Chapter 2

Top Priority: The Patient

Learning Objectives

• The healthcare professional, both as a professional and as a healthcare consumer.

• RED: respect, empathy, and dignity.• The Patient’s Bill of Rights.• The healthcare provider-patient relationship

(including contracts and consent).• Handling transference (boundaries).• The healthcare consumer.• Reasons a patient could be released from care.

Key Terms

Consent Informed consent Contract of care (or express

consent)Countertransference NoncomplianceDignity Patient Care

PartnershipEmpathy Patient’s Bill of

RightsGood Samaritan Law RespectHealthcare Consumer Standard of CareImplied Consent Transference

Establishing Ethical Standards

• Dr. William Mayo, founder of the Mayo Clinic upheld that “the best interest of the patient is the only interest to be considered” and that a patient should be “treated as a whole.”

• Seeing the patient as an individual is essential in performing healthcare services to the highest standards: no patient, no health care.

Establishing Ethical Standards cont…

• A foundation of trust should exist in every healthcare provider-patient relationship.

• To foster ethical trust, healthcare providers must hold themselves to the highest ethical standards.

• Examples of ethical standards: do not let an external influence, such as a drug representative, compromise the patient’s best interest; do not waste resources (e.g., overusing supplies) or withhold needed items of care.

Seeing RED: Respect, Empathy, and Dignity in Health Care

• It is professionally wise and ethically sound for the healthcare professional to put the patient first by providing the best care, regardless of the patient’s appearance, economics, or beliefs.

• Ethical professionalism revolves around treating the patient with respect, empathy, and dignity.

Seeing RED: Respect, Empathy, and Dignity in Health Care cont…

• The highest standard of professionalism involves maintaining a spirit of helpfulness, knowledge, and regard for the patient’s condition, always showing empathy and concern, with the patient’s best interest being the top priority

• Empathy: treating a patient as you would ant to be treated; understanding the patient’s needs fosters the trait of empathy.

Seeing RED: Respect, Empathy, and Dignity in Health Care cont…

• Respect: respecting someone is to show that person attention and regard the person’s feelings.

• Dignity: showing a patient respect empowers that person to feel dignity; dignity arises from another person showing you regard. This is especially an issue in vulnerable populations like the elderly.

The Healthcare Consumer

• The healthcare professional experiences two roles, that of provider and that of consumer.

• Anyone seeking professional care or treatment for health is a healthcare consumer.

• Healthcare facilities deal with two sensitive issues: the patient’s health and money.

• Healthcare is expensive, so healthcare consumers rightfully expect the highest standard of care.

Ethical Considerations in healthcare Provider-Patient Relationships

• The highest standard of care requires giving attention to a patient that would reasonably be given to anyone in a similar situation.

• There are guidelines for appropriate professional behavior dealing with these areas:Fostering trust. Listening without

judging.Patient undressing. Respecting boundaries.Appropriate language. Sexual or other contact.Intimate examinations. Avoiding promises.

Transference

• Transference occurs when a patient retains feelings or attitudes associated with childhood which may surface during treatment and be transferred onto the healthcare provider.

• Counter-transference occurs when the provider experiences feelings for the patient that are out of the norm, such as anger.

• The primary responsibility for honoring the provider-patient relationship boundaries is in the hands of the healthcare provider.

Contracts and Consent

• The healthcare provider-patient relationship is a type of contract.

• A contract of 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. This consent can be informed or implied.

Contracts and Consent cont…

• Informed consent: this occurs when a provider explains the treatment or procedure and the patient or patient representative agrees. This form of consent can be verbal but is usually written in a signed consent form.

• Another term for informed consent is express consent.

Contracts and Consent cont…

• Implied consent occurs when a patient’s behavior suggests compliance (e.g. rolling up a shirt sleeve when the nurse arrives to administer a shot).

• In emergency situations consent by accident victims is considered to be implied.

Contracts and Consent cont…

• In emergency situations, the Good Samaritan law protects the provider from being sued when performing medical care in good faith. Every state in the U.S. has some version of this.

Can a Physician “Fire” a Patient?

• A provider has a right to release a patient. In June 1996, the American Medical Association (AMA) issued Opinion 8.115 – Termination of the Physician-Patient Relationship. Notice must be given to the patient or patient’s representative sufficiently in advance to permit a replacement.

Can a Physician “Fire” a Patient? Cont…

• Patients may be dismissed by a provider due to noncompliance (not following the provider’s advice), insurance plan participation, failure to keep appointments, and nonpayment for services.

The Patient Care Partnership

• The American Hospital Association (AHA) developed the Patient’s Bill of Rights in 1973, which was revised in 1992, and then replaced in 2003 with the Patient Care Partnership.

• This document is a guide for patients to understand their rights and responsibilities when receiving care during a hospital stay.

• This document also addresses financial aspects of patient care, confidentiality, and patient choices in their own medical care.

Putting It All Together

• Healthcare professionals must always be mindful that if there is no patient there can be no health care and that the patient’s best interest must always prevail.

• The patient has certain rights, including respect, empathy, and dignity (RED).

• Patient rights can be reviewed in the U.S. Government’s Patient’s Bill of Rights under the 2010 Affordable Care Act. These rights empower the consumer to receive the highest standard of care via appropriate consent and contract.

Chapter Checkup

• Fill-in-the-Blank.1=p30; 2=p30; 3=p30; 4=p22,32.

• In Your Own Words.1=pp.23-24; 2=p25.

• Multiple Choice.1=32p; 2=28p.