Top Priority: The Patient

1
Chapter 2

• Top Priority The Patient

2
Learning Objectives

• The healthcare professional, both as a
  professional and as a healthcare consumer.
• RED respect, empathy, and dignity.
• The Patients 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.

3
Key Terms

• Consent Informed consent
• Contract of care (or express consent)
• Countertransference Noncompliance
• Dignity Patient Care Partnership
• Empathy Patients Bill of Rights
• Good Samaritan Law Respect
• Healthcare Consumer Standard of Care
• Implied Consent Transference

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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.

5
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 patients best
  interest do not waste resources (e.g., overusing
  supplies) or withhold needed items of care.

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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 patients appearance, economics, or beliefs.
• Ethical professionalism revolves around treating
  the patient with respect, empathy, and dignity.

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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 patients condition, always
  showing empathy and concern, with the patients
  best interest being the top priority
• Empathy treating a patient as you would ant to
  be treated understanding the patients needs
  fosters the trait of empathy.

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

• Respect respecting someone is to show that
  person attention and regard the persons
  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.

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

10
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.

11
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.

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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 patients agreement to treatment.
  This consent can be informed or implied.

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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.

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Contracts and Consent cont

• Implied consent occurs when a patients 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.

15
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.

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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 patients representative
  sufficiently in advance to permit a replacement.

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Can a Physician Fire a Patient? Cont

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

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The Patient Care Partnership

• The American Hospital Association (AHA) developed
  the Patients 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.

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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 patients 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.
  Governments Patients 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.

20
Chapter Checkup

• Fill-in-the-Blank.
• 1p30 2p30 3p30 4p22,32.
• In Your Own Words.
• 1pp.23-24 2p25.
• Multiple Choice.
• 132p 228p.