Medical-Legal Implications in Surgery

Besides the actual professional relationship of physician and patient, there are certain legal factors which must be remembered when your doctor treats you. There is no written contract drawn, but there is an implied contract be­tween the physician and the patient which is just as legal as a formal written contract. There are certain agreements and obligations of both parties which are upheld by law.

When a physician accepts a patient, he is obligated to exercise the average skill and abil­ity of other members of the same profession practicing in that community or similar locality, in accordance with the existing state of medical science. He must possess and use the ordinary skill and knowledge of the profession in general: he must exercise care and judgment in appli­cation of this skill and learning, and he will re­sort to such drugs and techniques as experience of medical science has shown most applicable. In cases where emergency or peculiar circum­stances do not afford the standard medical equipment and supplies, he is obligated to exer­cise good judgment.

The patient’s part of the contract obligates him to carry out specifically all the doctor’s orders. He must divulge his full medical history and he must submit to whatever tests and exam­inations the doctor orders. He must make as many office visits as the doctor decides are nec­essary and must be hospitalized when the doc­tor so orders. The doctor determines the num­ber and the frequency of office, home, and hos­pital calls necessary. The physician also decides when consultation is desirable, and the patient must submit. The patient must pay the physician for his services.

The implied contract between physician and patient may be terminated at any time by the patient. It may be broken by the physician only after sufficient notice has been given the patient for him to secure adequate medical care else­where. Legally, a doctor does not have to accept a patient who seeks his care, and he may refuse treatment to anyone. However, doctors feel mor­ally bound to accept all patients, or else acquire a physician who will care for them.

When you are about to undergo an operation in the hospital, you will be asked to sign an operative permit. Legally, this is not necessary, because an implied contract with the surgeon still exists, but it shows that you are in complete accord with treatment by operation and relieves the hospital employees from any responsibility. It gives the surgeon a free hand to do whatever he thinks best at the time of operation.

Under the physician’s code of ethics he is not permitted to give any information about a pa­tient to anyone. However, this has been modified in cases where the patient involved is agree­able to such—for example, when an insurance company requests information about a patient. This is called the privilege of communication, and you may be asked to sign such a statement that will permit your doctor to divulge facts about you to your insurance company, or in some other situation.

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