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 ( 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: