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Medical directors play an integral role in the care of patients in the prehospital setting. Along with the ability to have a positive impact on the care of the patient goes the responsibility to strive for the best possible outcome. Medical directors must ensure that they carry out their roles with the due care which the law will impose on them. The failure to carefully carry out their roles may not only result in harm to the patient, but also to liability of the physician and the physician's employer.


  • Define the circumstances which must be present in order to form a physician-patient relationship.

  • List the components of the physician-patient relationship.

  • Identify whether a physician-patient relationship has been formed given a set of facts.

  • Discuss the nature of the physician-patient relationship when a physician responds to the field to assist with treatment.

  • Identify potential liability issues when a physician provides online and off-line medical direction.

  • Explain the roles of the physician in providing off-line medical direction

  • Describe ways in which EMS agencies can obtain useful feedback and detail a method for handling complaints.


In the United States, the physician-patient relationship is defined on a state-by-state basis through either judge made case law or state ­statute. As a result, the definition of this relationship varies from state to state. Physicians are generally not obligated to treat a patient unless they choose to do so or have assumed a duty to do so, although there are certainly exceptions to this rule. A patient-physician relationship is formed when a physician affirmatively acts on behalf of a patient by examining, diagnosing, or treating the patient or by agreeing to do so. Once the physician consensually enters into a relationship with a patient in any of these ways, a legal contract is frequently formed in which the physician owes a duty to that patient to continue to treat the patient until the relationship is actually and properly terminated.

The American Medical Association has commented on the ­physician-patient relationship as follows:

The practice of medicine, and its embodiment in the clinical encounter between a patient and a physician, is fundamentally a moral activity that arises from the imperative to care for patients and to alleviate suffering.

A patient-physician relationship exists when a physician serves a patient's medical needs, generally by mutual consent between physician and patient (or surrogate). In some instances the agreement is implied, such as in emergency care or when physicians provide services at the request of the treating physician. In rare instances, treatment without consent may be provided under court order…. Nevertheless, the physician's obligations to the patient remain intact.

The relationship between patient and physician is based on trust and gives rise to physicians' ethical obligations to place patients' welfare above their own self-interest and above obligations ...

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