Doctor Patient relationship

Psychology

Dr. Maha Younis

Lec 22. Doctor- Patient relationship

Doctor-Patient relationship

It is very important, it is viewed by the law as a contract because of the mutual rights and obligations that exist between them.
Express warranties : law suit - in event of a breach
Done in writing
Implied warranties: in absence of any expressed terms, psychiatrist’s promises:
Confidentiality: psychiatrist will not dis-close the patient’s confidential communications without the patient’s consent or as may be otherwise required or permitted by law.
Competence: a degree of skill and knowledge that the ordinary member of the profession is expected to have the standard (ordinary skill), the education and training to treat patients competently and not exceed the scope of his or her abilities.
Due care: the psychiatrist will perform in the manner of a duly careful member of the profession, adhering to the standard on care established by the profession.


Informed consent
Informed consent has to be obtained in many physical and surgical interventions so that to keep the physician (not guilty) of acting against the patient’s willed.
If the physician treats without an adequate informed consent, this may constitute a form of malpractice.
Elements of informed consent:
Adequate information
Voluntariness
Competency

Information: detailed and comprehensive explanations about the procedure, risks, benefits and alternatives.
Professional standard of dis-closure, what is right to dis-close?
Risk-potential
Anticipated benefits
Alternatives
Voluntariness: freely given without coercion that undermines the patient decisions.
Competency: patient should have the sufficient mental ability to decide properly. Incompetent person, minors, MR, organic brain damage, acute psychosis.
Exceptions to the informed consent
Emergencies: immediate action must be taken to prevent serious damage to a patient’s life, violent patient or excited immediate restrain or medication self harm.
Incompetency: incompetent patient is unable to give informed consent.
Therapeutic privilege: withholding information that might be directly damaging to the patient. Information that would impede rational patient, decision making or be anti-therapeutic could be withheld. There are few situations in the practices of psychiatry to which the therapeutic privilege applies.
Rules of dis-closure:
The most severe, the most common treatment risk even if rare.
Potential interference: any reasons to doubt patient’s competency.
Documentation: should be made either through signed, written consent forms or through physician’s records.
Records, Confidentiality:
In psychiatric practice or psychological sitting, all physicians owe their patients the duty not to dis-close except with the patient consent or as may permitted or required by law, personal and private information about the patient that was acquired in the course of treatment. (strict).
Consent for release of information:
Should be written
Valid
Specific
Time limited
Patient should be informed of the right to revoke.
Patient’s record
Privileged communications:
Professional liability:
Malpractice: negligent practices, careless, non-deliberate error omission, failure to do the expected good work.
Equipment: injury caused by faulty equipment.
Deliberate wrongful acts: holding a patient against the patient’s will, assault battery, sexual misconduct with a patient, fraud, coercion.
Malpractive: Burden of proof examples:
Negligent diagnosis
Negligent treatment
Breach of confidentiality
Violation of patient’s rights.


IBO Ibrahim Ghazi