Public Health Law Map - Beta 5 - Medical and Public Health Law Site

Introduction
The core of the physician–patient relationship is the exercise of medical
judgment.
Consultants also have a legal relationship with patients.
Good Samaritan laws protect physicians who stop at accidents.
Contracts with health plans restrict the medical care practitioner’s right to choose
the patients they will treat.
The basic legal relationship in medicine is between the physician and the patient.
Although recognizing that there are many nonphysicians delivering medical care
services, the courts and the legislatures still use the physician–patient relationship as the
paradigm for the legal rights and responsibilities that flow between medical care
practitioners and patients. At this point in time, it is unclear how much of the law
developed for the physician–patient relationship will be applied to other medical care
practitioners. Some duties, such as the duty to protect the patient’s confidence, clearly
apply to everyone who provides medical services. Some do not—the courts have not
applied the “learned intermediary” doctrine to nurses. [Mazur v. Merck & Co., 964 F.2d
1348 (3d Cir. [Pa.] 1992).] Until the courts rule on more cases involving the legal
relationship between nonphysician medical care practitioners and patients, it is difficult
to predict which direction the law will go.
A. Managed Care and the Professional Relationship
This section deals with traditional physician– patient relationship law. The core legal
assumption about the physician–patient relationship is that it is a fiduciary relationship.
The law expects physicians to put their patients’ financial and other interests first.
Managed care is dramatically changing the nature of the physician–patient relationship
in ways that are not contemplated by existing law. This is resulting in litigation and
increased scrutiny by state regulatory agencies. Physicians and other medical care
practitioners are caught between the economic power of the managed care
organizations with their control of the stream of patients, and the demands of patients
and consumer advocates that they live up to the traditional values of the physician–
patient relationship. There are several specific problem areas that will be discussed in
this section. In general, medical care practitioners must assume that the traditional
physician–patient relationship applies in the managed care setting until the courts or
legislatures change the law.
B. Establishing the Relationship
Historically, the primary legal characteristic of the physician–patient relationship was
that it was voluntary. The physician was free to choose which patients to treat. The
patient, in theory, was free to choose a physician. Unfortunately, this voluntariness
permitted racial, religious, and economic discrimination against patients. Federal and
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