Viewpoint: The cardinal rules of patient conduct

October 3, 2008

We wouldn't blame you for daydreaming about a code of conduct that would apply to the patients you serve each day.

It's a safe bet that most of you, in the course of several years or many years of practicing medicine, have been faced with a colleague whose actions compromised your ability to deliver the best patient care possible-or perhaps even to run a peaceful, efficient practice.

By January 1, the Joint Commission will require more than 15,000 accredited U.S. health-care organizations to institute revised codes of conduct for dealing with disruptive medical professionals. And though all instances of misconduct can be traced to a fraction of the physician population, the consequences of their behavior can be felt much more widely, among fellow physicians, office staff, and-most important-patients. For this reason, increased scrutiny would seem to be a good thing.

Of course, we wouldn't blame you for daydreaming about a similar code of conduct for the patients you serve each day. An informal Med Ec poll of physicians revealed a variety of pet peeves, among them a number of common courtesies that apparently aren't all that common these days:

Among the responses, several universal themes emerged-what we might call the "cardinal rules" of patient conduct:

Joseph Scherger, MD, a clinical professor at the University of California-San Diego, chooses a more conciliatory tack when it comes to matters of patient behavior. He invokes the lyrics of Bob Dylan, from the song "Nothing Was Delivered":

Remember when you're out there tryin' to heal the sick, that you must always first forgive them.

Scherger knows that respect for a physician's advice is paramount to a successful visit. But he also emphasizes the key tenet of patient-centered care: The patient is in charge of his or her own health, and the role of the medical provider is to serve the patient as best as possible.

According to Scherger, no patient is obligated to take prescribed medications, follow treatment plans, or return for follow-up care. Encouraging such active participation could be the key to developing more engaged, responsible patients.

"What's really exciting is that patients are going to start coordinating their own care," says Scherger, an adviser to the American Academy of Family Physicians' TransforMED program of patient-centered care (to learn more about the program, go to http://www.memag.com/TransforMED. "It's an interesting dynamic, but it requires a culture change, and culture changes don't happen easily."

In other words: Feel free to keep daydreaming of the perfect patient visit, but be prepared to keep finding stray gummy bears.

Erich BurnettEditor-in-Chief