A physician cannot have a sexual relationship with a patient that they are currently treating. While most physicians will say that they see the “clear line in the sand” when it comes to the prohibition against having a sexual relationship with a patient, they often don’t see the other boundary violations they may be committing. It is also a boundary violation to engage in a financial relationship with a patient or to prescribe a medication to a friend or employee without conducting a physical examination or maintaining a patient record. Professional boundaries are blurred in many ways aside from the obvious prohibition against sexual involvement with a patient.
It is important to keep in mind what role you play as a physician. If you have a doctor-patient relationship with a person, you should not employ that person in your practice, loan them money, enter into financial arrangements with them, agree to pick medications up for them at the pharmacy, agree to treat them privately for “free off the books” because they do not have insurance or for any other reason. You need to treat all persons to whom you provide medical care to the same. While you may have sympathy for a patient who does not have insurance or may not be able to get an appointment with their “regular treating doctor”, if you elect to treat someone as a patient, you must follow the accepted standards of care for such treatment.
There is no prohibition from a physician treating an employee of their practice. However, the employee needs to be treated exactly like every other patient in the practice. They need to be physically examined and a patient chart needs to be maintained for any treatment or prescribing that is done for the patient. They need to be referred out for consultation or sent for followup tests or evaluations. Their chart should also include the same history, physical and background information that you would include for any patient.
When treating friends or employees, physicians will often fail to maintain a patient record or fail to accurately record the examination and treatment that they provided to the patient. Any written record is better than no written record, however, you should prepare a written medical record for this friend/patient as you would for any other patient in your practice.
Too often, physicians allow themselves to be “cornered” by a neighbor to call them in a prescription over the weekend and then they fail to take the appropriate steps to examine the patient and document their treatment. I have also seen physicians who have agreed to treat a patient for free and then not maintain any medical record for the patient. They have told me “I wasn’t billing insurance, so I did not create a record”. This is inappropriate. You may subject yourself to disciplinary action by the State Medical Board of Ohio if you do not maintain medical records when you treat a patient. It doesn’t matter if you are not billing insurance for your service. If you provide medical care to a patient, you need to have a medical record showing what treatment you provided.
Know what hat you are wearing. It is never a good idea to have multiple relationships with patients. However, if you choose to treat a friend or an employee, you still need to practice above the standard of care, which dictates that you record a history and physical and document the treatment you provided to the patient.
As always, if you have any questions about this post or the State Medical Board of Ohio in general, feel free check out my website at www.collislaw.com or email me at beth@collislaw.com or call me at (614) 486-3909.
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