AAPM&R Code of Conduct

• Introduction and General Overview
• Ethics Relating to the Patient and the Patient's Family
• Relationships with Members of the Rehabilitation Team
• Physician to Physician Relationships
• Relationships with Community and Government
• Research and Scholarly Activity

I. Introduction and General Overview

Ethics is the discipline dealing with moral values which governs principled relationships between individuals and defines what one should do. This code has been developed by the Ethical Issues Subcommittee of the Medical Practice Committee of the American Academy of Physical Medicine and Rehabilitation to serve as a guideline for professional and personal behavior and to promote the highest quality of physiatric care. It is a statement of ideals, commitments and responsibilities of the physiatrist to patients, their families, other health professionals, society and to themselves.

As a physician, the physiatrist has a significant responsibility for the welfare, well being, and betterment of the patient being served. This responsibility should take precedence over all other aspects of professional practice. It is recognized, however, that as a physiatrist there are numerous other responsibilities and relationships which carry significant, if not nearly equal, weight. This code, therefore, attempts to outline ethical practice within these various relationships emphasizing contemporary issues that confront most physiatrists. It makes no claim to being a comprehensive review of medical ethics and, in itself, is not a legal or policy manual. Ethics manuals take many guises and therefore the reader is referred to those from other medical specialty societies for further enlightenment (see end of document).

II. Ethics Relating to the Patient and the Patient's Family

1. The physiatrist shall be first and foremost dedicated to the principle of providing the best available patient care that resources and circumstances can provide.

2. The physiatrist shall function within the competence and capability of his/her training and provide care that presents the prevailing standards of physiatric practice. Physiatrists should participate in a regular program of continuing education.

3. When the patient's needs exceed the scope of the physiatrist's education and training, appropriate consultation should be obtained with practitioners of recognized competence.

4. Patient confidentiality must be respected at all times. This includes confidentiality of the medical records. Patient's privacy should be honored unless mandated by law. Consent of the patient or other responsible party should be obtained for release of information.

5. The physiatrist shall at no time render care to a patient while impaired by alcohol, drugs, or illness such that the patient would be placed at risk. The physiatrist has a responsibility to maintain his/her own professional and personal well being.

6. The physiatrist should maintain a reputation for truth and honesty. Patients must be treated with respect and not abused psychologically or physically, sexually, or financially.

7. The physiatrist should prepare and maintain records which include relevant history, physical findings, assessment and plan of evaluation and treatment. Patients are entitled to information contained in their medical records, although discretion should be used if such information may be detrimental to the patient.

8. The physiatrist shall be entitled to fair compensation for medical services delivered to or supervised on behalf of a patient. The physician shall not be entitled to compensation for patient referrals to other physicians or to health care facilities.

9. Conflicts of interest between the patient and physiatrist must be resolved in the best interest of the patient. If such a patient-oriented resolution is not possible, the physiatrist should seek out another physician to assume care of the patient. The patient is under no obligation to remain with the physiatrist and is entitled to change physicians if so desired and records should be transferred to the new physician or provided to the patient. The physician may discontinue the professional relationship by notifying the patient and with the patient's approval, transfer all appropriate medical records to another physician. Discontinuation of treatment under such circumstances is contingent upon adequate health care being available elsewhere and that the patient's health is not jeopardized. All attempts must be made to assure continuity of care.

10. The patient - physiatrist relationship is based on mutual agreement to care for the patient. The physiatrist, however, is under no obligation to see an individual patient provided other physicians are available in the community. The physiatrist, however, must not refuse to see a patient on the basis of race, religion, nationality, disability and gender. Where a physiatrist is competent to diagnose and/or treat a condition presented, the physiatrist should not refuse to diagnose or treat on the basis of a disability. Continued failure to follow treatment regimens or similar disciplinary problems are a basis for refusing to provide care to a patient.

11. It is unethical for a physiatrist to refuse to see a patient solely because of medical risk or perceived medical risk to the physician. It is, however, the obligation of the physician to minimize or avoid such risk.

12. The patient's family shall also be treated with respect and consideration while following all applicable laws regarding such relationships (release of information, advance directives, etc.) This is especially pertinent as many patients served by the physiatrist are incapable of speaking or making their wants and needs known.

13. Surrogate or proxy decision makers must be legally valid representatives of the incompetent patient's interest. They should know the patient's values well and be free of obvious fiscal or emotional conflicts with the patient.

To Code of Conduct, continued