Physician-Patient Relationship

Patient Relationship

How do you end a physician-patient relationship?

Before a physician can abandon or withdraw from a case without liability, they must give reasonable notice or provide a competent physician in his place.
Norton v. Hamilton, 89 S.E.2d 809 (Ga.Ct.App. 1955)

Appropriate steps to terminate the patient-physician relationship include...

  • “Providing written notice to the patient — preferably by certified mail — with a return receipt request"
  • "Providing the patient with a brief explanation for terminating the relationship"
  • "Providing treatment/access to services for a reasonable period of time after termination of relationship, to allow patient to secure care from another person"
  • "Providing resources and/or recommendations to help patient locate another physician of like specialty"
  • "Offering to transfer records to a newly-designated physician upon signed patient authorization.” AMA's E-8.115

Click here for the Georgia Composite Medical Board’s FAQ.

Patient Consent

Can minors consent to their own health care decisions?

"Under Georgia statute, the age of legal majority is 18 years; until that age all persons are minors." § 39-1-1(a) 

In general, parental consent is needed before a physician may treat a minor. However, there are some exceptions to this rule which have been recognized by statute, including…

  • A pregnant minor, regardless of marital status, may consent to medical treatment relating to her pregnancy without the consent of her parents § 31-9-2
  • A minor can consent to medical treatment for his or her minor child § 31-9-2(a)(3)
  • Emergency situations § 31-9-3

Facilities that receive Title X Federal Family Planning Funds (e.g., Planned Parenthood) are allowed to treat minors age 14 and older pursuant to federal law. Private physician offices do not receive such funds and are not subject to such law.

AMA has several ethical policies on this issue, including AMA E-5.055

Must a physician seek patient consent in writing?

Yes, a patient's consent should be obtained in writing. There are two types of consent including basic consent and informed consent. Basic consent avoids a charge of battery (e.g. unwanted touching), which could potentially occur in a case of unwanted emergency treatment. If informed consent is required under Georgia statute, then consent should be obtained in writing in accordance with the requirements of the statute. If informed consent is obtained orally, no presumption will exist as to the validity of the consent. § 31-9-6.1(b)

Does a minor need parental consent to get a birth control prescription? 

No. Under Georgia law, any female - regardless of age - can consent to birth control. §31-9-2(5)

Special Needs Patients

Is a physician obligated to provide a foreign language interpreter for patients who cannot speak English?

Probably yes under federal law…

  • The Americans with Disabilities Act provides that “No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any person who owns, leases (or leases to), or operates a place of public accommodation.” 42 U.S.C 12182(a)
  • Health care providers who receive federal assistance from public insurance companies are required to provide a foreign language interpreter for patients with limited English proficiency under the Civil Rights Act. The provider is required to incur the cost associated with providing the interpreter and cannot charge the patient or the patient’s insurance company. 42 U.S. Code, sec. 2000d

There is no Georgia law requiring a physician to provide foreign language interpreters for non-English speaking patients, but there are several laws regarding related issues…

  • A woman must be provided with information about the risk of carrying an unborn child to term in a language understood by the patient through a translator when she is considering an abortion. § 31-9A-3(1)(C)
  • The Georgia Department of Human Resources is required by law to provide information to help a woman through a pregnancy and information about the different stages of fetal development. § 31-9A-4
  • The physician profile published by the Georgia Composite State Board of Medical Examiners must include the identification of any translating services available at the primary practice setting if requested by the physician. § 43-34A-3(c)(9)
  • For children with severe emotional issues, the coordinated system of care shall be culturally and ethnically sensitive. § 49-5-222

According to HHS, health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation. Federal Register 65, no. 247

Go to AMA H-160.924 for the AMA's policy.

What is a physician required to provide for hearing-impaired patients?

The Americans with Disabilities Act requires that physicians provide appropriate auxiliary aids and services to individuals who are deaf or hard of hearing where such aids and services are necessary to ensure effective communication with the patient and such aids/services do not do not impose an undue burden or fundamentally alter the physician's services. Physicians need to ultimately remember that failure to provide a reasonable aid, either literally or in the patient’s eyes, could result in a discrimination lawsuit. 42 U.S.C 12182(a) (See foreign language interpreter for additional details on this law.)

Go to MAG 155.997 for MAG's policy.

Go to AMA D-160.992AMA D-90.999, and AMA H-215.982 for AMA's policies.

Legal

Can MAG provide legal advice to physicians?

No. MAG is more than happy to provide information about current Georgia law to member physicians, but MAG cannot provide legal advice or representation. The information provided on MAG's website or via telephone is intended to serve as useful information. It is not intended to serve as legal advice or a legal relationship. A physician should discuss legal issues with a private health care attorney and/or medical malpractice liability carrier for specific advice and recommendations.

Can MAG recommend a private health care attorney?

Yes, MAG can refer physicians to a qualified attorney. MAG will also refer practices to an outside attorney for consultations that require more than one hour of staff time. The practice will be responsible for any fees that are required by the referral attorney. MAG will not collect a fee for any referrals. MAG 530.884

Does MAG have guidelines for expert witnesses?

Yes, MAG’s expert witness guidelines include…

  • “Expert witnesses are expected to be impartial and should not adopt a position of advocacy except as a spokesman for the field of special knowledge that they represent."
  • "The physician serving as an expert witness should testify as to the practice behavior of a prudent physician." 
  • "A physician serving as an expert should have actual professional knowledge and experience in the area of practice or specialty in which the opinion is to be given as the result of having been regularly engaged in the active practice of such area of specialty for at least three of the last five years immediately preceding such testimony, or the teaching of such area of practice or specialty for at least half of his or her professional time as an employed member of the faculty of an accredited institution of medical education for at least three of the last five years preceding such testimony." 
  • "Prior to offering any testimony, the physician serving as an expert witness should become familiar with all pertinent data relating to the particular matter at issue in the case and should review prior and current concepts relating to the pertinent standard medical practice." 
  • "The physician serving as an expert witness should present the court with those opinions which represent the broad spectrum of medical thought and practice." 
  • "The expert should honestly describe where his or her opinions vary from common practice."
  • "The expert should not present his or her own views as the only correct ones if they differ from what might be done by other physicians."
  • "The provision of expert testimony by a physician constitutes the practice of medicine."
  • "The physician serving as an expert witness should not concern him or herself with the legal issues of the matter in question. Rather, the physician should champion what he or she believes to be the truth, not the cause of one party or another."
  • "Compensation of the physician serving as an expert witness should be reasonable and commensurate with the time and effort given to preparing for his or her deposition or court appearance." 
  • "Physicians should not accept contingency fees for serving as an expert witness.” MAG 265.994

Does MAG have a policy compendium?

Yes. Click here for MAG's policy compendium.

What does a physician need to do when they are charged with a DUI or other offense?

A physician has a duty to report any DUI or arrest or conviction to the Georgia Medical Composite Board at the time of renewal; however, it is best to do so within 30 days of the charge. Click here to go to the Georgia Composite Medical Board’s website.

What does a physician need to do when they recognize that they have developed an addictive disorder?

The physician should contact the Georgia Professional Health Program (Georgia PHP). The Georgia Composite Medical Board (the Board) partnered with Georgia PHP in June 2012, when it selected Georgia PHP, Inc. to conduct the Board’s Professional Health Program. Georgia PHP is an organization that helps physicians who have developed a substance abuse or other mental health problem during the course of their medical career. It is designed to help physicians get the help they need and protect the public.

According to Georgia PHP, their primary goal is to ensure that the professionals who return to the practice of medicine do so only if they can practice with reasonable skill and safety. Georgia PHP provides initial triage, referral to treatment, and long-term monitoring services for health care professionals with addictive disorders. To access the Georgia PHP website, click here. To find out more information about the Georgia PHP partnership, click here.

Where do I file a complaint regarding a physician in Georgia?

The Georgia Composite Medical Board accepts complaints by mail or on their website. The complaint forms can be downloaded online. Click here to view the Board’s instructions on how to file a complaint.

What does the Georgia Prescription Monitoring Program (GA PDMP) entail and how does a physician sign up?

All practitioners licensed by the Georgia Composite Medical Board who have authority to prescribe or order controlled substances can now register to access the GA PDMP. Georgia prescribers will be able to use the GA PDMP to determine which pharmacies their patients are having their prescriptions filled, and if their patients have been obtaining controlled substance prescriptions from other physicians and where those prescriptions have been filled. Prescribers will also be able to see a listing of how many controlled substance prescriptions have been filled under their name or DEA permit number. Click here to learn more about the GA PDMP. 

Are physicians in Georgia required to purchase medical malpractice liability insurance? 

No, Georgia physicians are not required to have liability insurance; however, they are required to inform the Georgia Composite Medical Board of whether they do or do not have liability insurance. 43-34A-3

Fees

Can physicians charge fees to complete paperwork and forms for patients?

With the exception of Medicare and Medicaid patients, a physician may charge fees to complete patient paperwork. There is no specific Georgia law regarding this issue, patients should be notified of any such charges in advance as a courtesy. Physicians should also check their contracts with commercial insurance companies to see if the terms of the contracts prohibit of the charging of administrative fees.

Neither Medicare nor Medicaid recipients may be charged fees to complete patient paperwork.

Medicare requires physicians to provide advance notice to patients before items or services are furnished. Medicare allows physicians to charge Medicare beneficiaries (not the Medicare program) extra fees for items and services that are not covered by Medicare, as well as deductibles and coinsurance.  But charging extra fees for services already covered violates Medicare rules. The details of the Medicare rules violation may be accessed in a bulletin issued by the Office of Inspector General. Providers should exercise caution.

AMA suggests that physicians should complete simplified insurance claim forms without charge - but it is appropriate to charge for more complex or multiple forms. AMA E-6.07

Can physicians charge a missed appointment fee?

With the exception of Medicaid patients, physicians may charge patients for missed appointments. MAG believes that once patients and physicians agree upon the goals of therapy and a treatment plan, patients have a responsibility to cooperate with the physician and to keep their appointments. MAG 140.975

Medicare also allows physicians to charge Medicare beneficiaries (not the Medicare program) for items and services that are not covered by Medicare, as well as for deductibles and coinsurance. But charging extra fees for services already covered violates Medicare rules. Additionally, Medicare allows a practice to bill Medicare beneficiaries (not the Medicare program) for “no show” patients as long as the practice does the same for non-Medicare patients. 

Neither Medicare nor Medicaid recipients may be charged fees to complete patient paperwork.

AMA suggests that a physician may charge a patient for a missed appointment or for one not canceled 24 hours prior to the appointment, if the patient is fully advised of such charges in advance. AMA E-8.01