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The Physician's Responsibilities

1. DISCUSS THOROUGHLY WITH PATIENT IN NONTECHNICAL TERMS THE DIAGNOSIS(ES), WORK-UP, THERAPY, AND PROGNOSIS. Probably the most common failing of physicians is to explain health problems and the related issues thoroughly and repeatedly to the patient. First, the doctor may be so familiar with the illness that he doesn't realize he is skipping vital basic information. Sometimes, you may find you have to do the reminding. Second, the doctor may feel you do not want a lot of information; if so, ask questions or simply say, "I need more information to understand and cope with my hepatitis." Third, some doctors believe that patients "can't handle" the technical information or whole truth about their problems. Such an antiquated approach has little room in modern medical practice. Remember, the doctor's responsibility is to the patient, and as such it is inappropriate for other family members--children, parents, siblings--to ask the doctor not to discus the illness with the person affected. It is the patient's health that is at stake, and should be only his decision if he does not wish information.

2. PRESENT TO THE PATIENT, WHEN APPROPRIATE, ALTERNATIVE GENERALLY ACCEPTED APPROACHES TO THERAPY OR TO REACHING A DIAGNOSIS EVEN IF THE PHYSICIAN DOES NOT PERSONALLY ACCEPT THEM. There are often several approaches to therapy or to establishing a diagnosis. These will vary some among physicians, institutions, or even parts of the country depending on philosophies, availibility of sophisticated medical testing and therapeutic equipment, and regional successes with therapy. The physician should present to you the relative pros and cons of each alternative approach.

3. RECOMMEND TO THE PATIENT WHAT THE PHYSICIAN CONSIDERS THE BEST APPROACH AND EXPLAIN WHY. While it is important for your doctor to make you aware of alternative approaches, it is just as important for him to recommend what he feels is best for you. To some extent, these recommendations reflect his bias, but they also take into account other factors which are peculiar to you. He will, in recommending therapy, consider the disease as it is present in you, your personality,your approach to illness, your ability to comply with recommended treatment, your work demands, your family support, or whatever unique factors exist in your case. If after this has all been explained to you, you are still uncertain whether you want to proceed with therapy, you must inform the doctor. Either the two of you will be able to agree on an alternative, or if not, he can refer you to another physician.

4. ALLOW ADEQUATE TIME (ON AT LEAST ONE ADDITIONAL OCCASION) TO ANSWER PATIENT QUESTIONS AND DISCUSS PATIENT CONCERNS. Often the initial visit to the doctor is sort of a blur. You may be nervous and you will not remember much information. Questions will not occur to you until you walk out the door. It is critical for you to have time to adjust emotionally to a new diagnosis or treatment. You will find yourself with more unanswered questions. At least a second session, if only for talking to the doctor or counseling, is really necessary. This is also a good way of making sure medications are taken correctly. The doctor's failure to allow for, or the patient's failure to take advantage of, this second session can be a major factor in a breakdown of the relationship. It can also lead to misconceptions about the illness, misunderstanding about medication regimens, and other problems.

5. PROVIDE ADEQUATE FOLLOW-UP AND EMERGENCY CARE AND MAKE PATIENTS AWARE OF THIS. Clear cut arrangements should be made for handling emergency problems, or problems that occur during non-office hours.

6. ASK FOR SPECIALIST CONSULTATION OR A SECOND OPINION WHEN UNCERTAIN ABOUT A DIAGNOSIS. Every physician has had the experience of being stumped. So much new information is generated through medical research each year that it is impossible for the internist to keep up on all diseases. Most doctors realize that occasionally they will encounter difficulties in diagnosis or treating a particular patient. The same illness never looks quite the same in different people. Sometimes the doctor simply cannot be sure with which illness he is dealing. At this point the internist should arrange for a visit to a doctor whose specialty likely includes the disease in question. For example, a person with hepatitis may be sent to a hepatologist or a gastroenterologist.

7. ASSIST IN OBTAINING RELEVANT SOCIAL SERVICES OR REHABILITATION SERVICES FOR THE PATIENT. The total care of the patient, especially in chronic illness, extends far beyond the specific treatment of the disease. Your doctor or his staff should be able to refer you to the appropriate agencies and assist you in obtaining these ancillary services. Other problems may occur within the family that required psychological or psychiatric intervention. Appropriate referral for these services should also be available.

8. KEEP COMPLETE PATIENT RECORDS. It is both a legal and moral obligation of a physician to keep complete care records of his patients. This assures a smooth transition, for whatever reason, of care from one physician to another. It also helps prevent unfortunate errors because memory fails on exact medication or on exactly what was decided at what visit or during what phone conversation. Finally, it is crucial as documentation in any legal proceeding brought for whatever reason.

9. ASSIST IN A SMOOTH TRANSITION FOR THE PATIENT TO ANOTHER DOCTOR WHEN A RELATIONSHIP HAS BEEN ENDED. If, for whatever reason, your care has been transferred to another doctor, your former doctor should facilitate the move by promptly forwarding records (at your written request), and if necessary discussing your case with the new doctor. This is true also in situations where the change in doctors is caused by your or his moving to a new location.

10. MAKE AVAILABLE TO PATIENTS A LIST OF HIS CHARGES FOR THE SERVICES HE PROVIDES. All physicians have some system for charging their patients. Often, initial visits are one charge, follow-up visits a somewhat lesser charge. The doctor should have available a summary of his usual charges so you will know what sort of financial commitment you are making when you visit him. Often, doctors will reduce fees for patients who are not able to pay the full charge. Also remember that physician fees do not pay for laboratory tests or the services of other persons or equipment that may be needed.

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