Chapter 14: Primary Care Provider’s Responsibility in Cancer Care

INTRODUCTION

Family physicians are the medical practitioners who are specially trained to provide health care to all individuals regardless of age, sex, or type of health problem. They provide primary and continued care for the whole family in their communities. They tend to physical, psychological, and social problems as well as coordinate comprehensive health care with other specialties as needed. They are also known as a family physicians or generalists in different countries.¹

According to the National Cancer Institute’s Dictionary of Cancer Terms, a primary care doctor is one who manages a person’s health over time. A primary care doctor is capable of providing a wide range of care, including prevention and treatment. This can include discussion of treatment options for cancer and referral of patients to specialists.²

Family medicine is the medical specialty concerned with providing comprehensive care to individuals and families, integrating biomedical, behavioral, and social sciences. It is an academic medical discipline that includes comprehensive systems of health care, education, and research.²

Current patient care has evolved greatly. With constant changes in the provision of medical services and medical care and the increase in intermediaries, the primary care of the patient does not fall solely on doctors (allopathic or osteopathic doctors). The term provider is now applied to individuals providing such care and, hence, its use in the chapter’s title. These denominated “mid-level providers” are now partly responsible for providing primary care. Changes in the practice of medicine have also contributed to the increase in participation of mid-level providers in the system. Among these changes are the prominent part of paying intermediaries of health service, the increase in shortages in certain geographical areas of primary care physicians, and changes in delivery of medical care. The mid-level practitioner has been more and more present, out of necessity in some cases and for economic considerations in others, taking a prominent or principal role in the delivery of primary care to patients in our society. These mid-level practitioners include nurse practitioners (certified advanced registered nurse practitioners [ARNP-C]) and physician assistants (PAs). Depending on jurisdiction, these health care professionals have more or less autonomy when it comes to providing primary medical care, either supervised or unsupervised. As a result, they can be solely responsible for the primary care of patients. In this chapter, we will outline how this provider-patient relationship evolves into a professional responsibility of the physician/provider from a legal point of view. We will try to focus on the responsibility of the physician, from the point of view of a traditional and increasingly less frequent service delivery model that is directed by physicians. We will use the word provider except when discussing vicarious responsibility and the agent model, where the mid-level practitioners (ARNP or PA) are employees of a physician or medical group.

We will mainly focus on situations in which the primary physician is exposed ...