HCA 315 Module 2 The Patient-Physician Relationship and Consent Example

A Relationship With Duties: Forming, Ending and Consenting Within the Patient-Physician Relationship

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Health Care Administration Program, Aspen University

HCA 315: Legal Aspects of Health Care Administration

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Month Day, Year

A Relationship With Duties: Forming, Ending and Consenting Within the Patient-Physician Relationship

The patient-physician relationship is the legal foundation of medical care. Once it forms, the physician owes the patient duties, including competent care and continued attention, and the patient's consent governs what may be done. This paper explains how the relationship begins and ends, then examines consent through a composite outpatient procedure.

How the Relationship Begins

The relationship usually begins when a physician agrees, expressly or by conduct, to treat a patient: scheduling and seeing the patient, giving advice about the patient's condition or accepting the patient in a covered managed care panel. It can begin without a face-to-face visit, for example when a physician gives specific advice by phone. Casual conversation at a social event usually does not create one.

Duties Within the Relationship

Once formed, the relationship creates duties: to provide care that meets the professional standard, to keep information confidential, to obtain consent and to continue care until the relationship properly ends. Patients have responsibilities too, such as providing accurate information and following agreed plans, though failure to meet them does not remove the physician's duties. Ethics texts ground these duties in respect for autonomy and in beneficence, the obligation to act for the patient's good (Beauchamp & Childress, 2019).

Ending the Relationship

A physician may end the relationship but must do so properly to avoid abandonment, which is ending care when the patient still needs it without adequate notice or opportunity to find another provider. Proper termination includes written notice, a reasonable period of continued availability, often 30 days, help with records transfer and referral information. A physician may not end the relationship in the middle of an acute episode.

The Right to Decide

Consent rests on the principle that competent adults decide what is done to their bodies. Writing for New York's highest court, Judge Cardozo held that a competent adult controls what is done to his or her body, so a surgeon who operates without permission commits an assault (Schloendorff v. Society of New York Hospital, 1914). That principle underlies modern consent law.

Forms of Consent

Express consent is stated in words or writing. Implied consent is shown by conduct, such as holding out an arm for a blood draw, or presumed in emergencies when a patient cannot consent and delay would cause harm. Informed consent is required for procedures with significant risk and means the patient agreed after receiving the information needed to decide.

Elements of Informed Consent

The table lists the elements, applied to a composite case: Mr. O., 52, is scheduled for removal of a skin lesion on his back in the office.

Standards of Disclosure

States use different standards for how much must be disclosed. Some ask what a reasonable physician would disclose; others ask what information a reasonable person in the patient's position would consider important to the decision. The trend has been toward the patient-centered standard, which makes the patient's perspective the measure of what is material.

Understanding, Not Just Signing

A signed form is evidence of consent, not consent itself. Patients often understand less than clinicians assume. A systematic review of 44 studies found that communication interventions, including written information, multimedia, extended discussions and test-and-feedback techniques, were generally effective in improving comprehension, although only 6 studies measured all four elements of understanding (Schenker et al., 2011). Teach-back questions before signing help confirm understanding.

Capacity

Consent requires capacity: the ability to understand the information, appreciate how it applies, reason about options and communicate a choice. Capacity is decision-specific and can change. When a patient lacks capacity, a legally authorized surrogate, such as a health care agent or next of kin under state law, decides using the patient's known wishes or best interests.

Minors

Parents or guardians generally consent for minors, but state laws allow minors to consent to some services, such as care for sexually transmitted infections or substance use, and emancipated minors may consent for themselves. Office staff need a quick reference to their state's rules.

Language and Interpreters

Patients with limited English proficiency need qualified interpreters for consent discussions. Using family members, especially children, risks errors and omissions. The interpreter's name or identification number is recorded with the consent.

Documentation

Mr. O.'s record includes the signed form, a note by the surgeon summarizing the discussion, the risks mentioned and his questions, and the time. The administrative role is to make sure the correct form is prepared, signed before the procedure, witnessed as required and scanned into the record.

Refusal of Treatment

Consent includes the right to refuse. A competent patient may decline a recommended procedure even when the clinician disagrees. The clinician's duty is to explain the risks of refusing, confirm understanding and document the discussion, often with an informed refusal form. Respecting refusal is part of the same principle that requires consent.

Telehealth and the Relationship

Telehealth raises new questions about the relationship. A relationship can form through a video visit, and consent for telehealth should cover its limits, such as the lack of a physical examination, and how privacy is protected. Licensure usually follows the patient, so a clinician needs a license in whatever state the patient sits in during the video visit.

Research Consent

Consent for research differs from consent for treatment. Research participants must be told that the study is research, its purpose, risks and benefits, alternatives and that participation is voluntary and can be stopped at any time. An institutional review board oversees research consent, and clinical staff should not blur treatment and research discussions.

Conclusion

The patient-physician relationship creates duties from the moment it forms and must be ended properly to avoid abandonment. Consent, grounded in the right of self-determination, requires disclosure of the nature, risks, benefits and alternatives of care, capacity and genuine understanding. Administrators support these duties through clear termination procedures, sound consent forms, interpreter access and reliable documentation.

References

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

Schenker, Y., Fernandez, A., Sudore, R., & Schillinger, D. (2011). Interventions to improve patient comprehension in informed consent for medical and surgical procedures: A systematic review. Medical Decision Making, 31(1), 151-173. https://doi.org/10.1177/0272989X10364247

Schloendorff v. Society of New York Hospital, 211 N.Y. 125 (1914).