Professional Ethics: Autonomy, Consent, Confidentiality, Fiduciary Duty, and Boundaries
Autonomy and informed consent
Consent is a conversation, not a signature. The patient must receive the diagnosis, the nature of the proposed treatment, material risks and benefits, alternatives (including no treatment), and the consequences of refusal, in language they understand. Consent must be voluntary and the patient must have capacity; for minors, a parent or legal guardian generally consents. Document what was discussed, not merely that a form was signed.
Confidentiality
Protected health information is guarded by HIPAA and by California's Confidentiality of Medical Information Act. Disclose only the minimum necessary, and only for treatment, payment, operations, or a legally required exception (mandated abuse reporting, court order, public-health requirements). Never post patient images or details on social media without written authorization - including in "private" groups.
Fiduciary duty
The patient's interest comes before the provider's financial interest. Disclose ownership or referral relationships, avoid fee-splitting and kickbacks, never bill for services not rendered, and never let production pressure drive recommendations.
Boundaries
Romantic or sexual relationships with current patients are prohibited. Dual relationships (employer, close friend, family) require extra care with consent and records. Gifts, treating staff, and informal texting all demand the same documentation standard.
Traps
Equating a signed form with valid consent; assuming confidentiality ends at death or disappears with a subpoena (verify authorization or court order); assuming a family member may receive information without the patient's permission.
Worked example: A patient asks for a copy of her records to seek a second opinion. Provide the copies promptly, without commentary or delay - withholding them to retain the patient breaches both ethical and legal duties.