experiences that influence patient behavior. Regardless of cause, when a patient’s behavior threatens the safety of health care personnel or other patients, steps should be taken to de-escalate or remove the threat. (d) Prioritize the goals of care when deciding whether to decline or accommodate a patient’s request for an alternative physician. Physicians should recognize that some requests for a concordant physician may be clinically useful or promote improved outcomes. (e) Within the limits of ethics guidance, trainees should not be expected to forgo valuable learning opportunities solely to accommodate prejudiced requests. (f) Make patients aware that they are able to seek care from other sources if they persist in opposing treatment from the physician assigned. If patients require immediate care, inform them that, unless they exercise their right to leave, care will be provided by appropriately qualified staff independent of their expressed preference. (g) Terminate the patient-physician relationship only when the patient will not modify disrespectful, derogatory or prejudiced behavior that is within the patient’s control, in keeping with ethics guidance. Physicians, especially those in leadership roles, should encourage the institutions with which they are affiliated to: (h) Be mindful of the messages the institution conveys within and outside its walls by how it responds to prejudiced behavior by patients. (i) Educate staff, patients, and the community about the institution’s expectations for behavior. (j) Promote a safe and respectful working environment and formally set clear expectations for how disrespectful, derogatory, or prejudiced behavior by patients will be managed. (k) Clearly and openly support physicians, trainees, and facility personnel who experience prejudiced behavior and discrimination by patients, including allowing physicians, trainees, and facility personnel to decline to care for those patients, without penalty, who have exhibited discriminatory behavior specifically toward them. (l) Collect data regarding incidents of discrimination by patients and their effects on physicians and facility personnel on an ongoing basis and seek to improve how incidents are addressed to better meet the needs of patients, physicians, other facility personnel, and the community. AMA Principles of Medical Ethics: I,II,VI,IX 1.2.3 Consultation, Referral, and Second Opinions Physicians’ fiduciary obligation to promote patients’ best interests and welfare can include consulting other physicians for advice in the care of the patient or referring patients to other professionals to provide care. When physicians seek or provide consultation about a patient’s care or refer a patient for health care services, including diagnostic laboratory services, they should: (a) Base the decision or recommendation on the patient’s medical needs, as they would for any treatment recommendation, and consult or refer the patient to only health care professionals who have appropriate knowledge and skills and are licensed to provide the services needed. (b) Share patients’ health information in keeping with ethics guidance on confidentiality. (c) Assure the patient that he or she may seek a second opinion or choose someone else to provide a recommended consultation or service. Physicians should urge patients to familiarize themselves with any restrictions associated with their individual health plan that may bear on their decision, such as additional out-of-pocket costs to the patient for referrals or care outside a designated panel of providers. (d) Explain the rationale for the consultation, opinion, or findings and recommendations clearly to the patient. (e) Respect the terms of any contractual relationshipsthey may have with health care organizations or payers that affect referrals and consultation. Physicians may not terminate a patient-physician relationship solely because the patient seeks recommendations or care from a health care professional whom the physician has not recommended. AMA Principles of Medical Ethics: IV,V,VI 1.2.4 Use of Chaperones Efforts to provide a comfortable and considerate atmosphere for the patient and the physician are part of respecting patients’ dignity. These efforts may include providing appropriate gowns, private facilities for undressing, sensitive use of draping, and clearly explaining various components of the physical examination. They also include having chaperones available. Having chaperones present can also help prevent misunderstandings between patient and physician. Physicians should: (a) Adopt a policy that patients are free to request a chaperone and ensure that the policy is communicated to patients. (b) Always honor a patient’s request to have a chaperone. (c) Have an authorized member of the health care team serve as a chaperone. Physicians should establish clear expectations that chaperones will uphold professional standards of privacy and confidentiality. (d) In general, use a chaperone even when a patient’strusted companion is present. (e) Provide opportunity for private conversation with the patient without the chaperone present. Physicians should minimize inquiries or history taking of a sensitive nature during a chaperoned examination. AMA Principles of Medical Ethics: I,IV 1.2.5 Sports Medicine Many professional and amateur athletic activities, including contact sports, can put