COMMENTARY

Do Physician 'Rules of Conduct' Extend to Physicians Working Outside of Medicine?

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Hello and welcome. I am Dr. George Lundberg, and this is At Large at Medscape.

For the vast majority of modern Americans who receive a medical degree, that degree confers not only a distinguished permanent label with lofty expectations, but also membership in a learned profession -- even a calling -- and opens the opportunity for a lifetime of privileged work applying that knowledge and skill. But for some, obtaining the MD is only one step, perhaps related or a prerequisite, or perhaps irrelevant to their primary future endeavors -- becoming a journalist or a politician, for example.

What rules of conduct govern the behavior of these "MDs"? The behavior of an American physician is guided by the ethics of medicine, and the laws that govern are those of the state that licenses the physician.

When a physician is not "practicing medicine," it can become tricky to determine the extent (if any) to which that person has a responsibility to behave in a manner that upholds the best traditions of the medical profession. Should the physician be expected to do so? If performance problems occur, should another yardstick, something like "professional moral turpitude," come into play? Should society's expectations of physician behavior consider context? Or should the more universal doctrine of caveat emptor apply to that physician’s other activities? Can a person who is known to be a physician ever take off "the physician hat" and don another hat with impunity or even with disregard of possessing the MD and a medical license?

Once a Doctor, Always a Doctor?

There are many examples of MDs who play roles outside of traditional medical practice. Should such deviations be considered concurrent dual careers, add-on hobbies, avocations, sequential careers, or what? You help me.

Is being an author a dual or subsequent career for Robin Cook or William Carlos Williams, or for composer Alexander Borodin, or politicians Rand Paul or John Kitzhaber, or for businessman Bill McGuire?

Is being a musician a hobby for members of the Longwood Symphony Orchestra (with a majority of members involved in the healthcare professions), or for comedian Steve Allen, or for famed lecturer William Harvey?

Did being a financier replace being a physician for Thomas Durant, or for executive Jim Madera, or for athlete Bobby Brown, or for explorer/astronaut Mae Jemison, or for investor Denton Cooley?

Was being a theologian simply an add-on to being a physician for Albert Schweitzer, a very different add-on for members of the Society of Physician Entrepreneurs, for real estate developer Tom Rockwell, and for actor Ken Jeong?

Then we have other categories, like radio and television personalities Nancy Snyderman and Drew Pinsky, and editors and columnists like many of us. Are we also still physicians and governed by those ethical and legal conventions?

Of course there are numerous other personal roles such as parent, sibling, daughter, spouse, grandparent.

How should we handle those omnipresent physician-like, often preposterous white-coated product endorsers? If they just play a doctor on TV, that is one thing. But what if they are actual MDs? To whom or what are they responsible?

I have sometimes been accused of excess idealism, even hyperethicism. And I do not know quite how to handle this conundrum.

What I do believe is that if a person with an MD uses that label to gain advantage over another in a power relationship or to gain a position of undue influence, that MD is obliged to follow the ethics and laws of medicine in that representation. If the activities are wholly unrelated to the MD label, perhaps the rules of that other activity, whatever it may be, override. But then again, perhaps not.

The next time you see Dr Oz*, or other "Pop Docs" of his ilk hawking the next medical-miracle-for-money du jour, think about this. Maybe we should all just start realistically calling him and his kind Mr. or Ms., or "Hey you."

That is my opinion. I am Dr. George Lundberg, at large for Medscape.

*Editor's Note: Mehmet Oz, MD, is Vice-Chair and Professor of Surgery at Columbia University in New York City. He also directs the Cardiovascular Institute and Complementary Medicine Program at New York Presbyterian Hospital.

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