In order to ensure high quality health care in disease diagnosis and treatment, a good physician-patient relationship is essential. For effective treatment a patient must have confidence in his/her physician. The essentials of a good physician–patient relationship are: mutual respect, knowledge, trust, shared values and perspectives. Such a relation increases the accuracy of a diagnosis and the patient’s knowledge about the disease. The existence of a physician’s duty arises out of the professional relationship between the physician and his/ her patient. The relationship thus arising between a physician and patient creates a duty on the part of the physician to exercise proper care[i]. Only when this relationship exists can a breach of duty resulting in medical malpractice occur[ii]. Additionally, a physician-patient relationship is a legal prerequisite to a medical malpractice cause of action[iii].
A physician’s duty of care arises from the physician- patient relationship[iv]. The physician-patient relationship is generally characterized as a contractual one. The patient knowingly and voluntarily seeks the professional assistance of the physician, and the physician knowingly agrees to treat the patient.
The acceptance of physician service can be express or implied. In a contractual relation, the parties’ consent is essential for the validity of a contract. The agreement is that the doctor will treat the patient with proper professional skill and the patient will pay for such treatment[v].
However, the creation of the physician-patient relationship does not require all the formalities of a contract[vi].
When a patient accepts a physician’s service for medical or surgical treatment, a physician patient relation is created. Generally, a physician-patient relationship is created only where a physician personally examines a patient. However, a physician’s indirect contact with a patient does not preclude the finding of a physician-patient relationship.
A physician-patient relationship arises when a physician is contacted by someone on behalf of the patient. Additionally, an implied physician-patient relationship arises when a physician gives advice to a patient. No physician-patient relation is created when a physician gives an informal opinion[vii].
Moreover, a physician’s duty to treat a patient with proper professional skill derives from the consensual relationship between a patient and physician[viii]. A physician operating on a patient without his/her consent is liable for damages resulting from the physician’s actions. To establish a relationship, there must be some positive act on the part of the physician. A physician-patient relationship continues until the parties conclude the contract by mutual consent. The relationship can be ended by the patient. Change of medical situation also causes a termination of the physician-patient relation.
A physician and a patient can enter into contract for a specific result. The breach of a special contract to achieve a particular result or cure is actionable. A physician or surgeon is bound by express contract to perform a cure or obtain specific results by treatment or operation[ix].
A physician has the right to keep his/her patient’s treatment records. The physician is the primary custodian of the treatment record. However, his/her right is not exclusive. A patient has the privilege to inspect his/her treatment and disease records.
The physician-patient relationship is fiduciary in nature. The relation is based on trust and confidence. A physician is obliged to exercise good faith in his/her treatment and operation.
Moreover, in a physician-patient relation, a patient must communicate to his/her physician all information about the disease. Providing all information enables a physician to administer the most helpful and efficacious treatment. In the U.S., communication between a physician and a patient is amply protected. The reason is that a public circulation of a physician-patient communication is embarrassing and harmful to the patient. All the U.S. states have enacted statutes protecting patients from compulsory disclosure of confidential communications between patient and physician. The rule is mainly applied in judicial proceedings. However, a patient can waive this right or s/he can give consent for disclosure of communication.
[i] Kelley v. Middle Tenn. Emergency Physicians, P.C., 133 S.W.3d 587, 592 (Tenn. 2004).
[ii] Majzoub v. Appling, 95 S.W.3d 432, 436 (Tex. App. Houston 1st Dist. 2002).
[iii] Oja v. Kin, 229 Mich. App. 184, 187 (Mich. Ct. App. 1998).
[iv] Kelley v. Middle Tenn. Emergency Physicians, P.C., 133 S.W.3d 587, 593 (Tenn. 2004).
[v] Sterling v. Johns Hopkins Hosp., 145 Md. App. 161, 169 (Md. Ct. Spec. App. 2002).
[vi] Majzoub v. Appling, 95 S.W.3d 432, 436 (Tex. App. Houston 1st Dist. 2002).
[vii] Seeber v. Ebeling, 36 Kan. App. 2d 501, 515 (Kan. Ct. App. 2006).
[viii] St. John, 901 S.W.2d at 423, 437 (Tex. App. Houston 1st Dist. 2001).
[ix] Noel v. Proud, 189 Kan. 6, 8 (Kan. 1961).