Insights From Wapiti

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Hidden Perils to Practice Boundaries

Adapted from Mag Mutual article: Attorney Viewpoint: Traps for the Unwary Physician

By: Susan J. Levy, Esq., Levy Pruett Cullen

The practice of medicine continues to change, and many well-intentioned acts by physicians may violate state medical board rules. It is vital for healthcare providers to follow state board guidance on patient-physician relationships to avoid investigations and potential sanctions.  For instance, it is key to maintain complete medical records, including history and physicals, progress notes, and lab reports, impart and maintain proper boundaries with patients, and read your state’s board rules to properly follow treatment protocol and limit the scope of patient relationships.

Today, a physician who prescribes medication for a friend or neighbor in need, with good intentions but without properly examining the patient, creating a chart, and formally documenting the evaluation and treatment of the patient may end up in my law office having to defend that decision to the medical board.

Say, for example, you’re an emergency medicine provider and you prescribe Ambien for your buddy at the gym who has struggled with insomnia. By doing so, you risk a visit from a state investigator and possible discipline by the licensing board, which could include probation, suspension, or revocation depending on the seriousness of the alleged violation. Even if your state board ultimately decides not to issue sanctions, the process can be stressful.  All it takes is one disgruntled patient, co-worker, or friend to file a complaint on the state medical board’s website and an investigation will ensue.

Another potential trap for the unwary physician lies in maintaining proper boundaries with patients. Even little things like favoring a VIP patient, forming a business with a patient, or dating a former patient can be a violation. As referenced in the AMA Journal of Ethics, any motive not related to the patient’s care radically disrupts professional objectivity and trust in the profession. The listed examples above are all boundary crossings that could rise to the level of a violation, risking discipline from a state board.

Physician conduct constituting a boundary violation may generally be categorized as “unprofessional” or “unethical” conduct in your state’s medical board rules, and whether such conduct ultimately threatens your license to practice medicine depends on the particular details of the violation as well as the state in which you practice.

Very few physicians set out to violate their board rules. Most often, they did not know the rule, did not think their conduct was a big deal, or simply made a mistake. Knowledge is, in fact, power. Read your state’s board rules – they are almost all available and easy to find on the board’s website. If not, Google them. Another adage to keep in mind is “when in doubt, don’t,” at least not before reading the rules or consulting a lawyer who has.