THE PRACTICE OF MEDICINE

July 21, 2011

What is the practice of medicine?

Is a privilege or franchise granted by the state to any person to

perform medical acts upon compliance with law.

The law referred to is the Medical

Act of 1959.
The practice of medicine consists of judging the nature, character and
symptoms of a disease , in determining the proper remedy to the disease.
The practice of medicine means the diagnosis and application and the use of
medicine and drugs for curing, mitigating or relieving bodily disease or
conditions.

ACTS CONSITITUTING THE PRACTICE OF MEDICINE

1.Who shall, For compensation fee, salary or reward in any form paid to him
directly or indirectly or through another, or even without the same, physically
examine any person and diagnose, treat, operate or prescribe any remedy for
human disease, injury, deformity, mental or physical condition or any ailment,
real or imaginary, regardless of the nature of remedy or treatment
administered, prescribed or recommended.
From the first provision:

Physically examine a person and diagnose

Physically examine a person and treat
Physically examine a person and operate
Physically examine a person and prescribe any remedy.

Provided that the above mentioned acts are performed, the following do not
affect the act as to the practice of medicine:

Regardless of the nature of the remedy or treatment administered.

MEDICAL DIAGNOSIS - is the art of balancing probabilities.

DIAGNOSIS - is a mental process whereby one or more persons
appraise a situation and make a decision based on their judgment, that may
or may not lead to action.
TREATMENT all steps taken to effect a cure of an injury or disease.
OPERATION - is an act or succession of acts performed upon the body
of a patient for his relief or restoration of normal condition. Either by
manipulation or the use of surgical instruments or both.
PRESCRIPTION is a direction of remedy or remedies for a disease and
the manner of using them; a formula for the preparation of a drug and a
medicine.

ACTS CONSTITUTING THE PRACTICE OF MEDICINE

2. Who shall by means of signs, cards, advertisement, written or

printed matter, or through the radio, television or any other means of
communication, either offer or undertake by any means or method to
diagnose, treat ,operate , or prescribe any remedy for any human disease,
injury, deformity, physical mental or psychical condition.

The purpose of this 2nd provision is to protect the people who through deceptive
advertisement or machination may be able to induce them to be under the
medical service of one who is not in a capacity to do so.
ACTS CONSTITUTING THE PRACTICE OF MEDICINE:

Only NATURAL person can practice medicine.

( starts at birth an ends at death ).
CLASSIFICATION OF MEDICAL PRATICE
1. As to the scope of practice:
General
Specialist
2. As to the venue of practice:
Clinic
Hospital
3. As to number :
a. individual
b. group
PHYSCIAN

Whether or not the act was done with or without compensation.

DEFINITION OF TERMS:

WHO ARE QUALIFIED TO PRACTICE MEDICINE IN THE PHILIPPINES?

1. Those who complied with the prerequisites to the practice of medicine in
accordance with the medical act.
2. Those who can have limited practice without any certificate of registration.
3. Balikbayan physicians P.D 541 allowing former Filipino Professionals to practice
their respective professions in the Philippines.
4. Those foreign physicians qualified to practice by reciprocity or by endorsement.
5. Limited practitioners of healing art.
6. Medical Students renders service under the direct supervision and control of
registered physician without any compensation.

C. Who shall use the title of M.D after his name.

Licensed Physician
License to practice medicine
One who has received a degree from an institution and one that is
lawfully engaged in the practice of medicine.
WHO definition:
- is a person who after completing his secondary education follows a
prescribed course of medicine at a recognized university or medical school.

PENALTIES OF ILLEGAL PRACTICE:

A. CIVIL LIABILITIES :
- there is a wrongful act of a physician.
- a civil suit is filed against physicians and/or hospitals is premised on
recovery of damages for their wrongful act or of the employees.
B. CRIMINAL LIABILITIES:
- when the act or omission of a physician constitute a crime, which may be
done with deliberate intent or on account of imprudence, negligence, lack of
foresight or lack of skills.
-proof beyond reasonable doubt.
C. ADMINISTRATIVE LIABILITIES

Penalty imposable is reprimand or suspension or revocation of license

File at Professional Regulations Commission

HIPPOCRATIC OATH

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose
steps I walk, and gladly share such knowledge as is mine with those who are
to follow.

I will apply, for the benefit of the sick, all measures [that] are required,
avoiding those twin traps of over-treatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and

that warmth, sympathy, and understanding may outweigh the surgeon's knife
or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my
colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not
disclosed to me that the world may know. Most especially must I tread with
care in matters of life and death. If it is given me to save a life, all thanks. But

it may also be within my power to take a life; this awesome responsibility

must be faced with great humbleness and awareness of my own frailty.
Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth,

but a sick human being, whose illness may affect the person's family and
economic stability. My responsibility includes these related problems, if I am
to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to

cure.

I will remember that I remain a member of society, with special

obligations to all my fellow human beings, those sound of mind and body as
well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I
live and remembered with affection thereafter. May I always act so as to
preserve the finest traditions of my calling and may I long experience the joy
of healing those who seek my help.

PHYSICIAN-PATIENT RELATIONSHIP
July 21, 2011
PHYSICIAN-PATIENT RELATIONSHIP

Relationship of Doctor and patient is CONTRACTUAL.

Contract- is the meeting of minds between two persons whereby one
binds himself with respect to the other, to give something or to render
some service.

Nature of Relationship:

It is CONSENSUAL it is based on mutual consent of both the physician

and then patient.

It is FIDUCIARY the contractual relation is based on mutual trust and

confidence in one another.

Requisites of a Contractual Relationship:

Casual question asked of physician in an unordinary case such as social

gathering or party.

Psychological Patterns of Physician-Patient Relations:

ACTIVITY-PASSIVITY RELATION:
- no interaction between doctor and patient.
- patient is unable to contribute to the activity.
- seen in an emergency situation
( unconscious patient )
GUIDANCE COOPERATION RELATION:
- patient is conscious.
- he is ready and willing to cooperate.
- Physician is in a position of trust.
MUTUAL PARTICIPATION RELATION:
- patient thinks he is equal to the doctor.
- Physician feels that the patient is uncooperative.
- Patient feels that Physician is unsympathetic and lacks understanding.
Specific type of Medical Service which the patient may solicit from his physician:

To perform specific tests or examination.

To examine the patient, diagnose his condition and give him

emergency treatment only.

To examine the patient, diagnose his conditions and treat him as to

only one or more, but not all conditions affecting him without followup care.

To9 examine the patient, diagnose his condition and treat him as to
only one or more but not all conditions affecting him and with followup care.

To examine the patient, diagnose his condition and treat him fully
,giving him full follow-up care.

There must be consent of the contracting parties:

- manifested by the meeting of the offer and the acceptance upon the thing and
the cause which are to constitute a contract.
- must be voluntary

Relation between pathologist performing an autopsy.

To examine patient and inform him of the state of health.

To examine the patient, diagnose the condition, inform him of it and
recommend the appropriate remedy, without giving any treatment.

Duties and obligations imposed on the physician to the physician-patient

relationship:

He should possess the knowledge and skill of which an average

physician is expected.

There must be cause or consideration:

- this is the factor that instigated the physician to render medical service.

He should use such knowledge and skill with ordinary care and
diligence.

There must be an object which is the subject matter of the contract.

- object or subject matter is medical service.

He is obliged to exercise the best judgment.

Requisites.

Forms of Physician-Patient Relationship:

EXPRESSED CONTRACT :
- when the nature and extent of the medical service to be rendered by the
physician and the renumeration to be given by the patient is explicitly stated
orally or in writing.

IMPLIED CONTRACT:
- agreement inferred by LAW as matter of reason and justice for their acts or
conduct, the circumstances surrounding their transaction, or even a necessary
assumption that a contract existed between them by a tacit understanding.
- the existence of a contract can be inferred from the acts of the contracting
parties.
Instances when there is no physician-patient relationship by decisions of Courts:

Pre-employment physical examination

Physical exam. for the purpose of eligibility for insurance.
When physician is appointed by the trial court to examined the
accused and to report whether he was insane or not.

He has the duty to observe utmost good faith.

Terms which are not included in Physician-Patient relationship

It does not imply any promise or guaranty by the physician that the
treatment will be successful.

It does not imply any promise or guaranty that the treatment will
benefit the patient.

It does not imply or guaranty that the treatment will produce certain
result.

It does not promise that the physician will not commit errors in an
honest way.

Duties and Obligations Imposed on the Patient in the course of the PhysicianPatient Relationship

The patient must give an honest medical history of the illness.

Even if the patient has to submit to painful management he will
cooperate and follow the instructions,orders and suggestions of the
physicians.

He must inform the physician of that occurred in the course of the

treatment so that the latter may know effect of treatment he is giving.

If he is given the necessary instructions, he must state whether he

understands the contemplated course of action and the things
expected of him

The patient must exercise the prudence to be expected of an ordinary

patient under the same circumstances. In other words, he cannot act
as if he was stranger to his own problem.

Commencement of the Physician-Patient Relationship

Very important to know is the determination of the establishment of

physician-patient relationship

Termination of Physician-Patient Relationship

Recovery of patient from the condition for which he was receiving

treatment or when the physician considers that his further services will
no longer be beneficial to the patient.

Withdrawal of the physician

Expiration of period, if the contract of medical service is for a specific

period.

Mutual agreement between the physician and patient that the

physician-patient relationship is terminated.

Discharge of the physician by the patient.

Death of the patient.
Death or incapacity of physician.
Fulfillment of the obligations stipulated in the contract.
In case of emergency, when the attending physician or physician of
choice of the patient is already available, or whenever there is
cessation of condition of emergency.