A Letter You Never Want to Receive
You've received a letter from your state medical board, and you read that a patient has filed a complaint against you. You're sure the complaint is groundless, and you're furious that the patient went to the board instead of bringing his concerns to you.
How you respond -- or fail to respond -- to that initial letter can make a huge difference in the outcome of your case.
There are several approaches to medical board investigations that experts agree can determine whether a complaint is dismissed or is just the beginning of an ordeal that can go well beyond the initial charge.
To be sure, the numbers of physicians who are disciplined by a state medical board are small. The Federation of State Medical Boards (FSMB) told Medscape that of 878,194 actively licensed physicians nationwide in 2012, a total of 4479 (fewer than 1%) were disciplined. Still, the consequences of such action are substantial and may involve loss of licensure, livelihood, and profession.
Which Behaviors Can Result in Discipline?
Each state board specifies the infringements it monitors, so it's wise to check with the board in the states in which you are licensed. Complaints involve both clinical and nonclinical actions, and can range from billing matters to criminal conduct. According to Brian Zachariah, MD, Chief Medical Coordinator at the Illinois Department of Financial and Professional Regulation (IDFPR) in Chicago, complaints about "bad doctoring" are far fewer than for unprofessional conduct, such as informed consent, confidentiality, and billing issues. "I don't think a lot of doctors understand that," he says.
The advent of emails and social media has spawned a new source of complaints. Ofer Zur, PhD, a psychologist based in Sonoma, California, and author of "When the Board Comes Knocking: How to Respond to a Licensing Board Investigation and Protect Your License, Professional Career, and Livelihood," speaks of the "Wild West of the digital age."
"A patient gave a bad Yelp review, and the doctor responded emotionally, saying the patient was mentally ill," Zur recalls. "The medical board asked, 'Did you violate the patient's confidentiality?' The answer was 'Yes.' This case is pending; we don't have outcomes yet, but these cases are a moving target."
State boards' responses to issues of "online professionalism" were explored in a study that used hypothetical vignettes to determine what areas were of greatest concern. The investigators found a high consensus that an investigation was "likely" or "very likely" if a doctor cited misleading information about clinical outcomes, used patient images without consent, misrepresented his or her credentials, or inappropriately contacted patients.
The study authors suggested these were "online behaviors" that physicians should never do. They also described "gray areas," such as violating a patient's confidentiality; using derogatory speech toward patients; showing alcohol use, with or without intoxication; and providing clinical narratives that didn't violate a patient's confidentiality.
With greater awareness of these "gray areas," the investigators suggested, physicians could reduce their risk of being investigated and improve their online professionalism.
Another area that is receiving broad scrutiny involves prescribing pain medication.
"This is a very critical area, and there's a lot of pressure on boards," says Lisa A. Robin, Chief Advocacy Officer at FSMB. "The best thing the physician can do is document evidence of his judgment, thinking, and intent to provide good care -- and that he or she actually saw the patient."
Regardless of the complaint or its source, if you receive that letter from your state board, here are things that are practically guaranteed to make matters worse.
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Cite this: 4 Things Not to Do at a Medical Board Hearing - Medscape - Mar 13, 2014.