Frequently Asked Questions in Ethics

1. First, try to identify whether the conduct was unethical.
   The first step in filing a complaint is to determine whether the physician has acted unethically or unprofessionally. Opinions in the AMA’s Code of Medical Ethics may be one way to determine this. The AMA and its Code of Medical Ethics have always maintained that physicians should provide competent medical care with compassion and with respect for patients. The AMA’s Council on Ethical and Judicial Affairs (CEJA) has developed guidelines for physicians who strive to practice ethically. Fundamental Elements of the Patient-Physician Relationship, Opinion 10.01, outlines in general what the AMA believes to be the ethical basis of all interactions and relationships between physicians and patients. We hope it clearly articulates what the medical profession believes you can and should expect from physicians when you seek medical treatment.
   Other Opinions of the Code of Medical Ethics may be accessed online by searching through the broad topic categories found in the table of contents.
   Additionally, you may wish to contact one or more of the medical specialty societies. The AMA serves as an umbrella organization representing all state medical and national specialty societies. When a particular concern is related to psychiatry or surgery, for example, the specialty association may have policy or practice guidelines that are specific to that concern.
2. Next, take action.
   Once you have determined that unethical or unprofessional conduct has occurred, there are a number of recommended steps you may choose to take. First, you may want to approach your physician and explain your concerns. Second, you may choose to report the behavior to another physician who works with your physician or who has treated you or a member of your family. Also, a number of hospitals and group practices have grievance mechanisms in place for patients to lodge complaints.
   
   Other avenues for addressing complaints include the state medical society or licensing board. These organizations have appropriate investigative bodies at the local level that can review physicians’ conduct. If appropriate, the licensing board can take disciplinary action against a physician’s license to practice medicine. Contact information of the licensing boards in all 50 states.

• If your concern is related to a hospital or healthcare organization, you may wish to contact the American Hospital Association (AHA) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
  
• If your concern is related to a health plan or health insurer, you may wish to contact America’s Health Insurance Plans (AHIP).
• If your concern is related to a non-physician health care professional (e.g., dentist, psychologist, optometrist, podiatrist, nurse), you should contact the professional association that represents that specific health care professional. Also, most states require that all health professionals be licensed. Your state medical licensing board should be able to direct you to the department that regulates these professionals in your state.
  Contact information of the licensing boards in all 50 states.

The AMA is a professional association representing American physicians. Approximately 30% (or 300,000) of American physicians are members of the AMA. Physicians who are members of the AMA pledge to uphold the AMA’s Principles of Medical Ethics.

The AMA serves as an umbrella organization of state medical associations and national specialty societies. Because of this role, the AMA is not in a position to investigate allegations of unprofessional or unethical conduct at the local level. Instead, we defer to state medical societies and national specialty societies to conduct fact finding investigations when such allegations are made. If the physician in question is a member of the AMA, the investigative body will forward its findings to the AMA for review by the AMA’s Council on Ethical and Judicial Affairs (CEJA) as set forth in the AMA Bylaws and CEJA’s Rules. The Council on Ethical and Judicial Affairs does not review complaints submitted by the general public.

At the conclusion of its proceedings, the Council on Ethical and Judicial Affairs has the authority to acquit, admonish, censure, or place on probation the accused physician or suspend or expel him or her from AMA membership (CEJA Rules pertaining to Disciplinary Action). However, the AMA is not in a position to take action against a physician’s license to practice medicine.

The AMA encourages all practicing physicians in the US to consider our ethics policy as a useful source for guidance. If the practitioner is a health professional other than a physician (e.g. dentist, psychologist, optometrist, podiatrist, nurse) you should consider looking for policy from a professional association specific to that profession.

To find out how to file a complaint with the state medical association or licensing board, please view the complaint information above.

• The Federation of State Medical Boards (FSMB) provides a service known as DocInfo which provides physician disciplinary information for a fee (approximately $10).
• Additionally, some state licensing boards may provide physician disciplinary information. This service may be free or a fee may be charged.
  Contact information of the licensing boards in all 50 states.

AMA Policy can be found in several ways:

• Ethics policies can be found in the Code of Medical Ethics, by searching through the broad topic categories found in the table of contents.
• If you want more in-depth information, you can look at the full text of many CEJA Reports from which AMA ethics policies originate.
• In addition, the AMA has an online tool called PolicyFinder which enables you to perform keyword searches of other AMA policies.

Please note that it can take several months following a meeting of the AMA’s House of Delegates for new policies to be added to the PolicyFinder database.

The AMA’s Code of Medical Ethics can be purchased online or by calling AMA Customer Service at (800) 621-8335. Ask for the 2008-08 edition of the Code of Medical Ethics, Current Opinions with Annotations.

The AMA does not have formal policy related to the Oath. Some of the tenets of the Oath represent long-standing ethical traditions that the AMA supports, while others are somewhat outdated. A May 2000 article from AMNews discusses the modern meaning of the Hippocratic Oath.

The AMA used to reprint a translation of the Oath in our Code of Medical Ethics. We still have information on the history and relation of the Oath to the AMA Code of Medical Ethics included in the preface to the Code.

Physicians may take other oaths when they begin or when they graduate from medical school. In addition, they may pledge to uphold professional standards and codes of ethics when they become members of professional associations, such as the AMA or their specialty or state medical society. For instance, every physician who is a member of the AMA must uphold the AMA’s Principles of Medical Ethics.

Because most oaths and codes are administered by voluntary associations and not by regulatory agencies (such as the state agencies that issue licenses to practice medicine), the most serious disciplinary action these voluntary associations typically can take is to expel the member physician from the association.

However, regulatory agencies that oversee physicians take allegations of unethical or unprofessional conduct very seriously, and such actions may warrant more serious disciplinary action against a physician’s license to practice. For further information on how to contact these agencies, please see the information above on how to file a complaint.

Find background questions and answers about the initiative.

AMA Staff cannot recommend individual physicians. However, you may wish to use the AMA’s DoctorFinder, which can be used to search for physicians by name, location, or specialty.

Physicians should encourage patients to obtain a second opinion when either the patient or the physician feels it is appropriate (Opinion 8.041 from the Code of Medical Ethics.) However, AMA Staff do not give specific medical advice. National specialty societies are responsible for developing specific practice standards and may be better equipped to assist you in finding medical information related to your concern. You may download a directory of medical specialty societies (PDF, KB).
For help in finding a second opinion, you may wish to utilize the AMA’s DoctorFinder, which can be used to search for physicians by name, location, or specialty.

The patient’s right to receive information from his or her physician is a fundamental element of the patient-physician relationship. Therefore, it is important for a physician to make every effort to provide information to patients (see Opinion 10.01, Section 1, Fundamental Elements of the Patient-Physician Relationship). Furthermore, the physician has an ethical and legal obligation not to neglect their patients (see Opinion 8.11, "Neglect of Patient").

However, there is also a long-standing ethical principle of evaluating the medical need of patients (for example in performing triage in an emergency room and seeing patients in order of medical need instead of on a first-come, first-serve basis). AMA Policy in such instances is described in general terms in Opinion 2.03, "Allocation of Limited Medical Resources".

Overall, physicians should try to communicate with their patients in a timely manner and should always try to return calls, but their failure to do so does not necessarily result in unethical conduct.

AMA policy in the Code of Medical Ethics permits that a reasonable fee be charged for copying medical records. This policy may be found in Opinion 7.02, "Records of Physicians: Information and Patients".

In addition, individual states may have regulations defining what a reasonable fee is. You should contact your state licensing board or medical society to find out what the regulations are in your particular state. Contact information of the licensing boards in all 50 states.

Opinion 7.02, "Records of Physicians: Information and Patients" states that providing a copy of the medical record "should not be withheld because of an unpaid bill for medical services."

Opinion 7.03, "Records of Physicians Upon Retirement or Departure from a Group" specifies that when a physician leaves a practice "…patients should be notified and urged to find a new physician and be informed that upon authorization, records will be sent to the new physician." When the physician is leaving a group, the patient "should also be notified of the physician’s new address and offered the opportunity to have their medical records forwarded to the departing physician at his or her new practice."

When a practice is being sold, Opinion 7.04, "Sale of a Medical Practice" recommends that patients should be notified, and the records should be transferred to another physician who will, upon written request, send copies to a physician of the patient’s choice.

In addition, individual states may have regulations pertaining to the transfer of medical records and the notification of patients. You can contact your state licensing board or medical society to find out what the regulations are in your particular state. Contact information of the licensing boards in all 50 states.

Opinion 7.05, "Retention of Medical Records" specifies that "[p]hysicians have an obligation to retain patient records which may reasonably be of value to a patient." Opinion 7.05 discusses a number of factors a physician should consider, but does not define a specific time, because this is a matter that is largely affected by state law. You should contact your state licensing board or medical society to find out what the regulations are in your state. Contact information of the licensing boards in all 50 states.

The general AMA policy on billing is Opinion 6.05, "Fees for Medical Services." This Opinion does not specifically address whether a physician might refuse to see a patient due to an unpaid bill. However, Opinion 8.11, "Neglect of Patient" states, "Once having undertaken a case, the physician should not neglect the patient." Refusing to see a patient might be considered neglect, unless the physician appropriately terminated the patient-physician relationship. Opinion 8.115, "Termination of the Patient-Physician Relationship" states that the physician should provide "notice to the patient, the relatives, or responsible friends sufficiently long in advance of withdrawal to permit another medical attendant to be secured."

In addition, there may be specific regulations in your state that pertain to unpaid bills or the termination of the patient-physician relationship. You should contact your state licensing board or medical society to find out what the regulations are in your state. Contact information of the licensing boards in all 50 states.

Opinion 6.05, "Fees for Medical Services" states, "A physician should not charge or collect an illegal or excessive fee." If you feel your physician is charging an illegal or excessive fee, you may want to find out from the appropriate specialty society what appropriate fees are, and then consider discussing the fee with your physician.

Health care coverage can depend on many things, including your employer, what state you work in, and what type of health insurance plan you are enrolled in. For further help with your plan, we recommend that you contact America’s Health Insurance Plans (AHIP).

In general, the AMA Code of Medical Ethics states that physicians are free to choose whom to serve (see Principles of Medical Ethics, Principle VI), but that "physicians have an obligation to support continuity of care for their patients" (Opinion 8.115, "Termination of the Patient-Physician Relationship"). Once a patient-physician relationship has been established, the physician should not neglect a patient (see Opinion 8.11, "Neglect of Patient"). Opinion 8.115 provides guidance on how physicians should proceed in circumstances when it is necessary to terminate the patient-physician relationship.

Physicians and patients wanting to know more about the appropriate mechanism for terminating a patient-physician relationship should also determine if there are any applicable laws pertaining to the amount of notice required, documentation, etc. You should contact your state licensing board or medical society to find out what the regulations are in your state. Contact information of the licensing boards in all 50 states.

Opinion 10.05, "Potential Patients" defines circumstances in which a physician may ethically decline to accept specific patients before a patient-physician relationship has been established.

The AMA has a service known as DoctorFinder, which can be used to search for physicians by name, location, or specialty.

At its December 2001 Meeting, the AMA House of Delegates adopted the "Declaration of Professional Responsibility: Medicine’s Social Contract with Humanity," a public reaffirmation of physicians’ dedication to the ideals and obligations of the profession. These ideals and obligations transcend physician roles and specialties, professional associations, geographic boundaries and political differences, uniting all physicians in a community of service to humankind.

E-Force is a program fostered by the AMA’s Institute for Ethics to identify and promote ethical expectations for all participants in health care; to develop valid and reliable measures of achievement of ethical expectations; and to encourage the widespread adoption and use of these expectations and measures.

• The AMA Code of Medical Ethics and other AMA policies, are one helpful resource for doing research on topics in ethics or in medicine in general.
• PubMed, a free service provided through the National Library of Medicine, allows you to search MEDLINE, which is a reference of many publications in the medical and bioethics literature.
  

Please call (312) 464-4823 and ask to speak with a staff member from the Council on Ethical and Judicial Affairs