Read the Case-Based Curriculum for Neurology Residents.

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THE NEUROLOGIST-PATIENT RELATIONSHIP
The Practice of Neurology
The profession
neurology exists primarily ro srudy, diagnose and treat disorders of the
nervousystem The neurologist-parient relationship forms the foundation for neuroloqic
care.
Fiduciary and Contractual Basis
The neurorogists has fiduciary and contracruar duties to patients. As a fiduciary, the
neurologist has an ethical duty to consider the inreresrs ofthe patient firsr. As a pany ro an
rmplied contract, the.nzurorogist has a duty to practice competently and to respect patients'
autonomy, confi dentiality, and welfare.
Beginning and Ending the Relationship
The neurologist is free to decide whether or nor to undenake medical care ofa panicular
person. The neurologist mu$ not decline a padent on the basis ofrace, religion] natlonalrty,
or gender. once the relationship has begun, the neurologistrnurt pro,rid. clre untrl
complete,
care is
the patient ends the relationship, or the neurologist returns rhe patient to
the referring
the
physician.
care of
Ifthe neurologisi justifiably desire-s to end the relalrionsiip,
conunued
and if
neurorogi care is appropriare, he/she should assist in ",,unginf;;"
neurologist.
iy "nott ",
Informed Consenl
The neurologist must obtain the patient's consent for tests or treatment.
should
The neurologisr
disclose inf:1nali9n that the average person would need to know
appropriate
to make an
medical decision. This informition should include ben.nt.,
altematives
;rtf-"orts,
to the proposed.tr^eatment.
ano
Ifthe patient lacks medical a""i.ion--"r.ing
the neurologist capacrry,
must obtain informed consent fiom an appropriate proxy.
Communication
The neurologist has a duty to communicateffectivery with the patient. The
shoutd
neurologist
convey ret":::::1"::l* in terms the patienr can undersrand "nJ
opponunity
Jtoi uo"quu,.
for the patient to raise questions "nd dir"ur, rnutt"., ,.l"t.Jio """i."*
Emergency Care
In an emergency situation, the neurologist should render services to the patient
hivher
to the
ability
best
while
of
obtaining inrormea consent is desirable before beginning treatment,
neurologist should
the
not delay urgently needed treatment because of concerns about
consent.
informed
Medical Risk to the Phvsician
A neurorogist should not.refuse to care for a padenr sorery because ofthe rear or perceived
medical risk to the neurorogist. The neurorogist shourd tike appropriate p."*riiinr,o
minimize his/her medical risk.
Medical Decision-Making
The patient has the ultimate right.to accept or reject the neurologist's recommendatron about
medical treatment The neurolo_gist should respect decisions.ui" uy puti"ni, nJtr, o""i.ionmaking
capacity and by the lawfur proxy of patienrs who lack decision-making cafacny.
neurorogist
If
cannot
the
honor the patient's or proxy's decision, the neurologisi sho-uta !".r to