provider-Patient Relationships

• Relationships with patients are fragile.
• "Standard of care" means providing attention reasonably expected in a similar situation.
• In a professional relationship, the patient can trust the healthcare team.
• Here, special care is given to the patient.
• Important to clearly set the lines as to what behavior is, and is not appropriate.
• A list of guidelines to maintain the professional relationship are as follows.

Maintaining Professional Relationships

• Care is built on trust; failing to deliver high-quality care violates that trust.
• Allow patients privacy when undressing for examinations.
• In needed to assist the patient, have another healthcare professional present.
• Avoid inappropriate language, sexual content, and racial slurs.
• During intimate examinations, another healthcare professional can be present.
• Discussions during an intimate examination should inform the patient.
• Listen without judging.
• Patients' problems are valid regardless of personal opinions.
• Avoid overstepping boundaries: keep interactions professional.
• Sensitive topics should be avoided unless directly relevant.
• Emphasize providing the best health care possible.
• Sexual contact or flirting is never acceptable conduct.
• You can be seen as a provider outside of work, this is unethical.
• Avoid visiting patients outside of the healthcare setting.
• Never make promises to patients because that is unethical and illegal.

Transference

• Relationships between healthcare providers and patients are unique.
• Transference occurs when a patient redirects feelings from childhood onto the provider.
• It can involve feelings other than attraction.
• Countertransference happens when the provider has feelings for the patient.
• Healthcare providers must never engage in personal relationships with patients.
• Providers are responsible for maintaining boundaries.

Contracts and Consent

• The healthcare provider-patient relationship involves contracts.
• Contracts for care establish the relationship where a provider gives care.
• Consent is a patient's agreement to procedures.
• Consent comes in two forms, implied and informed.
• Informed consent requires understanding and agreement to care.
• This brings a patient into their own decision-making.
• Designees can make decisions for those who are unable to.
• Occurs when the physician explains the treatment or procedure(s), and the patient agrees to have them performed.
• Express consent, is a type of informed consent, is most protective of the physician’s liability.
• One example of express consent: when the physician tells a patient she has thyroid cancer and discusses/explains treatment.
• HHS/HRP: “process, not just a form”.
• The Joint Commission: "nation's oldest and largest standards-setting and accrediting body in health care."
• The commission is concerned with patient-care and rights.
• Signing a consent form does not guarantee a patient understands the procedure(s).
• It is very important, the patient, or designated representative, understands the care, warnings, and procedures.
• Before meeting the medical giver should confirm the patient, or representative, understand.

Understanding Medical Treatments

• The Joint Commission lists barriers to patient understanding.
• One: basic information lacking from the consent form.
• Two: poor communication.
• Three: lack of health literacy consideration.
• Four: Lack of awareness for cultural issues.
• Implied consent occurs when behavior indicates compliance.
• An example, patient rolling up their sleeve for the shot.
• In emergencies, consent is implied.
• The Good Samaritan law protects those giving good-faith emergency care.

"Fire" a Patient?

• Patients can seek other treatments if they are unsatisfied.
• Physicians also can "fire" (release) the patient.
• The AMA states physician must not withdraw patient care without advanced notice to the patient or family.
• Physicians must ensure continuity of care.
• Physicians can terminate care due to contract violations:
• Noncompliance: If patient doesn't follow doctor's advice.
• Insurance Plan: physicians may need to dismiss a patient due to participation.
• Appointments: Consistently late for, or, not showing up.
• Non-payment: not paying for service.

The Patient Care Partnership

• The American Hospital Association's Patient Care Partnership helps patients to understand their rights.
• This document addresses finances, privacy, medical care, and patient choices.

Putting It All Together

• No patient, no health care.
• It is always the patient’s best interest that should prevail.
• Treat all patients properly, with the best care, regardless of different beliefs.
• The patients need respect, empathy, and dignity (RED).
• Always strive for the highest standard of care.
• In any circumstance be sure to understand ones obligation to the patient, what legal and ethical considerations exist, the good samaritan law, and physicians right to release a patient.
• A constant need as a healthcare provider is that the best care of the patient is, and should be, your concern.
• Immediately check yourself and your actions if you disagree at any point.