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

staff knows that the orders are only advisory and cannot be acted upon until
reviewed and approved by the attending physician. If it is not possible to ensure
that student orders will not be acted on, as is the case in most private hospitals,
students should not write orders in the patient’s chart. If a student is going to do a
procedure on a patient, the attending physician should personally assist the student
to prevent wrong actions and to take over the procedure if the student has
difficulty.
Maintaining the integrity of the physician–patient relationship is important to
successful teaching within a private practice. Patients may choose whether they
wish to participate in the teaching program. The student should understand that he
or she must be as unobtrusive as possible. If the patient is uncomfortable with the
situation, then compliance is likely to suffer and the quality of care will deteriorate.
The attending physician’s first duty is always to the patient.
d) The Physician–Student Relationship
The duty to teach students is sometimes contractual but usually only an ethical
obligation. Faculty members who receive a salary for teaching must educate the
students under their supervision. Physicians who accept staff privileges at a
teaching hospital also may have a contractual duty to teach. If teaching is a
requirement for staff membership, accepting the staff privileges means accepting
the teaching responsibility. For most physicians, there is no formal contract that
requires teaching, but there is an ethical duty to improve the practice of medicine
and to educate new physicians. If the physician derives any benefit from the
presence of students, this ethical duty becomes very strong.
In theory, a student should not be allowed to do anything to a patient that the
supervising physician cannot legally authorize a layperson to do. The physician
should verify everything the student does. For instance, if a medical student does a
history and physical examination and dictates the findings, the physician must
repeat the history and physical to determine their accuracy before signing the
dictation. Otherwise, the physician would be illegally delegating the practice of
medicine to the student.
If the person doing the history and physical is a resident in a teaching hospital, it
may not be necessary for the attending physician to repeat all the work. The
resident may have a limited license to practice medicine through his or her training
institution. It is important to know the legal status of the student or resident. A
student doing an intern- like rotation is still a student and may not do any medical
practice. A resident who has no independent license is restricted to practicing
within the limitations of whatever institutional license he or she may have. Even an
independently licensed resident physician may be limited in the scope of practice
by the residency policies. These may not carry the force of law, but they may affect
malpractice insurance coverage.
Whether a physician has the right to refuse to treat a patient who will not
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