Patient and provider relationships: Consent, confidentiality, and managing mistakes in integrated primary care settings.

Abstract

Health care in the United States is advancing toward increasingly integrated primary care systems. With this evolution comes a responsibility for providers to carefully consider a variety of issues related to ethical conduct. While working within the same teams on behalf of the same patients and families, professionals representing different disciplines are guided by different sets of baseline ethics guidelines and codes-and the overlap and differences between these principles can easily translate into ethical breaches. Using a clinical vignette as the basis for our discussion, we address issues of informed consent, confidentiality, and grievance procedures specifically. We review extant literature and formal ethics codes upheld by nine leading professional organizations across these foci, offer recommendations about how to manage this clinical scenario, and highlight what is needed to advance our understanding of integration ethics.

Professional Counselors' Experiences on Interprofessional Teams in Hospital Settings

“…Regarding IPTs, PCs voiced their appreciation for the support provided by the ACA Code of Ethics (ACA, 2014) and noted the importance of having a firm grasp on counseling ethics, boundaries, and scope of practice. The ethical concerns of PCs are substantiated in other research studies that focused on health care professionals on IPTs aligning multiple codes of ethics, communication, and ethical boundaries (Green & Johnson, 2015; Hodgson et al, 2013; Löffler et al, 2017). The participants in our study supported this idea and expanded on some potentially effective interventions for mitigating these disagreements: focusing on common ethical themes, having a strong base in one's own ethics codes and resources, and understanding the ethics codes of other disciplines.…”

“…Engaging on IPTs in hospital settings brings to light unique ethical challenges, such as scope of practice, navigation of several different ethical value systems and codes, conflict resolution among team members, and settings‐based turf challenges that can be further complicated by reimbursement (Kossaify et al, 2017; Madigosky et al, 2019; Manspeaker et al, 2017). Although health care ethical codes do have similar core values, researchers have suggested that navigating different professional ethical codes in interprofessional collaboration is a major challenge (Hodgson et al, 2013). An ethical challenge for PCs in hospital settings is role confusion—both their own and other team members’ understanding of PCs’ role and contributions on IPTs (Arthur & Russell‐Mayhew, 2010; Crumb et al, 2018; Johnson, 2016).…”

Medical Family Therapy in Rural Community Health: A Longitudinal “Peek” into Integrated Care Successes

“…Patients, too, needed to be educated about the new IBHC model, so a flag system was developed in the EHR in year one that alerted the MedFT to know whether or not a patient needed to be educated about the IBHC model before introducing themselves as a member of the healthcare team. It was especially important for all PCPs to inform patients about the inclusion of a MedFT as part of the healthcare team because it was another means of ensuring consent for this type of treatment and for the potential of mental health services (Hodgson et al, 2013 ).…”

How Medical-Dental EHR Integration Can Improve Diabetes Care

“…34 Integrated service delivery facilitated by HIE also nourishes professional ethics and health equity. 35,36,37 MCHS/FHC established medical-dental interoperability, via EHR integration, to identify diabetic and prediabetic patients in predominantly rural areas of Wisconsin and Michigan and to facilitate such patients' access to prevention and management interventions. Integrated care holds promise for alleviating health inequities, specifically for rural populations.…”