Professional Relationships: Just What Are Our Responsibilities?

When we think about professional relationships in health care, what probably comes to mind first is the direct patient-practitioner relationship. While this relationship is the basis of existence for the entire healthcare field, there is another professional relationship for which we are, or should be, responsible - the relationship with our colleagues. Of course, relationships with patients are the focus that drives the relationships with colleagues. Nevertheless, relationships with colleagues have their own unique demands and concerns, and a practitioners relationship with other practitioners may affect the care of patients.

In our professional status as clinicians, we generally rely on patient care to be the basis of our behavior. Indeed, there are circumstances when the concern for patient care interacts with our personal status. As, or when, we attain professional status, the tenet of patient care is arguably the single most important element in our behavior and does not necessarily involve just our own patients. In striving to keep this tenet (patient care) in constant focus, we often encounter distractions, which might be in forms of dilemmas or tensions. Professional tensions or dilemmas in the work environment generally arise from one or two sources.

One source is extrinsic, such as observing a colleague being impaired while administering to a patient, or a colleague who differs from you on the management of a patient. These are situations in which you cannot control the behavior of another person.

A second source is intrinsic, such as your sense of loyalty or obligation when observing a colleague's misconduct, or your fear of reputation or harm should you make known your observations. This is behavior you can control. When making a decision on how to deal with these dilemmas, whether intrinsic or extrinsic, what we try to avoid is compromising two of the major principles of our code of ethics: beneficence and nonmaleficence.

While wrestling with one of these issues, invariably we come to what, if anything, should be disclosed to a patient. This, in itself, raises questions such as:

  • Is what we see clear and convincing enough so that someone else would make the same judgment?
  • Would/could our disclosing to a patient bring or add harm to the patient?
  • Should we be concerned with possibly being involved in a legal action?
  • Would we be vulnerable to any professional sanction?
  • Should we be considering the possible impact on another professionals career?

On the other hand, might disclosing to a patient enhance the patient's understanding of his/her condition? Might disclosing help prevent any co-morbid emotional distress in the patient? Of course, there is also the issue of whether or not the patient may be entitled to compensation. Altruistically, the first and most important concern we should have is the patient's health, whether or not the patient is our patient.

Once we decide how to deal with a patient, we are confronted with how to deal with a colleague. Once we recognize that a patient's welfare should override our personal concerns, we must consider the welfare of a colleague. In doing so, probably the best way to go is to try to be as constructive as possible as opposed to being punitively oriented. The most common causes of clinician impairment or distraction are alcoholism, substance abuse, financial difficulties, and family affairs. All of these issues are potentially solvable. A major decision we have to make, if we decide to be involved, is do we confront the colleague directly or do we first confide in or enlist outside help, such as an administrator or supervisor, a staff ethicist, legal counsel, a professional help individual or organization (such as the PRN-or Physicians Recovery Network), etc. Sometimes review boards and/or licensing agencies may get involved. The Health Care Quality Improvement Act (1986) may require the reporting of disciplinary actions, but not the reporting of accusations. This is yet another consideration when pondering what should be done when there is suspect behavior of a professional colleague.

Medicine generally and historically has enjoyed the Public Trust. The feeling is that we, in the occupation of seeing to the health of citizens, are self-evaluating, self-policing, and self-regulating. We have our own checks and balances, review boards, and judicial processes. So can't this be interpreted that not only are we, as individual clinicians, responsible for the welfare of our own patients, but also, to some degree, responsible for the welfare of all patients by virtue of our relationships and involvement with professional colleagues? The more we cannot show that we appreciate and honor the Public Trust, the closer we come to more and more outside regulation, evaluation, and overseeing.

There is no question about our responsibility to our patient when they walk into our office and we accept him/her. But when we become aware of a colleagues mistreatment of his/her patient, by virtue of the spirit of the Public Trust (in addition to our own conscience and morality), are we not responsible, at least indirectly, for all patients?

Isn't it possible that we actually have a Double Obligation, one to our patients and one to all patients? As a clinician, just what are our responsibilities?


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