FUNDAMENTAL ELEMENTS OF THE PATIENT-PHYSICIAN RELATIONSHIP

American Medical Association

1990, updated 1993

This document, which constitutes one part of the American Medical Association's complete code of ethics, extends the rights language introduced in the 1980 Principles of Medical Ethics (Section II) to a separate statement listing the specific rights of patients. The opening paragraph of the Fundamental Elements also mentions the responsibilities of patients. Points of particular interest include: (1) Right #4 on confidentiality, which contains the therapeutic privilege exception dropped from the Principles of Medical Ethics in 1980 and still not restored to the principles themselves; (2) Right #5 on continuity of care, which implies that treatment may be discontinued, without making alternative arrangements for care, when further treatment is not "medically indicated"; and (3) Right #6, which establishes a basic right to adequate health care, but explicitly does not guarantee the fulfillment of such a right.

From ancient times, physicians have recognized that the health and well-being of patients depends upon a collaborative effort between physician and patient. Patients share with physicians the responsibility for their own health care. The patient-physician relationship is of greatest benefit to patients when they bring medical problems to the attention of their physicians in a timely fashion, provide information about their medical condition to the best of their ability, and work with their physicians in a mutually respectful alliance. Physicians can best contribute to this alliance by serving as their patients' advocate and by fostering these rights:

1. The patient has the right to receive information from physicians and to discuss the benefits, risks, and costs of appropriate treatment alternatives. Patients should receive guidance from their physicians as to the optimal course of action. Patients are also entitled to obtain copies or summaries of their medical records, to have their questions answered, to be advised of potential conflicts of interest that their physicians might have, and to receive independent professional opinions.
2. The patient has the right to make decisions regarding the health care that is recommended by his or her physician. Accordingly, patients may accept or refuse any recommended medical treatment.
3. The patient has the right to courtesy, respect, dignity, responsiveness, and timely attention to his or her needs.
4. The patient has the right to confidentiality. The physician should not reveal confidential communications or information without the consent of the patient, unless provided for by law or by the need to protect the welfare of the individual or the public interest.
5. The patient has the right to continuity of health care. The physician has an obligation to cooperate in the coordination of medically indicated care with other health care providers treating the patient. The physician may not discontinue treatment of a patient as long as further treatment is medically indicated, without giving the patient reasonable assistance and sufficient opportunity to make alternative arrangements for care.
6. The patient has a basic right to have available adequate health care. Physicians, along with the rest of society, should continue to work toward this goal. Fulfillment of this right is dependent on society providing resources so that no patient is deprived of necessary care because of an inability to pay for the care. Physicians should continue their traditional assumption of a part of the responsibility for the medical care of those who cannot afford essential health care. Physicians should advocate for patients in dealing with third parties when appropriate.