The American College of Physicians has issued a position paper to help
guide physicians through the ethical challenges that can arise when the
physician-patient relationship is broadened to include caregivers.
The paper emphasizes the need for respect of patients' dignity, rights and
values, and provides guidance for effective communication among all
parties.
Although many physicians understand that patients' family members and
neighbors are important players on the health care team, caregivers
sometimes are relegated to the shadows, said Dr. Virginia Hood, chair of
ACP's Ethics, Professionalism and Human Rights Committee, which developed
the paper.
"Although we don't want anything to interfere with the physician-patient
relationship, which is still key to all health care, we have to work out
ways that caregivers are a part of this process too -- as long as the
patient agrees," Dr. Hood said.
The paper was endorsed by 10 other professional medical societies. It was
published online Jan. 9 in the Journal of General Internal Medicine and
includes resources for caregivers
(www.acponline.org/running_practice/ethics/issues/policy/).
The paper advises physicians that privacy requirements under the Health
Insurance Portability and Accountability Act should not be viewed as a
barrier to communicating with a caregiver. Simply asking a patient's
permission to speak to a caregiver is sufficient for HIPAA compliance.
"In my own practice, a patient arrives with somebody more than 50% of the
time," Dr. Hood said.
Physicians also should be alert for signs of distress in caregivers,
keeping in mind that the job they have taken on, most frequently as a
volunteer, can be overwhelming in physical as well as emotional and
financial demands, the paper notes. As a result, a caregiver's health may
be negatively impacted.
When a family caregiver is also a patient of the treating physician,
separate appointments are encouraged, but can perhaps be scheduled
back-to-back to limit the burden on the caregiver, the paper said.
Caregivers not only help the patient understand complex medical
instructions, but often can fill in medical history and convey instructions
given by other physicians. "Our health care system is so fragmented, almost
everybody needs somebody in addition to themselves to hold all the pieces
together," Dr. Hood said.
The full and original article can be found here:
http://www.ama-assn.org/amednews/2010/02/01/prsc0202.htm
