Your doctor knows a lot about your body and the ways to treat it. As a patient, most times you simply have to trust the she or he has solely your best interests in mind. Unfortunately, this is not always the case, and so rules have been constructed to make sure medical professionals behave correctly. As early as 400 BCE, the power of physicians and the problem it could cause were readily acknowledged. The great Greek physician Hippocrates devised an oath to be sworn by doctors just entering practice, aimed at keeping these knowers of mysteries and cures on the right path. In more modern times, the newly-formed American Medical Association formed rules in 1847 to guide doctors to proper behavior. To this day, the Code of Medical Ethics is held sacred, though not religiously followed.
The code defines ideal behavior and covers ten main issues, ranging from social responsibility to advertising to billing to that key element, patient care. Physicians in the U.S. are not legally obligated to follow this Code of Ethics, though they can have problems with their license and hospital privileges if they do not; and if there is a lawsuit, unethical behavior undermines any defense.
Chapter ten of the AMA Code of Ethics (yes, it is the last chapter!) is titled Patient-Physician relationship and really comprises a “Patients Bill of Rights.” It demands that doctors must keep the patient’s interests paramount. For instance, it declares that medical treatment should be proven to be effective and as economical as possible. Physicians are barred from using placebos, nor are they to provide futile care, such as administering useless chemotherapy to cancer patients or prescribing antibacterial medications (=antibiotics) when there’s no concern of bacterial infection. Doctors are not allowed or let pharmaceutical sellers influence their prescribing patterns and are prohibited from taking most types of gifts from these vendors. Healthcare providers are required to be candid and courteous with patients and are morally and legally obligated to maintain strict confidentiality. Note, electronic health records have made confidentiality harder to maintain and new laws have been enacted to assure confidentiality rights are safeguarded. That is why most offices now have to review security information (that’s the “HIPAA” stuff, =Health Information Portability and Accountability Act) each time you visit–it may seem a nuisance, but it is to protect your privacy!
Additionally, the medical code of ethics also insists that physicians freely and rapidly share patients’ medical information with other involved doctors so as to coordinate/optimize care. Medical providers are prohibited from withholding health information such as test results from their patients. They are obligated to provide care to the poor. And doctors must teach patients about healthy lifestyle habits and reinforce this issue on a regular basis. So don’t begrudge your doctor for nagging about smoking, weight control and exercise—they have to!
Also included in this key chapter of the code of ethics: doctors must not refuse or “fire” patients based on race, sex or belief system. They may, however, dismiss patients for many other reasons, including incompatibility and failure to follow instructions, as long as reasonable notice is provided. Healthcare providers need to intervene if a patient is driving when is it not medically-allowed and may be required to contact their state’s Department of Motor Vehicles to ensure the license is invalidated. Also, doctors are obligated to consider their patient’s wishes and opinions regarding their medical treatment.
The other (first nine) chapters of the American Medical Association Code of Ethics address widespread concerns. Doctors may not participate in torture or executions (consistent with the “above all do no harm” phrase in the Hippocratic oath). They are to heed concerns of their nurses and cannot force them to perform actions outside the scope of their training. They may advertise, but misleading and/or outlandish claims are not allowed.
This all sounds good, doesn’t it? Rules such as these improve the likelihood the patient will get reasonable care. Enforcing effective ethics rules has not always been consistent or easy. The AMA actually uses the term “opinions” to describe its ethical stances, undermining the moral and legal strength of the document. And physicians themselves many times partially or completely breach these ethical standards with no repercussion.
Healthcare is an essential element to a good quality of life. The ever-expanding field of scientific medical knowledge makes it more essential now than ever that doctors use their special knowledge properly. Deviations from code of ethics can dramatically increase the cost and danger of medical care, so it is imperative that all physicians know and honor this code. The health of the nation depends on it.