maintenance organizations) restrict freedom of choice,
and patient and surgeons are assigned. An ethical surgeon should abstain from a system that denies serving
the best interests of the patient by refusing referral out
of the system.
Freedom of choice means that either the patient
or the surgeon may terminate the physician-patient
relationship. When a patient exercises this right, the
surgeon should transfer copies of the medical record
to the new surgeon or another appropriate physician.
When a surgeon exercises this right, he or she should
notify the patient in writing and provide copies of the
medical record to the new surgeon or physician. All
parties should cooperate to ensure continuity of care
during the transfer.
H. Confidentiality of Medical Records
Patient confidentiality is a fundamental tenet of medical care. The information in the medical record belongs
to the patient but is shared with those health care professionals responsible for providing care. However, in
most jurisdictions, the records belong to the physician
or institution that compiles and maintains them for the
caregivers. Access to medical records by caregivers,
insurers, government, and other parties places patient
privacy in jeopardy. Nevertheless, every health care
worker is honor bound to protect patients’ confidentiality. U.S. law—the Health Insurance Portability and
Accountability Act (HIPAA), which went into effect
April 14, 2003—protects all medical records from
unauthorized disclosure. All surgeons in the U.S. are
obliged to understand and abide by HIPAA regulations.
HIPAA provides for the use of medical information
in the public interest—for example, reducing public
health risks and accumulating vital statistics.
Surgeons should avoid disclosing identifiable health
care information to any person without authorization
from the patient. Also, discussion of identifiable patient
information in public places is unethical.
I. Conflict of Interest
The physician-patient relationship requires that the
patient’s interests supersede all other interests, includ-
ing the personal and financial interests of the surgeon,
the corporate and financial interests of the payor, and
the corporate and financial interests of all vendors
including pharmaceutical companies and the manu-
facturers of instruments, equipment, prosthetic devices,
supplies, and services. Modern marketing strategies and
tactics place extraordinary pressure on surgeons. Sur-
geons must strive to maintain the knowledge, insight,
and discipline required to keep the patient’s interests
above all others.
J. Unnecessary Operations
No operation should be performed without suitable
justification. It is the surgeon’s responsibility to perform a careful evaluation, including consultation with
others when appropriate, and to recommend surgery
only when it is the best method of treatment for the
K. Quality Assurance
Quality assessment and improvement have become
integral concepts in the effort to improve patient outcome. Hospitals have established formal committees to
assess and improve the quality of patient care. Fellows
are strongly encouraged to be actively involved as leaders of quality assessment and improvement activities
in their own hospitals.
L. Surgical Fees
In the U.S., government and private insurance carriers
establish many professional fee schedules. Payments for
services may require documentation. Surgeons should
accurately document services in compliance with government standards.
Fellows of the College are urged to hold to the traditional principles of ethics and compassion in providing
patient care and must not participate in any arrangements that encourage unnecessary operations or
referrals made primarily for reasons other than optimal patient care.
Surgeons provide many uncompensated services,
particularly when patients are unable to pay. If the surgeon expects the patient to personally pay a fee, he or
she or a qualified representative should discuss the fee
with the patient before the operation. Fees should be
commensurate with services rendered and may be
related to the economic status of the patient.
SEP 2016 BULLETIN American College of Surgeons
ACS STATEMENTS ON PRINCIPLES