Fiduciary RelationshipPatient Physician

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THE FIDUCIARY RELATIONSHIP

The physician-patient relationship is a member of a special class of legal relationships called fiduciary relationships. Through the creation of fiduciary duties, the law recognizes that there are relationships in which the parties inherently have unequal power. In the words of one court:

[T]he physician-patient relationship has: ... its foundation on the theory that the former [physician] is learned, skilled and experienced in those subjects about which the latter [the patient] ordinarily knows little or nothing, but which are of the most vital importance and interest to him, since upon them may depend the health, or even life, of himself or family. [T]herefore, the patient must necessarily place great reliance, faith and confidence in the professional word, advice and acts of the physician.[29]

The essence of the fiduciary relationship is that the patient's interests must be paramount. This is in contrast to the usual legal rule of caveat emptor ("let the buyer beware"). In most businesses, the law assumes that there is an arms'-length transaction: the buyer and the seller have, in theory, the same access to information and the same bargaining power. For example, a merchant in a retail store encourages customers to buy the items that have the greatest profitability for the store. The merchant may not lie about the goods but is allowed to puff: to volunteer only favorable information and to make reasonable overstatements of the products' virtues. In contrast, the physician is expected to recommend treatments based only on the patient's medical and psychological needs.
Physicians should be familiar with fiduciary duties from the literature on informed consent to medical treatment. The fiduciary duty extends to all aspects of the physician-patient relationship. Breaching the financial aspects of the fiduciary duty to a patient can subject the physician to liability under commercial laws. Understanding the factors that make the physician-patient relationship a fiduciary one will help physicians recognize potential violations. [29]Witherell v. Weimer, 421 NE2d 869 (1981).

Self Interest:

regard for one's own interest or advantage, especially with disregard for others.

personal interest or advantage.

Vested Interest:

1. a personal stake or involvement in an undertaking or state of affairs, especially one with an expectation of financial gain.

"banks have a vested interest in the growth of their customers"

o    a person or group having a personal stake or involvement.

"the problem is that the authorities are a vested interest"

o    Law

an interest (usually in land or money held in trust) recognized as belonging to a particular person.

Fiduciary:

A fiduciary duty is an obligation to act in the best interest of another party. ... A person acting in a fiduciary capacity is held to a high standard of honesty and full disclosure in regard to the client and must not obtain a personal benefit at the expense of the client.

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 Professor Edward P. Richards, III, JD, MPH - Webmaster

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The question arises, " What or who does the physician owe his responsibility/allegiance to? "

Does the physician owe allegiance to his/her medical school where he is trained to perform in a certain manner regardless of the outcome or its cost to the patient?

Possibly he owes his allegiance to the pharmaceutical companies who have so generously contributed to his school and have an extensive financial stake  in promoting the expensive procedures and products that they sell.

Another possibility is that he owes quite a bit to the insurance companies who insist on following protocol no matter what the cost or outcome to the patient.  If you do everything by the book, you cannot be sued.

The physician owes his allegiance to the patient and the patient only.  Under all circumstances he/she must do what is best for the patient.   He is taught not only to act, but to act in a thoughtful,  responsible and timely manner.