Standard of Care

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Standard of Care

Postby OddDuck » Tue Mar 08, 2005 8:48 am

Trudy brought up an interesting perspective in another thread regarding the medical profession itself contributing (even if inadvertantly) to adjustment or adverse emotions for MS patients.

That brought to mind that perhaps some people might not be completely aware of what kind of treatment they can and in my opinion, should expect from their medical care professionals, as a minimum.

I thought I would just post some items from the American Medical Association. I will highlight some things, also.

I hope it helps.

Deb



http://www.ama-assn.org/ama/pub/category/4608.html

"Informed Consent

Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.

In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:

- The patient's diagnosis, if known;

- The nature and purpose of a proposed treatment or procedure;

- The risks and benefits of a proposed treatment or procedure;

- Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);

- The risks and benefits of the alternative treatment or procedure; and

- The risks and benefits of not receiving or undergoing a treatment or procedure.

In turn, your patient should have an opportunity to ask questions to elicit a better understanding of the treatment or procedure, so that he or she can make an informed decision to proceed or to refuse a particular course of medical intervention.

This communications process, or a variation thereof, is both an ethical obligation and a legal requirement spelled out in statutes and case law in all 50 states. (For more information about ethical obligations, see the AMA's Code of Medical Ethics, contained in the AMA PolicyFinder. Providing the patient relevant information has long been a physician's ethical obligation, but the legal concept of informed consent itself is recent.

The first case defining informed consent appeared in the late 1950's. Earlier consent cases were based in the tort of battery, under which liability is imposed for unpermitted touching. Though battery claims occasionally occur when treatment is provided without consent, most consent cases generally center around whether the consent was "informed", i.e., whether the patient was given sufficient information to make a decision regarding his or her body and health care. Because informed consent claims, unlike battery claims, are based in negligence, they generally are covered by liability insurance.

To protect yourself in litigation, in addition to carrying adequate liability insurance, it is important that the communications process itself be documented. Good documentation can serve as evidence in a court of the law that the process indeed took place. A timely and thorough documentation in the patient's chart by the physician providing the treatment and/or performing the procedure can be a strong piece of evidence that the physician engaged the patient in an appropriate discussion. A well-designed, signed informed consent form may also be useful, but an overly broad or highly detailed form actually can work against you. Forms that serve mainly to satisfy all legal requirements (stating for example that "all material risks have been explained to me") may not preclude a patient from asserting that the actual disclosure did not include risks that the patient unfortunately discovered after treatment. At the other extreme, listing all of the risks may not be wise either. A comprehensive listing will be difficult for the patient to understand and any omission from the list will likely be presumed undisclosed. If you are using a form that contains a list, consider, with your attorney, inserting language indicating that the list is not exclusive (such as "included, but not limited to") before the list begins.

Again, this is general knowledge you can use when you ask for further information and advice from qualified attorneys and/or other professional consultants. If you need a referral to a qualified attorney, please contact the AMA Solutions ConsultingLink/Doctors Advisory Network, a national network of pre-screened health care consultants and attorneys. When you reach the AMA Solutions homepage, go to "PracticeLink", then to "ConsultingLink", and then choose "Doctors Advisory Network Attorneys."

Prepared by the American Medical Association, Office of the General Counsel, Division of Health Law
Copyright 1998 American Medical Association

Posted: September 1998"



http://www.ama-assn.org/ama/pub/category/2512.html

Principles of medical ethics

Preamble

The medical profession has long subscribed to a body of ethical statements 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 standards of conduct which define the essentials of honorable behavior for the physician.

Principles 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 which are contrary to the best interests of the patient.

IV. 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.

VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

VIII. 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.

Adopted by the AMA's House of Delegates June 17, 2001.
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not a delagated representative

Postby texas_jim » Sun Mar 13, 2005 2:18 am

your addition of "not a delagated representative" caught my eye.

all this is well and good except in an emergency, especially in what we call the "pre-hospital environment"

i have been a paramedic for over 12 years. when we make contact with a patient/victim of an injury or illness, this creates, for good or bad, a physician-patient relationship between the person and the physician (who writes and approves our protocols we operate under in the ambulance)
we are acting as an "agent" of the physician. long gone are the days where a paramedic had to call a physician to ask to give a certain drug and/or perform a certain procedure. we operate with an incredible amount of autonomy (which is why nurses hate us-don't flame me i'm in nursing school!!!) but the end result is that both us and the doctor or responsible.

jim
paramedic with MS

"Informed Consent

Informed consent is more than simply getting a patient to sign a written consent form. It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention.

In the communications process, you, as the physician providing or performing the treatment and/or procedure (not a delegated representative), should disclose and discuss with your patient:

- The patient's diagnosis, if known;

- The nature and purpose of a proposed treatment or procedure;

- The risks and benefits of a proposed treatment or procedure;

- Alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance);

- The risks and benefits of the alternative treatment or procedure; and

- The risks and benefits of not receiving or undergoing a treatment or procedure.

[quote][/quote]
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Postby OddDuck » Sun Mar 13, 2005 5:20 am

Jim,

Remember, those aren't "my" words. I added nothing to the quote. That is still what is required from "physicians" under their ethical obligations and as also noted therein, "standard of care" for physicians is spelled out not only ethically under the AMA, but legally under the law. Nothing has changed, and as you can see by what I posted, even MORE laws have been enacted regarding "informed consent".

You, as a paramedic, not a "physician", fall under a different subset of laws and regulations. "Emergency care" is not exactly the same as the true doctor/patient relationship nor is it viewed the same under the law.

What you do and what physicians do are totally different legally.

Deb
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