Responsibility as an Ordering Physician

[Healthfan]

What is the name of your state (only U.S. law)? Nevada
My company routinely orders labs on patients I've never seen, and often never see.
1. Is this legal?
2. What is my responsibility?

 

[quincy]

What is the name of your state (only U.S. law)? Nevada
My company routinely orders labs on patients I've never seen, and often never see.
1. Is this legal?
2. What is my responsibility?

With the limited amount of information you have provided, there is no way to answer either of your questions. Would you like to expand?

 

[Proserpina]

Indeed - more info is needed.

But here's a real-world scenario: it's not uncommon for a PA to physically order the labs, despite me not speaking directly to my physician.

 

[Just Blue]

What is the name of your state (only U.S. law)? Nevada
My company routinely orders labs on patients I've never seen, and often never see.
1. Is this legal?
2. What is my responsibility?

Don't you have an attorney you could ask??

 

[quincy]

Don't you have an attorney you could ask??

I would think that the AMA Rules of Professional Conduct and the AMA Code of Ethics deal with this issue sufficiently, too. I think that most physicians would not need to seek an answer to these types of questions on an advice forum.

 

[Proserpina]

I would think that the AMA Rules of Professional Conduct and the AMA Code of Ethics deal with this issue sufficiently, too. I think that most physicians would not need to seek an answer to these types of questions on an advice forum.

Well, one would hope...

 

[Healthfan]

To further expand

What is the name of your state (only U.S. law)? Nevada
My company routinely orders labs on patients I've never seen, and often never see.
1. Is this legal?
2. What is my responsibility?

I've been practicing medicine for two decades, just a few months at a new company. This company appears to have set up protocols where scheduled patients, not yet seen, are routinely ordered labs, I don't know who is doing this, and my name is put on as the ordering physician. I receive the results, before I see the patient, and many times I never see the patient -- they cancel, reschedule, etc. When I was in medical school (yes, over 2 decades ago) and in every outfit I have worked for since -- until this outfit, I ordered the labs on patients -- not someone else (possibly a computer program?). I do not agree with reviewing labs and having to act on them without ever seeing a patient or have a patient history.

Don't get me started on the AMA; compare our healthcare to other countries and then ask "Who is to blame?" AMA is certainly part of the equation.

 

[Proserpina]

I've been practicing medicine for two decades, just a few months at a new company. This company appears to have set up protocols where scheduled patients, not yet seen, are routinely ordered labs, I don't know who is doing this, and my name is put on as the ordering physician. I receive the results, before I see the patient, and many times I never see the patient -- they cancel, reschedule, etc. When I was in medical school (yes, over 2 decades ago) and in every outfit I have worked for since -- until this outfit, I ordered the labs on patients -- not someone else (possibly a computer program?). I do not agree with reviewing labs and having to act on them without ever seeing a patient or have a patient history.

Don't get me started on the AMA; compare our healthcare to other countries and then ask "Who is to blame?" AMA is certainly part of the equation.

I agree that this is more serious than I thought.

You should be concerned - if nothing else, your name will be attached to any wrongdoing.

 

[ecmst12]

That seems like a good way to run things, saves the patient from having to make an extra visit to go over lab results. Perhaps you should ask your company about who decides what labs to order using what criteria.

 

[Dave1952]

If I'm following this, the OP is required by his employer to issue a standing order for labs (routine chem and blood?) prior to seeing the patient. This is not uncommon in clinical trials. I don't understand his concern. Perhaps he is referring to more invasive test though.
If the OP is uncomfortable he may wish to discuss this with a lawyer. And, of course, he can resign.

 

[Proserpina]

If I'm following this, the OP is required by his employer to issue a standing order for labs (routine chem and blood?) prior to seeing the patient. This is not uncommon in clinical trials. I don't understand his concern. Perhaps he is referring to more invasive test though.
If the OP is uncomfortable he may wish to discuss this with a lawyer. And, of course, he can resign.

Bit of a difference between clinical trials and OP's concern, don't you think?

Certainly in Phase III/IV anyway.

 

[You Are Guilty]

I can tell you that from a med mal perspective, should any of those labs indicate a problem and you didn't see/examine and tell the patient about them, your name goes to the top of the list of defendants that get sued.

Is there some sort of State Medical Ethics hotline you can contact?

 

[justalayman]

I would start with looking into your contract with this company. Does it allow for some entity other than yourself to order tests using your name? If so, maybe something should be done about that but above all else, it would show you had not read your contract thoroughly. I would think that you would have the right to control how your name is used in ordering any tests. If the company chooses to order tests as some standard protocol, then they need to find a way to do so without using a doctor's name that has no reason to order the tests.

It would be interesting to see who is determining what tests are ordered and how they come to the conclusion of what tests to order without the patient ever being seen.

especially given the concern and control of the insurance companies today, I would think ordering tests based on a patients general complaint, prior to even being seen by the treating physician would be a problem with them at least.

 

[betachains]

OP, This is not really a legal forum, and certainly not for the specialized area in which you are concerned.

From a clinical point of view, I think you would agree that some lab tests are just automatic. Yes, you as a physician will be responsible for follow-up, but if you are uncomfortable with the setup then you should look into other practices.

Of course you should have input into the criteria for these tests, but I don't see it much different from PA's testing and prescribing under your authority without your case-by-case approval.