Doctor-Patient Boundaries: Road Rules and Red Flags by Lee H. Beecher, M.D.
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Tips on improving your doctor-patient relationships
- Don't mix professional relationships with intimate ones. Doctors are rewarded by doing the work of being physicians
and are paid for this professional privilege. Combining sex and doctoring is bad medicine for both patients and doctors.
Sigmund Freud called the prohibition on doctor-patient sex the "Rule of Abstinence"—a necessary rule for professional relationships.
- When you feel embarrassed or puzzled by your doctor's questions, say so. Ask the doctor to explain why the information is needed.
- Inquire about data privacy and confidentiality of your medical/clinical records. Ask your doctor to record the following
statement in the clinical record: "Except in emergencies, no paper or electronic medical records are to be released to any party
outside of the clinic organization without my expressed written consent." Ask that no records be released to any party in
non-emergencies without your explicit written consent. Don't withhold information that will likely affect your diagnosis and
treatment. Ask to see your medical records and keep your own file, including lab tests and medications.
- Know and document the training and licensing credentials of key clinicians involved in your care. If you have concerns about
unethical or unprofessional conduct from your clinician, talk to your doctor or clinic administrative personnel. You can also
contact the Minnesota Board of Medical Practice or the clinician's professional licensing body to consider filing a complaint.
- Be clear about the expected length and content of treatment sessions and recommended methods and plan of care (including
medications).
- The fee is a proper and necessary ingredient of the doctor-patient contract. Ask your doctor to disclose all insurance
arrangements (e.g., capitation, case rate caps, payment withholds and pay-for-performance incentives) involved in your case.
Such financial facts directly impact the nature of the doctor-patient alliance and are not only the insurance company's concern.
- Discuss expectations for treatment, including scientific evidence and treatment rationale with your doctor and treatment
team. What treatments have worked and what didn't? What are the pros and cons of specific treatment recommendations? Tell
your doctor exactly what you have and haven't done (including taking medications or not) to allow assessments of your
adherence to doctor's recommendations.
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