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American College of Physicians paper expresses concern about
laws that cross traditional boundaries and intrude into the realm
of medical professionalism
August 8, 2012
(Washington) - The American College of Physicians (ACP) today
released a paper,
Statement of Principles on the Role of Governments in
Regulating the Patient-Physician Relationship, which
for the role of federal and state governments in health care and
the patient-physician relationship.
"The physician's first and primary duty is to put the patient
first," David L. Bronson, MD, FACP, president of ACP, said. "To
accomplish this duty, physicians and the medical profession have
been granted by government a privileged position in society."
Dr. Bronson noted, though, that "some recent laws and proposed
legislation appear to inappropriately infringe on clinical medical
practice and patient-physician relationships, crossing traditional
boundaries and intruding into the realm of medical
Pointing to examples in ACP's paper, he expressed concern about
laws that interfere, or have the potential to interfere, with
appropriate clinical practice by:
The paper, produced by ACP's Health and Public Policy with input
from ACP's Ethics, Professionalism and Human Rights Committee,
offers a framework for evaluating laws and regulations affecting
the patient-physician relationship, rather than taking a position
on the specific issues that are cited by lawmakers to impose
particular restrictions or mandates.
ACP's paper states that:
ACP recommends seven questions that should be asked about any
proposed law to impose restrictions on the patient-physician
Is the content and information or care consistent with the best
available medical evidence on clinical effectiveness and
appropriateness and professional standards of care?
Is the proposed law or regulation necessary to achieve public
health objectives that directly affect the health of the individual
patient, as well as population health, as supported by scientific
evidence, and if so, are there no other reasonable ways to achieve
the same objectives?
Could the presumed basis for a governmental role be better
addressed through advisory clinical guidelines developed by
Does the content and information or care allow for flexibility
based on individual patient circumstances and on the most
appropriate time, setting and means of delivering such information
Is the proposed law or regulation required to achieve a public
policy goal - such as protecting public health or encouraging
access to needed medical care - without preventing physicians from
addressing the healthcare needs of individual patients during
specific clinical encounters based on the patient's own
circumstances, and with minimal interference to patient-physician
Does the content and information to be provided facilitate
shared decision-making between patients and their physicians, based
on the best medical evidence, the physician's knowledge and
clinical judgment, and patient values (beliefs and preferences), or
would it undermine shared decision-making by specifying content
that is forced upon patients and physicians without regard to the
best medical evidence, the physician's clinical judgment and the
Is there a process for appeal to accommodate individual
By insisting that such questions be asked of proposed laws
before a decision is made on their adoption, legislators will have
appropriate guidance before enacting ill-considered laws that "can
cause grave damage to the patient-physician relationship and
medical professionalism and undermine the quality of care,"
concluded Dr. Bronson.
The American College of Physicians is the
largest medical specialty organization and the second-largest
physician group in the United States. ACP members include 133,000
internal medicine physicians (internists), related subspecialists,
and medical students. Internists specialize in the prevention,
detection, and treatment of illness in adults. Follow ACP on
David Kinsman, (202) firstname.lastname@example.org
Jacquelyn Blaser, (202) email@example.com