Fiduciary Duty of Doctor and Patient

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 What Is a Fiduciary Duty in Healthcare?

A fiduciary is an individual who has either a legal or ethical relationship of trust that they owe another party. When a person has a fiduciary duty to another person, the fiduciary must conduct themselves according to the benefit of that other person. The person to whom the duty is owed is commonly referred to as either the principal or the beneficiary.

One of the most important legal duties of a fiduciary is the obligation to act for the beneficiary’s benefit, not the benefit of the fiduciary. Fiduciary duties are commonly categorized based on one of three duties that may be owed:

  1. The Duty of Care: When a fiduciary must act with a duty of care, that fiduciary is expected to use the amount of care that any ordinarily prudent person would exercise in a similar position, and under similar circumstances.
    • For example, when a physician owes a duty of care to their patients, they are expected to use and act with the same amount of care as that of other physicians in similar positions;
  2. The Duty of Good Faith: When a fiduciary owes a duty of good faith, that fiduciary is tasked with the duty of acting with conscious regard for their responsibilities as a fiduciary. This means that the fiduciary must not act in any fraudulent or deceitful way, to the detriment of the beneficiary; and
  3. The Duty of Loyalty: When a fiduciary owes a duty of loyalty, that fiduciary must act for the benefit and advantage of the beneficiary, without making any decisions that would be disadvantageous for the beneficiary.

As far as the fiduciary duty and fiduciary relationships established in a healthcare setting, the most commonly cited fiduciary duty is the duty of care when a doctor patient relationship is established. This means that when a doctor establishes a relationship with a patient and begins to diagnose or treat them, that doctor owes that patient a legal duty of care so long as that relationship exists.

Do Doctors Have a Fiduciary Duty to Patients?

As mentioned above, the most commonly cited fiduciary duty that a doctor owes their patients is a duty of care. However, a doctor can also owe their patients a fiduciary duty of loyalty and a fiduciary duty of good faith.

For example, when prescribing medications to their patients, a doctor should not act in consideration of themselves, such as whether or not they will receive any kickbacks or financial advantage for prescribing a certain brand or type of medication; instead a doctor should operate within their fiduciary duty of loyalty and prescribe the medication that is most advantageous for that patient.

Similarly, a doctor should also not be fraudulent or deceitful in their treatment of a patient. For example, a doctor should not fraudulently diagnose or treat a patient, especially in a way that would result in the patient suffering any sort of harm. For example, a doctor should not fraudulently diagnose a patient with a disease or disorder to allow the patient to secure certain medications.

What Are the Different Fiduciary Duties?

As mentioned above, the three most common fiduciary duties are:

  • The Duty of Care;
  • The Duty of Loyalty; and
  • The Duty of Good Faith.

In addition to those duties mentioned above, there are also additional fiduciary duties, including:

  • The Duty of Competence: Similar to the duty of care, as a medical professional, a doctor must be accredited and competent to treat their patients. This means that a doctor should receive the state and federally mandated education for their designated role, maintain their professional licensing, and stay current on available medical treatment and medications.
    • At a minimum, a doctor has the legal duty to stay at a baseline of competency in order to treat patients. Competency is commonly assessed by measuring what other medical professionals might do in a similar situation or under similar circumstances;
  • The Duty to Avoid Conflicts of Interest: A doctor also owes their patients the duty to avoid a conflict of interest.
    • For example, if the doctor developed a technique to treat patients with a certain condition, and that treatment is now marketed and sold, the doctor should be careful in always engaging in that form of treatment as they still owe their patient a duty of care in treating them in their best interest;
    • It may also be a conflict of interest if a doctor has shares of stock in a certain medical manufacture, or receives financial kickbacks for prescribing their patients a certain brand or type of drug.

Is Confidentiality a Fiduciary Duty?

In short, yes, doctor-patient confidentiality is another important fiduciary duty that doctors owe to their patients. A duty of loyalty also requires that the fiduciary maintain confidentiality regarding all decisions and private information they have been entrusted to.

For instance, a beneficiary may not wish for public disclosure of their private matters, such as their private medical information. As such, the fiduciary would be prohibited from disclosing information about the beneficiary’s treatment, without first obtaining their permission to do so.

However, even if a fiduciary relationship has not been established, doctors may still owe their patients a duty of confidentiality if they perform any diagnosis or treatment of the patient that may be considered to be harmful or embarrassing to that patient.

This means that a doctor owes both current and past patients a duty to not disclose any medical information connected with their treatment of the patient. As such, if a doctor discloses protected medical information without the patient’s prior approval, which is commonly executed in a waiver, such as a HIPAA waiver, then the client will be allowed to initiate a civil lawsuit against the doctor for breaching their duty of loyalty and releasing protected health information.

Importantly, there are both state and federal laws concerning when a medical professional may release protected health information. As such, a physician should never release a current or former patient’s health information without proper consent.

For example, the most commonly cited federal law in relation to the disclosure of a patient’s health records is the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), which is a federal law that provides protections concerning sensitive patient health information being disclosed without first obtaining a patient’s consent.

Do I Need to Consult an Attorney about Fiduciary Duties?

As can be seen above, there are numerous professional and fiduciary duties that a doctor may owe their patient when treating that patient. As such, if you are a patient, and you believe that a doctor may have improperly disclosed confidential information regarding your medical treatment or history without your consent, then that doctor may have breached one or more of their fiduciary duties that they owed to you.

If the doctor did in fact breach a fiduciary duty, and that breach resulted in you suffering harm, then you may bring a civil lawsuit against the doctor for that breach. If you are in this situation, it is in your best interests to consult an experienced personal injury lawyer.

An experienced personal injury attorney can help you determine if you are entitled to recover for wrongful disclosure of your confidential medical information. Further, an experienced attorney can also initiate a civil lawsuit on your behalf, and represent your interests in court, as necessary.


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