2.1.1: The Licensee-Patient Relationship

A licensee’s first responsibility is to his or her patients. Having assumed care of a patient, the licensee’s responsibility is to provide competent, compassionate, and economically prudent care within the standards of acceptable medical practice and to make treatment decisions that are in the best interest of the patient. It is the Board’s position that it is unethical for a licensee to allow financial incentives or other interests to adversely affect or influence his or her medical judgment or patient care. Patient advocacy is a fundamental element of the licensee-patient relationship and should not be altered by the health care system or setting in which a licensee practices. All licensees should exercise their best professional judgement when making patient care decisions. Patient welfare must always take priority over economic or other interests. Licensees who hold administrative leadership positions should foster policies that support the licensee-patient relationship and enhance the quality of patient care.

A. Elements of the Licensee-Patient Relationship

Receiving a license to practice medicine grants the licensee certain privileges and imposes corresponding responsibilities. The people of North Carolina expect a licensee to be competent and worthy of their trust. As patients, they come to the licensee in a vulnerable condition, believing the licensee has knowledge and skill that will be used for their benefit.

Mutual trust is fundamental to the licensee-patient relationship and requires that:

• There be appropriate professional communication between the licensee and the patient;
• The licensee timely report all significant findings to the patient or the patient’s legally designated representative;
• Conflicts of interest be resolved to the benefit of the patient;
• Personal details of the patient’s life shared with the licensee are held in confidence;
• The licensee maintain competence, professional knowledge, and skills;
• There is respect for the patient’s autonomy;
• The licensee maintains a compassionate and professional demeanor;
• The licensee respect the patient’s right to request restrictions on medical information disclosure;
• The licensee be an advocate for appropriate medical care;
• Patient advocacy remains unaltered by the healthcare setting; and
• The licensee provide neither more nor less than the medical problem requires.

The Board believes the interests and health of the people of North Carolina are best served when the licensee-patient relationship, founded on patient trust and fostered by professional communication, patient primacy, confidentiality, competence, patient autonomy, compassion, and appropriate care are foremost considerations of licensees.

B. Termination of the Licensee-Patient Relationship

The Board recognizes the licensee’s right to choose patients and to terminate the professional relationship with them when the licensee believes it is best to do so. That being understood, the Board maintains that termination of the licensee-patient relationship must be done in accord with the licensee’s underlying obligation to support continuity of care.

Patient termination must be accompanied by appropriate written notice provided to the patient or the patient’s representative sufficiently far in advance (at least 30 days) to allow other medical care to be secured. A copy of such notification is to be included in the medical record. Should the licensee be a member of a group or an employee of a large practice, the notice of termination must also state clearly whether the termination involves only the individual licensee, other licensees in the practice, or the entire practice. In the latter case, those members of the group joining in the termination must be designated. It is advisable that the notice of termination also include instructions for transfer of or access to the patient medical records.

When a licensee’s employment status is terminated by an employer, the licensee or his or her employer should notify the licensee’s patients that the licensee will no longer be working with the employer and should provide them with the licensee’s new contact information. Patients should be given the choice to continue to be seen by the licensee in his or her new practice setting or to be treated by another licensee still working with the employer.