BMJ  2003;327:E257 (22 November), doi:10.1136/bmj.327.7425.E257

BMJ USA: Letter

Letters

DEAR EDITOR:

In response to events that followed September 11, 2001, the American Medical Association's Council on Ethical and Judicial Affairs developed ethical guidelines for physicians, titled "Disrespect and Derogatory Conduct in the Patient-Physician Relationship." Some evidence revealed cases of refused treatment and verbal abuse on the basis of patient or physician ethnicity. The Council condemns such behavior on the part of health care professionals, who are ethically responsible for treating all those in need without prejudice. The Council recommends that the following guidance be disseminated broadly to physicians and patients:

"The relationship between patients and physicians is based on trust and should serve to promote patients' well-being while respecting their dignity and rights. Trust can be established and maintained only when there is mutual respect.

"Derogatory language or actions on the part of physicians can cause psychological harm to those they target. Also, such language or actions can cause reluctance in members of targeted groups to seek or to trust medical care and thus create an environment that strains relationships among patients, physicians, and the health care team. Therefore, any such conduct is profoundly antithetical to the tenets of medical ethics.

"Patients who use derogatory language or otherwise act in a prejudicial manner toward physicians, other health care professionals, or others in the health care setting seriously undermine the integrity of the patient-physician relationship. Such behavior, if unmodified, may constitute sufficient justification for the physician to arrange for the transfer of care."

Council on Ethical and Judicial Affairs American Medical Association Chicago amy_bovi{at}ama-assn.org

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