Physicians - What are your Obligations as Fiduciaries?
Physicians are fiduciaries to their patients just like lawyers are fiduciaries to their clients.
When hospital by-laws or medical group standard practices are not optimal, physicians may have a legal obligation to discuss this with their patients. This issue often arises in whistleblower cases and in defending peer review cases. The law is continually evolving in this area.
Fiduciary Duty of Physicians
A fiduciary duty is a relationship where one party must act with the utmost good faith for the benefit of another party. This relationship typically arises when one person places trust and confidence in another, and the fiduciary voluntarily accepts this trust. In the context of healthcare, the doctor-patient relationship is a fiduciary relationship.
Legal Precedent: The doctor-patient relationship is recognized as a fiduciary relationship (Heller v. Norcal Mutual Ins. Co., 1994). A fiduciary duty creates an obligation to act affirmatively in the best interests of the party to whom the duty is owed. For nearly seventy years, California courts have recognized that the fiduciary relationship between a healthcare provider and patient imposes a duty of full disclosure.
Obligations in Patient Care
Equipment and Referrals: If a medical group has equipment that is less than optimal, physicians have an obligation to inform their patients. Similarly, if the best referral is outside the group, the physician must disclose this to the patient.
Legal Rulings: In Berkey v. Anderson (1969), the court stated that a physician violates their duty to the patient if they withhold any facts necessary for the patient to make an informed decision about treatment. The physician must also explain every risk attendant upon any surgical procedure or operation, no matter how remote.
Implications for Medical Malpractice and Whistleblowing
These issues can arise in medical malpractice cases, referral malpractice, and whistleblowing cases when a physician demands improvements and suffers retaliation.
I you have a conflict with a hospital or medical group where your obligations to your patients is being undermined by policies, politics or practices, we can help.
About the Horowitz Medical Group
Daniel Horowitz is the premier physician lawyer in California. His group defends doctors and never represents hospitals or entities targeting individual doctors. Call us if you need assistance.