Medical Misconduct, Part II: Preventing an Incident

Respected internist, Dr. Larry Peterson,* evaluated an elderly woman with cough, dyspnea, fever, and wheezing on a hectic Monday. Peterson thought she had pneumonia, administered bronchodilators, steroids, and antibiotics, and wanted immediate blood work and a chest x-ray. “Doctor,” the patient said, “I don’t want these tests. I’ll be fine with your medicines.” Peterson advised her to return Wednesday. Tuesday night, the emergency department called, informing Peterson this woman presented with massive pulmonary embolus, and died. Peterson felt terrible, but felt worse when the case catapulted him into a misconduct investigation. His records didn’t indicate he’d ordered tests, the patient’s refusal, or his intent to re-evaluate.

*Names and details changed.

Physicians claiming they’ve never made a mistake are either lying or haven’t been practicing very long.

Sometimes bad things happen to good doctors. How might physicians elude professional misconduct? Study your state’s medical board Web site. You’ll get some ideas for avoiding similar pitfalls.

While definitions of misconduct vary from state to state, subdivisions fall under the following categories:

• Violation of infection control practices

If you’re presented with a tenuous situation, always remember and be guided by the reason you became a doctor—your calling to help others. As for the fate of Dr. Peterson: The medical board issued Dr. Peterson a warning letter. But long before the letter arrived, he consciously documented patients’ refusals, his recommendations, and instituted a system to ensure follow-up on patients’ test results.

The Ten Commandments of Professional Medical Conduct

I. Thou shalt respect the nobility of thy profession, nurturing thy physical and mental fitness to care for others. You’re fortunate to possess knowledge and skill of healing arts, but despite what Aunt Martha thinks, you’re not perfect. Fatigue and unattended physical ailments affect judgment, tempting you to cut corners, clinically and ethically, which are potential pathways to trouble. Care for yourself, be it stress testing or anger management.

II. Thou shalt honor sanctity of thy prescription pad and Drug Enforcement Agency number. It seems unkind not to attend to your ill employee. But examine her and maintain proper records. This includes your family. Don’t offer narcotics to prostitutes or patients in exchange for sex. For being smart people, doctors sometimes do really dumb stuff.

III. Thou shalt document all you do, and do all you document. Rather than thinking of documentation as a chore, regard it as awarding yourself tangible credit. Documentation issues catapult doctors into misconduct messes faster than a ruptured aorta. Break habits of rote documentation. Investigators figure the nursing home patient with a fractured femur didn’t really have Romberg testing.

IV. Thou shalt inform thyself and honor all laws and regulations pertaining to thy practice. Not knowing state laws creates problems. Housekeeping chores pertaining to license paperwork or provision of requested patient records could springboard investigation.

V. Thou shalt not covet illegal or mind-altering substances. You needn’t be on drugs or drunk while practicing for misconduct charges to adhere. Seek help, now. Medical boards protect patient safety, but respect proactive physicians initiating substance abuse treatment more than doctors they drag away from practice.

VI. Thou shalt strive to maintain a high standard of care. Listen to your patients and treat them with respect. Perform thorough exams, look things up, obtain consultations, get the extra test, and follow up on studies you’ve ordered. Do these even when you’re busy, tired, and cranky.

VII. Thou shalt not covet thy neighbor’s wife, especially if she’s one of thy patients. Few earache patients require pelvic exams. Hippocrates cautioned against “seduction and especially from the pleasures of love with women or with men.” Ask yourself whether you’d rather concede to lust or lose your license and income-earning potential, in which case, a temptress might lose interest in you. Get help immediately. Use a chaperone.

VIII. Thou shalt not steal, be it billing, claims, advertising, or other fraudulent practices. Don’t bill for procedures you didn’t perform or order unnecessary testing. Ensure billing is substantiated by medical records. Never fabricate patient visits.

IX. Thou shalt not bear false witness under professional circumstances. Never get caught in professional lies. Maintain good relationships with patients and families. If something goes wrong, be honest. Never lie on applications to hospitals or insurance companies. Don’t alter medical records without dating and initialing them. You never know who’s gotten prior copies before asking for yours.

X. Thou shalt not covet, as professional greed may be thy downfall. Doctors will never attain the net worth of Bill Gates, Oprah, or the attorney who might buy another Porsche with the $50,000 to $100,000 they would earn defending you when you couldn’t resist getting involved in get-rich-quick schemes.

J. Thalia Cunningham, MD, FACEP, works with New York’s Office of Professional Medical Conduct and practices emergency medicine. She welcomes questions or comments at thalia@nycap.rr.com.