Abstract
This fiducial role implies special duties imposed where one person (the fiduciary) must act in the best interest of the other (the beneficiary), even if it is in the fiduciary's detriment to do so.
While a doctor/patient relationship is not generally a fiduciary relationship, part of the relationship may involve a fiduciary role for the surgeon.
The fiduciary duties include:
Keeping a patient's medical information confidential.
Open disclosure of surgical error.
Notification of an emergent medical risk to the patient.
Avoiding gifts from patients not freely given.
Avoiding conflict of interest in implant selection.
Disclosing financial involvement with healthcare facility.
Candour when a known risk has materialised. E.g. implant failure.
Share crucial information with patients to mitigate potential harm.
Follow up until the treatment period is over with relevant information.
Limit therapeutic privilege as grounds for non-disclosure.
Follow the Association's guidelines on product endorsement.
New procedures may require ethics approved clinical trials.
Avoid personal relationships with patients.
While the doctor–patient relationship requires a duty of care, a fiduciary duty implies a duty of loyalty and honesty. As per using navigation techniques in hip and knee surgery, the surgeon can use the above fiducials (markers) to navigate his way through his fiduciary role in managing patients; whether it is disclosing emergent risks arising during treatment, with new products or during clinical trials.
Fiduciary roles are independent of informed consent, which occurs before the event, but mitigate a risk that occurs after the event. It is an inbuilt quality assurance mechanism in risk management.
