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  • Dr. Jeffrey R. Leidy, DDS

    I actually contacted a resident doctor in Internal Medicine at a teaching hospital and asked if he would be interested in becoming my primary
    care doctor (PCP). My note briefly described my background in health outcomes research and two
    of our prescription drugs. He wrote back that he would be honored to be my PCP, and came
    across as professional, humble, and sincere. A new doctor-patient partnership was formed, and I contacted my existing doctor's
    office to arrange for my medical records to be
    moved, which immediately informed that workplace that I must be dissatisfied and going
    to a new doctor. I also shared with the particular resident doctor confidential information from
    my medical records and a copy of one of my professional
    presentations at a health care conference.

    A section administrator then contacted me to express the resident doctors are not obtainable every day
    of the week for clinic and are not even here when they do their ICU rotation. Also, the interior Medicine
    department protocol would not allow the resident doctor
    to write me a medication prescription for off label use.
    Finally, she was concerned that will in the past I
    have ordered and properly interpreted my own blood tests.
    The particular administrator's attitude reflects one of the main complaints
    Americans have with the healthcare system: the system is coming at them and requiring them
    to get health services in some predefined framework to which the
    facility is used but which eliminate any possibility of individualized treatment according to individual patients' needs.

    Apparently the administrator did not spend enough "careful consideration" to
    get her facts straight. I do not require to see my PCP daily or even monthly.
    My track record shows I saw my existing doctor once in the calendar year, and the prior doctor just
    before him I saw once in a 15-month period.
    So the administrator based the girl decision on her own ignorance of the facts.

    She also misstated specifics concerning off-label prescriptions for
    medicines by resident doctors. One of the medicines we are
    talking about is Clomiphene. Each a resident doctor and a good
    attending faculty physician at the teaching hospital advised me that they will
    be willing to write me (off-label) prescription medications for this drug,
    and the attending physician did indeed phone in a prescription for one of the drugs at
    my request. Similarly, the Dept. of Obstetrics and Gynecology (OB-GYN) advised myself that their doctors, both resident and
    attending, have prescribed Clomiphene to patients. Therefore , residents within Family
    Medicine and OB-GYN (both primary care departments)
    can create prescriptions for Clomiphene, but "protocol" prevents
    residents in Internal Medicine (also primary care) from composing off-label prescriptions.

    What kind of a cockamamie rule is that? What, the occupants in Internal Medicine are too dumb or too naive to understand
    off-label benefits of medicines?

    Finally, I had prepared for my resident PCP to order and interpret blood assessments each time I visited
    him. The administrator could have learned that fact when she had
    bothered to call or write me before jumping to conclusions and
    interfering within my doctor-patient relationship.
    I strongly deny the Director's paternalistic view associated with medicine
    in which she feels she has to protect resident doctors from patients which order
    or interpret their own blood tests. These resident doctors are young professionals who have completed
    their medical degrees; they don't need paternalistic
    oversight from a department administrator telling them who they can and can not invite
    to be patients.

    Apparently, an overwhelming number of patients who visit this training hospital's doctors want to be told
    what to do and how to feel. I am the exact reverse;
    I take personal responsibility for and manage my own health, which is strongly advocated under health care change.
    Having a more equal, collaborative partnership with my PCP works for me personally, and that seems to be the true
    reason for the particular administrator's interference.
    Studies show that healthcare malpractice rates drop with a non-paternalistic model of health
    care services. That fact of reducing litigation risks is pressing more health care systems across
    the country in order to migrate to a non-paternalistic model.


    I. Formation of Doctor-Patient Relationship

    The first question to address is actually, based on this fact pattern, the doctor-patient relationship was formed.

    Once i gave the Internal Medicine resident physician confidential information on two off-label drugs that I take, that act
    will be analogous to a prospective client approaching a lawyer
    with facts about his case to see if the lawyer will assist him.
    Getting in touch with a lawyer this way does not create an attorney-client relationship.
    However , the attorney is under an ethical responsibility to protect
    the confidentiality of the info shared by the prospective client.
    Similarly, the particular resident doctor was under an ethical duty to keep the information We shared with him confidential.

    When an attorney responds to a prospective client, "I say yes to take your case, "
    or "I will be your lawyer, " or words to that effect, then an attorney-client relationship is created,
    and the protection afforded to the client's information rises to the level of constitutionally protected attorney-client privilege.

    In this case, when the resident doctor responded that he would be honored to become my PCP, we
    have offer plus acceptance forming a contract.
    The offer-acceptance could be construed as my offering to be his patient,
    which this individual accepted, or his offer to be my PCP, which I accepted.

    Yet offer and acceptance are only two of the three required elements to form a contract.
    The third essential element is definitely exchange of consideration, expressed in Latin as the quid pro
    quo. In this case, there have been several separate exchanges of account that
    complete the formation of the contract and thereby render it enforceable in a court of
    law. Consideration is defined as some act or even some transfer of an item from party to the other, for which the getting party had no legal right to otherwise obtain that consideration.
    There is no requirement that the consideration have intrisinc value.
    For example , the transfer of the scrap piece of paper can constitute valid consideration that
    renders a contract binding and enforceable.

    The initial disclosure of confidential information from the health history amounts to enough consideration. Second,
    the fact that both We and the doctor each began going after scheduling an appointment for me to see your pet is also consideration: neither of us had a prior legal right entitling us to
    that particular action by the other person. 3rd, when we continued
    to correspond after offer and acceptance, with more information being shared back and forth, further account was
    exchanged. My sending the resident doctor a copy of one of my professional
    presentations was a fourth example of consideration. Finally, our request that my medical records be transferred to the resident doctor's clinic constituted an obvious legal detriment based
    on reliance rendering the agreement enforceable.