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Questions and Answers
Which of the following is NOT a necessary component for valid consent according to the outlined principles?
Which of the following is NOT a necessary component for valid consent according to the outlined principles?
In the absence of parents, who is prioritized for giving consent on behalf of a minor?
In the absence of parents, who is prioritized for giving consent on behalf of a minor?
What constitutes fraud regarding failure to disclose necessary facts?
What constitutes fraud regarding failure to disclose necessary facts?
Who is considered incapable of providing consent in all situations?
Who is considered incapable of providing consent in all situations?
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Which type of communication is protected under the concept of statutory privileged communication in the context of medical practice?
Which type of communication is protected under the concept of statutory privileged communication in the context of medical practice?
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What does the 'cause' in a physician-patient contract primarily refer to?
What does the 'cause' in a physician-patient contract primarily refer to?
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In determining the standard of care, what is measured under the locality rule?
In determining the standard of care, what is measured under the locality rule?
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Which of the following describes the similarity rule in the context of diligence?
Which of the following describes the similarity rule in the context of diligence?
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Which of the following best describes the 'object' of the physician-patient contract?
Which of the following best describes the 'object' of the physician-patient contract?
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What is the implication of using ordinary care and diligence in medical practice?
What is the implication of using ordinary care and diligence in medical practice?
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What is the primary concern of the Doctrine of Unjust Enrichment as mentioned?
What is the primary concern of the Doctrine of Unjust Enrichment as mentioned?
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Under which type of medical fee does the fee vary based on time rendered by the patient?
Under which type of medical fee does the fee vary based on time rendered by the patient?
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Which principle grants physicians authority over patient management procedures?
Which principle grants physicians authority over patient management procedures?
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What is a potential ethical issue found in the practice of soliciting patients?
What is a potential ethical issue found in the practice of soliciting patients?
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Which class of fees depends on the success of treatment provided?
Which class of fees depends on the success of treatment provided?
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What does the Right to Avail of Hospital Services encompass?
What does the Right to Avail of Hospital Services encompass?
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What does 'fee splitting' refer to in the context of medical fees?
What does 'fee splitting' refer to in the context of medical fees?
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How does the concept of retirement affect physicians according to the provision mentioned?
How does the concept of retirement affect physicians according to the provision mentioned?
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In which context does the principle of 'Service rendered service paid' apply?
In which context does the principle of 'Service rendered service paid' apply?
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What ethical guideline surrounds the solicitation of patients by a physician?
What ethical guideline surrounds the solicitation of patients by a physician?
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What characterizes the physician-patient relationship as a contractual relationship?
What characterizes the physician-patient relationship as a contractual relationship?
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What must be documented for informed consent to be considered valid?
What must be documented for informed consent to be considered valid?
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What action must a physician take if they decide to withdraw from the treatment contract?
What action must a physician take if they decide to withdraw from the treatment contract?
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In which situation can oral consent be accepted as valid?
In which situation can oral consent be accepted as valid?
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What implies a legally binding agreement in an express contract between a physician and a patient?
What implies a legally binding agreement in an express contract between a physician and a patient?
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What type of agreement is implied when a patient is voluntarily admitted to a hospital?
What type of agreement is implied when a patient is voluntarily admitted to a hospital?
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Under what circumstance is a hospital obligated to treat a patient?
Under what circumstance is a hospital obligated to treat a patient?
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What does the term 'consent' primarily refer to in the context of medical treatment?
What does the term 'consent' primarily refer to in the context of medical treatment?
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What is the effect on the hospital-patient relationship at the point of discharge?
What is the effect on the hospital-patient relationship at the point of discharge?
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What aspect is essential for a hospital when assessing a patient's eligibility for treatment upon arrival?
What aspect is essential for a hospital when assessing a patient's eligibility for treatment upon arrival?
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What is the preferred method for obtaining consent in modern healthcare?
What is the preferred method for obtaining consent in modern healthcare?
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What is the relationship between hospital and physician primarily based on?
What is the relationship between hospital and physician primarily based on?
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What does Article 2180 impose upon an employer related to vicarious liability?
What does Article 2180 impose upon an employer related to vicarious liability?
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What initiates the relationship between a physician and a hospital's medical staff?
What initiates the relationship between a physician and a hospital's medical staff?
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What must occur before a physician can continue treating a patient in active labor?
What must occur before a physician can continue treating a patient in active labor?
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Which of the following is NOT a stage in the credentialing process?
Which of the following is NOT a stage in the credentialing process?
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Which of the following is included in the three choices available to medical professionals after a patient’s condition is stabilized?
Which of the following is included in the three choices available to medical professionals after a patient’s condition is stabilized?
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What is implied by vicarious liability of the hospital related to physician actions?
What is implied by vicarious liability of the hospital related to physician actions?
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What best describes the concept of emergency consent?
What best describes the concept of emergency consent?
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What must a physician demonstrate to obtain a position on a hospital's medical staff?
What must a physician demonstrate to obtain a position on a hospital's medical staff?
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Study Notes
Physician-Patient Relationship
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Elements of a Physician-Patient Contract:
- Acceptance: The patient accepts the physician's medical service.
- Cause: The physician renders the medical service for compensation or an act of generosity.
- Object: The medical service the patient wants to receive.
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Physician's Responsibilities:
- Possess the knowledge and skill of an average physician.
- Use that knowledge and skill with ordinary care and diligence.
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Standard of Care:
- Locality Rule: Measured by the care exercised in the same locality.
- Similar Locality Rule: Measured by the care exercised in similar localities.
- National Standard of Care: Measured by the care exercised nationwide.
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Patient's Rights:
- Informed Consent: Receive full disclosure of their medical condition, proposed treatment, alternatives, risks, and chances of success/failure.
- Confidentiality: The physician must protect their health information.
- Statutory Privileged Communication: Physicians cannot disclose information acquired in a professional capacity without the patient's consent.
- Ethical/Professional Confidential Information: Physicians must uphold ethical and professional confidentiality, particularly when no longer in active practice.
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Physician’s Rights:
- Limit Medical Practice: The physician can choose to limit their practice based on their specialty, clinic/hospital, geographic location, time constraints, patient types, personal reasons, and legal/ethical obligations.
- Avail of Hospital Services: Choose the appropriate management procedure for their patients.
- Doctrine of Superior Knowledge: The physician has superior knowledge in their field, and patients typically follow their instructions.
- Respond to Emergencies: The physician has the right of way when responding to emergencies.
- Exemption from Instruments and Library: The physician may be exempt from certain instruments and library rules.
Legal Aspects of Hospital Administration
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Hospital Liability for Employee Wrongful Acts:
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Government/Public Hospitals:
- Governments are generally immune from lawsuits without consent.
- The principle of immunity is based on the idea that government funds should not be used to compensate for private injuries.
- Government hospitals performing proprietary functions (for profit) lose their immunity.
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Private Charitable, Voluntary, or for Charity Hospitals:
- These hospitals generally enjoy immunity from lawsuits.
- Key Doctrines:
- Trust Fund Doctrine: Donations should not be used to pay for damages.
- Implied Waiver Theory: Patients waive the right to claim damages by entering a charitable hospital.
- Public Policy Theory: Hospitals provide medical services for the community without seeking profit.
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Government/Public Hospitals:
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Patient Rights in Hospitals:
- Premature Discharge: The hospital and attending physician may be held liable if a patient is discharged before they are fully recovered.
- Detention for Non-Payment: Patients cannot be detained for non-payment of hospital bills. Legal remedies are available for collecting debts.
- Exceptions to Patient Release: Patients who are detained or convicted prisoners can be detained in a hospital.
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Ambulance Service:
- Ambulance drivers share the criminal liability of any other driver.
- The hospital is generally held liable for civil liability incurred by ambulance service drivers.
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Hospital Pharmacy:
- Hospital pharmacies are subject to the regulations of RA 5921 (The Pharmacy Act).
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Other Legal Considerations:
- Right to Refuse Treatment: Patients have the right to refuse treatment, even if it may be life-saving.
- Physician-Patient Confidentiality: This applies to information shared with other healthcare providers.
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Medical Fees and Billing:
- Simple Contractual Fee: A specific fee is established for the service.
- Retainer Fee: Based on the amount of time spent with the patient.
- Contingent Fee: Based on the outcome of the treatment.
- Dichotomous Fee (Fee Splitting): Physician shares fees with agents who solicit patients, which is unethical.
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Charitable Hospital Functions:
- A true charitable hospital provides services to a large segment of the public over an extended period.
- A hospital with a few charity beds is not considered a charitable institution.
Physician-Patient Relationship
- The physician-patient relationship is contractual based on an offer and acceptance.
- The relationship can be expressed or implied.
- An express contract is written or orally agreed upon in advance.
- An implied contract is based on the circumstance and conduct between the parties.
- Consent is permission for something to happen or agree to do something.
- Informed consent is a written, dated, and signed document by a capable person, or their legal representative.
- The physician may withdraw from the contract with reasonable notice.
- The patient may dismiss the physician.
- The relationship ends when the patient is cured, dies, or by mutual agreement.
Hospital-Patient Relationship
- The relationship starts with voluntary admission and the signing of forms, creating an express contract.
- It ends with the patient’s discharge or leaving against medical advice.
- Hospitals are not obligated to treat every patient, except in emergency-care situations.
- Hospitals have a procedure for assessing if a patient can be treated or transferred.
- The Anti-Deposit law requires hospitals to treat a patient in labor or an emergency medical condition until stabilized.
- Following stabilization, there are three options: continue treatment, transfer, or discharge.
- Hospital-physician relationships are based on contracts that allow physicians to bring patients to the hospital for treatment.
Hospital Liability
- The doctrine of vicarious liability holds hospitals liable for the negligence of employees.
- The hospital is liable for the actions of employees, but not necessarily for independent contractors, unless the hospital has apparent authority over them.
- The hospital is not responsible for a physician’s clinical practice, but it must ensure a competent medical staff.
- Incompetency or dangerous practices of doctors may warrant termination of a contract.
- Hospitals are liable for granting privileges to incompetent or dangerous doctors.
- The hospital may be liable for the negligence of an independent-contractor physician if the physician is their ostensible agent.
Doctrine of Apparent Authority
- For a hospital to be liable under the doctrine of apparent authority, the hospital or its agent must act in a way that could reasonably lead a person to believe the negligent individual is an employee or agent of the hospital.
- This includes consistent actions and knowledge by the hospital.
- The patient must have acted based on the hospital's conduct, demonstrating reasonable care and prudence.
References
- Article 2176 and 2180 of the Philippine Civil Code
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Test your knowledge on the key elements of the physician-patient relationship, including contracts, responsibilities, rights, and standards of care. This quiz covers important concepts such as informed consent and confidentiality. Perfect for medical students and healthcare professionals.
