refer, the physician should offer impartial guidance to patients about how to inform themselves regarding access to desired services. (g) Continue to provide other ongoing care for the patient or formally terminate the patientphysician relationship in keeping with ethics guidance. AMA Principles of Medical Ethics: I,II,IV,VI,VIII,IX 1.1.8 Required Reporting of Adverse Events Physicians’ primary ethical obligation to promote the well-being of individual patients encompasses an obligation to collaborate in a discharge plan that is safe for the patient. As advocates for their patients, physicians should resist any discharge requests that are likely to compromise a patient’s safety. The discharge plan should be developed without regard to socioeconomic status, immigration status, or other clinically irrelevant considerations. Physicians also have a long-standing obligation to be prudent stewards of the shared societal resources with which they are entrusted. That obligation may require physicians to balance advocating on behalf of an individual patient with recognizing the needs of other patients. To facilitate a patient’s safe discharge from an inpatient unit, physicians should: (a) Determine that the patient is medically stable and ready for discharge from the treating facility. (b) Collaborate with those health care professionals and others who can facilitate a patient discharge to establish that a plan is in place for medically needed care that considers the patient’s particular needs and preferences. (h) If a medically stable patient refuses discharge, physicians should support the patient’s right to seek further review, including consultation with an ethics committee or other appropriate institutional resource. AMA Principles of Medical Ethics: I,II,VIII 1.2.1 Treating Self or Family Treating oneself or a member of one’s own family poses several challenges for physicians, including concerns about professional objectivity, patient autonomy, and informed consent. When the patient is an immediate family member, the physician’s personal feelings may unduly influence his or her professional medical judgment. Or the physician may fail to probe sensitive areas when taking the medical history or to perform intimate parts of the physical examination. Physicians may feel obligated to provide care for family members despite feeling uncomfortable doing so. They may also be inclined to treat problems that are beyond their expertise or training. Similarly, patients may feel uncomfortable receiving care from a family member. A patient may be reluctant to disclose sensitive information or undergo an intimate examination when the physician is an immediate family member. This discomfort may particularly be the case when the patient is a minor child, who may not feel free to refuse care from a parent. In general, physicians should not treat themselves or members of their own families. However, it may be acceptable to do so in limited circumstances: (a) In emergency settings or isolated settings where there is no other qualified physician available. In such situations, physicians should not hesitate to treat themselves or family members until another physician becomes available. (b) For short-term, minor problems. When treating self or family members, physicians have a further responsibility to: (c) Document treatment or care provided and convey relevant information to the patient’s primary care physician. (d) Recognize that if tensions develop in the professional relationship with a family member, perhaps as a result of a negative medical outcome, such difficulties may be carried over into the family member’s personal relationship with the physician. (e) Avoid providing sensitive or intimate care especially for a minor patient who is uncomfortable being treated by a family member. (f) Recognize that family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician. AMA Principles of Medical Ethics: I,II,IV 1.2.2 Discrimination and Disruptive Behavior by Patients The relationship between patients and physicians is based on trust and should serve to promote patients’ well-being while respecting the dignity and rights of both patients and physicians. Disrespectful, derogatory, or prejudiced language or conduct, or prejudiced requests for accommodation of personal preferences on the part of either patients or physicians can undermine trust and compromise the integrity of the patient-physician relationship. It can make individuals who themselves experience (or are members of populations that have experienced) prejudice reluctant to seek care as patients or to provide care as health care professionals, and create an environment that strains relationships among patients, physicians, and the health care team. Trust can be established and maintained only when there is mutual respect. Therefore, in their interactions with patients, physicians should: (a) Recognize that disrespectful, derogatory, or prejudiced language or conduct can cause psychological harm to those who are targeted. (b) Always treat patients with compassion and respect. (c) Explore the reasons for which a patient behaves in disrespectful, derogatory, or prejudiced ways insofar as possible. Physicians should identify, appreciate, and address potentially treatable clinical conditions or personal