Legal Question

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futuredo32

futuredo32

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I didn't know where exactly to post this. I hope here is ok.

I graduated from a DO school and didn't match last year. I'm volunteering at a free clinic one day a week this year. The clinic has some broad malpractice insurance and they assured me this was fine. Usually, I see patients who present for primary care (not OB/Gyn) and then discuss them with licensed physicians who are seeing patients who present for primary care complaints and run everything by them to make sure I didn't miss anything and to make sure they agree with my treatment plan and they always cosign the chart. Occasionally, if a patient is really complex or I'm just not sure, I ask the physician to see the patient for him/herself.
There have been a few times at the end of the day where a patient came late and the only licensed physician at the clinic left was the OB/Gyn and I saw the patient and discussed the patient and treatment plan with the OB/Gyn and had her cosign the chart. Fortunately, none of these patients had anything complicated going on.

Well, next week they have me scheduled with a PA who sees patients for primary care issues (not anything OB/Gyn related) and with an OB/Gyn who sees patients presenting for OB/Gyn issues. I feel very fortunate to have this clinic where I can keep up my clinical skills and I don't want to make any unnecessary "waves." I think that a resident can't legally work under the supervision of a PA, so I'm guessing that would apply to me as well. Is it ok for me to see some pretty complex patients who come in for a variety of primary care issues and be supervised by the OB/Gyn for the whole day? I don't know how much she knows about things unrelated to OB/Gyn and I would hate for there to be a bad outcome because I didn't have a regular primary care doctor to run things by.
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futuredo32 said:
I didn't know where exactly to post this. I hope here is ok.

I graduated from a DO school and didn't match last year. I'm volunteering at a free clinic one day a week this year. The clinic has some broad malpractice insurance and they assured me this was fine. Usually, I see patients who present for primary care (not OB/Gyn) and then discuss them with licensed physicians who are seeing patients who present for primary care complaints and run everything by them to make sure I didn't miss anything and to make sure they agree with my treatment plan and they always cosign the chart. Occasionally, if a patient is really complex or I'm just not sure, I ask the physician to see the patient for him/herself.
There have been a few times at the end of the day where a patient came late and the only licensed physician at the clinic left was the OB/Gyn and I saw the patient and discussed the patient and treatment plan with the OB/Gyn and had her cosign the chart. Fortunately, none of these patients had anything complicated going on.

Well, next week they have me scheduled with a PA who sees patients for primary care issues (not anything OB/Gyn related) and with an OB/Gyn who sees patients presenting for OB/Gyn issues. I feel very fortunate to have this clinic where I can keep up my clinical skills and I don't want to make any unnecessary "waves." I think that a resident can't legally work under the supervision of a PA, so I'm guessing that would apply to me as well. Is it ok for me to see some pretty complex patients who come in for a variety of primary care issues and be supervised by the OB/Gyn for the whole day? I don't know how much she knows about things unrelated to OB/Gyn and I would hate for there to be a bad outcome because I didn't have a regular primary care doctor to run things by.
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IANAL...but I'm not going to let that stop me here.

You are neither a student nor a licensed healthcare provider. Therefore, nobody can (or should) supervise you (PA, MD, DO, NP, whatever) as you are not legally able to provide healthcare. You are an observer, which means exactly what it sounds like...look, but don't touch.

If there were to be a bad outcome related to your "care" or even at any time while you were involved with this clinic, and it came out that you were practicing medicine without a license or appropriate educational supervision (i.e. as a student on an approved clinical rotation), any half-decent malpractice attorney would take down the entire practice and all the providers in it.

Something tells me nobody ran this by the group's lawyer or malpractice insurance company.
 
Thank you for your reply, they did run it by their lawyer when I first started volunteering in this capacity. I started volunteering in their pharmacy and asked if I could shadow. They let me shadow for a few weeks and things went well and they offered me the opportunity to see patients under the supervision of a physician. I didn't think this was legally ok, but they checked and double checked into it for me and said it was fine.
My question was specifically about whether it's ok to be supervised by an OB/Gyn while I'm seeing patients that present for issues outside the scope of care that she provides. Can anyone address this?
I don't understand all of the details, but a free clinic has different legal requirements than regular for-profit clinics and even pharmacies. Prescriptions are often filled without a licensed pharmacist being on site.
 
futuredo32 said:
Thank you for your reply, they did run it by their lawyer when I first started volunteering in this capacity. I started volunteering in their pharmacy and asked if I could shadow. They let me shadow for a few weeks and things went well and they offered me the opportunity to see patients under the supervision of a physician. I didn't think this was legally ok, but they checked and double checked into it for me and said it was fine.
My question was specifically about whether it's ok to be supervised by an OB/Gyn while I'm seeing patients that present for issues outside the scope of care that she provides. Can anyone address this?
I don't understand all of the details, but a free clinic has different legal requirements than regular for-profit clinics and even pharmacies. Prescriptions are often filled without a licensed pharmacist being on site.
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I am also surprised that they are letting you volunteer in this capacity, and not just observing. Are you writing in the charts? Are you dispensing prescriptions? Do you even have a license?

During our orientation for intern year, we were told that our hospital's malpractice insurance would not extend to any services rendered while volunteering at an outside clinic, and so we were strongly discouraged from such volunteering. And we are people who DO have licenses.

In any case, I personally would not feel comfortable having only an OB/gyn on site. What if a male patient or a sick child comes in? Even if it's "legal," it's not safe for patients.

I honestly don't know what to tell you. Is the PA working on site unsupervised, with no attending physician nearby? That seems a little shady as well....as does this whole clinic.
 
This sounds about 92 different kinds of sketchy. I think supervision by a PA or an OB/Gyn is the least of your worries.

I wouldn't touch this kind of set-up with a 10 foot stethoscope as it has too much potential to screw up your future. It would really suck to have something bad happen and you lose the ability to get a license before you even had one. Never mind the patient outcome.

Good luck.
 
smq123 said:
I am also surprised that they are letting you volunteer in this capacity, and not just observing. Are you writing in the charts? Are you dispensing prescriptions? Do you even have a license?

During our orientation for intern year, we were told that our hospital's malpractice insurance would not extend to any services rendered while volunteering at an outside clinic, and so we were strongly discouraged from such volunteering. And we are people who DO have licenses.

In any case, I personally would not feel comfortable having only an OB/gyn on site. What if a male patient or a sick child comes in? Even if it's "legal," it's not safe for patients.

I honestly don't know what to tell you. Is the PA working on site unsupervised, with no attending physician nearby? That seems a little shady as well....as does this whole clinic.
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It's really not a shady clinic, I don't think. It's been in existence for several years. I talked about this experience at all of my interviews this year and no one who interviewed me ever mentioned that they thought it was illegal to be doing this.

The PA will be at the clinic this coming Tuesday with only the OB/Gyn, but I think this is definitely legitimate because I had a friend who was a PA and the doctor was almost never there, but she could contact him by phone if needed, and the phone contact was what made everything legal.

I write in the chart and I sign and an attending physician cosigns the chart. We have our own pharmacy and we order prescriptions on the chart, not a paper prescription that a patient takes to a pharmacy, but yes, I write for prescriptions (and again a licensed physician cosigns). The clinic has malpractice insurance that covers everyone there. Most of the physicians who volunteer are actually retired and I don't think they carry their own malpractice coverage. One of the "medical assistants" is a medical student taking a year off between her second and third years, the rest are retired nurses, nursing students, or EMTs.

We generally don't see kids at all (one time they saw a child as a favor to someone who volunteered at the clinic).

I just didn't want to make a big deal out of seeing patients with an OB/Gyn supervising me if it wasn't a big deal.
 
Agree with the HIGH concern about doing this. If you are just "shadowing" that is fine, like the medical student that is the assistant. But you are seeing patients by yourself and just checking them out for the most part. You are not doing this as a resident or a licensed physician. I would NOT seen folks independantly if I were you.

Someone has a bad outcome and there is only a cosignature on the chart, you will not survive that.
 
There's an old saying in human resources circles that "The only time the contract comes out of the drawer is when there's a problem." Every thing may seem on the up and up and the clinic may be "reputable" and it certainly doesn't seem like anyone is trying to do anything wrong. If nothing bad ever happens, ie. bad outcome, lawsuit or patient complaint to some legal authority, then you'll probably be ok. Interviewees will think it's cool and you'll keep your hand in the game. BUT if anything does go down you could be really screwed.

On first glance this seems like a good idea, "unlicensed doctor volunteers in free clinic supervised by licensed doctors." The problem is that you are essentially being used as a midlevel. However midlevels are licensed providers. You are not. The only way this could possibly pass muster is if your role is more of a medical assistant and each patient is seen by the doc as well. You also might want to refrain from introducing yourself as "Dr." to try to avoid confusion on the part of the patients."

As for the PA seeing patients without a doc on site that is common. Many PAs work with available supervision and periodic chart review/cosigning. That means they bill at a lower level than a physician (85%) but it is legal and commonplace.
 
Thanks for the replies.
The issue I first posted about is resolved- there's now a licensed primary care physician who will be at the clinic this coming week.

The larger issue of whether or not this is a good idea at all is definitely something I will look into.
 
smq123 said:
I am also surprised that they are letting you volunteer in this capacity, and not just observing. Are you writing in the charts? Are you dispensing prescriptions? Do you even have a license?

During our orientation for intern year, we were told that our hospital's malpractice insurance would not extend to any services rendered while volunteering at an outside clinic, and so we were strongly discouraged from such volunteering. And we are people who DO have licenses.

In any case, I personally would not feel comfortable having only an OB/gyn on site. What if a male patient or a sick child comes in? Even if it's "legal," it's not safe for patients.

I honestly don't know what to tell you. Is the PA working on site unsupervised, with no attending physician nearby? That seems a little shady as well....as does this whole clinic.
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Wait, why is an intern licensed while a DO graduate is not? There's no difference in educational completion between a med school graduate and an intern, is there?

What I mean is, both people just graduated from med school. So, what makes an intern eligible for licensure while a med school graduate can't get licensed?
 
GoodmanBrown said:
Wait, why is an intern licensed while a DO graduate is not? There's no difference in educational completion between a med school graduate and an intern, is there?

What I mean is, both people just graduated from med school. So, what makes an intern eligible for licensure while a med school graduate can't get licensed?
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I think an intern gets a training license during their internship year. (I could be mistaken)

I've really thought about this and maybe not from a legal standpoint, but from a practical standpoint, what I do in this clinic seems just like what I did as a medical student on several rotations. As a medical student, I was covered by whatever malpractice insurance my school provided and I was supervised by licensed physicians. Now, I'm covered by whatever malpractice insurance the clinic has and I'm supervised by licensed physicians. I am not arguing that there may be some difference if a malpractice suit occurs, but from a practical standpoint, I really don't see the difference.
 
futuredo32 said:
I've really thought about this and maybe not from a legal standpoint, but from a practical standpoint, what I do in this clinic seems just like what I did as a medical student on several rotations. As a medical student, I was covered by whatever malpractice insurance my school provided and I was supervised by licensed physicians. Now, I'm covered by whatever malpractice insurance the clinic has and I'm supervised by licensed physicians. I am not arguing that there may be some difference if a malpractice suit occurs, but from a practical standpoint, I really don't see the difference.
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Nobody here is arguing this point. Except for the whole "covered by malpractice insurance" thing, because you're likely not.

And when was the last time you saw a lawyer (particularly a malpractice attorney) see anything from a "practical standpoint?" Other than being able to "practically" pay off his beach house from the settlement in any lawsuit arising from this situation.

You can try to justify this any way you want, but if I was in your shoes, I wouldn't even set foot back in that clinic until their attorney and malpractice insurer can show you, in writing, where the state medical practice laws and the clinic's malpractice policy specifically permit your role as you describe it. Once that happens, be sure to keep a copy in a safe place and go back in with your head held high.
 
From a practical staindpoint, if while in medical school you saw someone and the attending just signed off on your note, that is wrong. They must see and perform some if not all of the history and physical exam themselves. From what you described you are just "checking them out" and not having everyone seen. It isn't really the same.

As far as MD vs DO, not even an issue in this discussion, the OP is just a graduate of a medical school, it doesn't matter if you are DO or MD here. Everyone must complete at least one year of residency to become independently licensed to practice medicine.
 
futuredo32 said:
Thanks for the replies.
The issue I first posted about is resolved- there's now a licensed primary care physician who will be at the clinic this coming week.

The larger issue of whether or not this is a good idea at all is definitely something I will look into.
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To reemphasize something that others have said: your malpractice coverage is sketchy at best. You do not have a contractual relationship with the insurance company. I assume that you don't even have a contractual relationship with the clinic. If these assumptions are true, how do you know you are covered? I'm willing to bet that the insurance contract only covers licensed providers (at least in the role you are performing). If something goes south, you will get sued, the "supervising" doc will get sued and so will the clinic. Who will pay your legal fees? What will you do if the insurance company and clinic refuse to indemnify you?

When med students go to institutions other than their home hospitals, agreements are signed by both places explicitly laying out malpractice responsibility (they're called MOAs or MOUs depending on the location).

Please take it from an attorney (who is not providing you specific legal advice and recommends that you discuss this with an attorney experienced with such matters in your jurisdiction) you have a huge degree of exposure here!

Ed
 
GoodmanBrown said:
Wait, why is an intern licensed while a DO graduate is not? There's no difference in educational completion between a med school graduate and an intern, is there?

What I mean is, both people just graduated from med school. So, what makes an intern eligible for licensure while a med school graduate can't get licensed?
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Lincenture for MD comes after you complete step 3... not sure about what it takes for DO...

As far as "what I did in medical school" medical students notes are not legally part of the chart... The only part of a medical student note that can be referrenced as part of the chart is the history, and even that is limited I believe. Nothing in regards to physical exam, laboratory data, or especially assesment and plan counts unless the physician actually does it and record that they did it (and no, Agree with above doesn't count).

As far as writing orders, also something that medical students are not legally allowed to do (even if I do it, I have never personally signed it... I've wrote the order and the resident signed it as if they wrote it... good practice for me writing orders, the resident reviews it to make sure what they are putting their name on, but still not really legit).

As far as your concerns over an OB/GYN, I guess it depends on the OB/GYN. Most old school attendings, regardless of specialty (and you said most were old retired docs there) know plenty about general medicine, as their training wasn't as super specialized as ours is. Plus, OB/GYN docs, in many circumstances, act as the primary care doc for their patients... so managing blood pressure, diabetes, colds, etc, can all fall under their knowledge base... anything too much more complex, though, and I don't think a clinic is appropriate for any sort of the care, regardless of what doctor it is.
 
edmadison said:
To reemphasize something that others have said: your malpractice coverage is sketchy at best. You do not have a contractual relationship with the insurance company. I assume that you don't even have a contractual relationship with the clinic. If these assumptions are true, how do you know you are covered? I'm willing to bet that the insurance contract only covers licensed providers (at least in the role you are performing). If something goes south, you will get sued, the "supervising" doc will get sued and so will the clinic. Who will pay your legal fees? What will you do if the insurance company and clinic refuse to indemnify you?

When med students go to institutions other than their home hospitals, agreements are signed by both places explicitly laying out malpractice responsibility (they're called MOAs or MOUs depending on the location).

Please take it from an attorney (who is not providing you specific legal advice and recommends that you discuss this with an attorney experienced with such matters in your jurisdiction) you have a huge degree of exposure here!

Ed
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Thanks, it's nice to have a lawyer chime in. I really kinda made a big deal about the whole legality of the situation when they first offered me the opportunity to see patients with the oversight of a physician. It's just such a friendly enviornment, asking to actually see this broad malpractice insurance for myself is something that I will definitely have to phrase delicately. They explained to me that they have a resident who sometimes volunteers, how the laws are different for a free clinic than a for profit clinic (they have social workers filling prescriptions instead of an actual pharmacist sometimes), etc etc. I just don't want to offend them. I definitely don't want to endanger anyone(and thought I was doing a good job of what I was doing and really getting the attendings to make sure they were overseeing me well , asking questions and not being afraid to look stupid for askign as many questions as needed, and asking for help when I needed it), but I kinda thought that if there were a bad outcome, even if the bad outcome wasn't anyone's "fault" that the malpractice insurance would just take care of things. I don't have any contract with the clinic- I filled out a short application when I started there and I started as a volunteer in their pharmacy. I don't know that anyone actually has a contract with the clinic. I know that the attendings provide the clinic with information about their license, but I kinda don't think there's more to it than that.
thedrjojo said:
Lincenture for MD comes after you complete step 3... not sure about what it takes for DO...

As far as "what I did in medical school" medical students notes are not legally part of the chart... The only part of a medical student note that can be referrenced as part of the chart is the history, and even that is limited I believe. Nothing in regards to physical exam, laboratory data, or especially assesment and plan counts unless the physician actually does it and record that they did it (and no, Agree with above doesn't count).

As far as writing orders, also something that medical students are not legally allowed to do (even if I do it, I have never personally signed it... I've wrote the order and the resident signed it as if they wrote it... good practice for me writing orders, the resident reviews it to make sure what they are putting their name on, but still not really legit).
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I had no idea. I signed all of the charts as a med student and very often, "Agree with above" and a signature was all that an attending actually wrote on the chart.


Thanks so much to everyone who replied. It is much appreciated:)
 
GoodmanBrown said:
Wait, why is an intern licensed while a DO graduate is not? There's no difference in educational completion between a med school graduate and an intern, is there?

What I mean is, both people just graduated from med school. So, what makes an intern eligible for licensure while a med school graduate can't get licensed?
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It has nothing to do with being a DO.

It has everything to do with being a resident. As a resident, at least in the state where I live, we (MDs AND DOs) receive training licenses so that we can write prescriptions, write orders, etc.
 
Just to continue pummelling this deceased equine.

Practically speaking, what the OP describes doing here is no different than what s/he did as a med student or what s/he would be doing as a resident in the same clinic.

Legally speaking (which, unfortunately is what will matter in the end), what the OP describes doing here is no different than a high school student or random homeless person wandering into the clinic and asking to help out (and being told, "sure...go for it...here's a stethoscope and the drug cabinet is over there").

At least, this is the case in the state where I am licensed to practice (which may or may not be the state where the OP is, but likely has similar rules), which has one of the most liberal medical licensure statutes in the nation (as an example, NDs and DCs can write for just about anything that's not Schedule II or chemotherapy and don't have to carry malpractice if they don't want to). As a resident, I rotated through a "free clinic" twice (which had a similar pharmacy policy). And even though both times it was as part of an approved rotation affiliated with the residency program, I had to go through a (cursory but legally vetted) credentialing process before starting the rotation.

FWIW, I hope I'm wrong WRT the OPs situation, but I doubt it.
 
The distinction has nothing to do with MD or DO. It has to do with being unlicensed and not baing in a residency. If you are an intern or resident (the difference, if there is one is a debate for another time) you are practicing in a setting where you have a specifically designated role with supervision and all of that is laid out in contracts that abide by multiple regulatory constraints such as ACGME and CMS. Some states use training licenses (e.g. PA), others do not (e.g. CA). In those that do not the unlicensed residents, again under s very closely prescribed set up for supervision and liability coverage, have to have everything signed off, overseen and scripts have to be signed by the licensed docs.
 
futuredo32 said:
I didn't know where exactly to post this. I hope here is ok.

I graduated from a DO school and didn't match last year. I'm volunteering at a free clinic one day a week this year. The clinic has some broad malpractice insurance and they assured me this was fine. Usually, I see patients who present for primary care (not OB/Gyn) and then discuss them with licensed physicians who are seeing patients who present for primary care complaints and run everything by them to make sure I didn't miss anything and to make sure they agree with my treatment plan and they always cosign the chart. Occasionally, if a patient is really complex or I'm just not sure, I ask the physician to see the patient for him/herself.
There have been a few times at the end of the day where a patient came late and the only licensed physician at the clinic left was the OB/Gyn and I saw the patient and discussed the patient and treatment plan with the OB/Gyn and had her cosign the chart. Fortunately, none of these patients had anything complicated going on.

Well, next week they have me scheduled with a PA who sees patients for primary care issues (not anything OB/Gyn related) and with an OB/Gyn who sees patients presenting for OB/Gyn issues. I feel very fortunate to have this clinic where I can keep up my clinical skills and I don't want to make any unnecessary "waves." I think that a resident can't legally work under the supervision of a PA, so I'm guessing that would apply to me as well. Is it ok for me to see some pretty complex patients who come in for a variety of primary care issues and be supervised by the OB/Gyn for the whole day? I don't know how much she knows about things unrelated to OB/Gyn and I would hate for there to be a bad outcome because I didn't have a regular primary care doctor to run things by.
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People are getting their panties in a bunch excessively I feel. It's some stupid free clinic, and according to most states, boards leave the question of scope of individual practice to the practitioner himself. I mean, if you mess up doing nerve blocks as a family practitioner and get complaints about it, you will probably be cited by your board for it and they will place that formal "don't do this" in your file (and maybe more). I don't think it's inappropriate for a pathologist to be starting someone on lexapro 10mg qd for a garden variety depression. isn't all of this tested on step 3? besides, if there are baseline parameters to monitor and follow, the doctor shouldn't be dumb enough not to look into those and learn about them... and follow up on this patient with a standard note to see how the depression is doing. I have heard of doctors who have been busted for having non-MD's (or like foreign-trained MD's) seeing patients at their clinics, but that was without any oversight... if the real MD is going in after the patient or at least agreeing w/ h&p (as what happens in the vast majority of medical schools, don't kid yourselves), then it doesn't seem too bad. so so many family practices i know employ medical assistants w/o degrees who place patients in rooms and obtain a brief h&p from the patient to populate in the EMR. it isn't far-fetched to suggest an a&p, i mean, i'm sure that MA has only seen it a million times, and maybe your patient may know that he always needs some penny G for his chancre. of course at the end of the day, a licensed doctor should have some oversight and look over, but anything else seems like various shades of grey that can be presented in a legit light.
 
Speculatrix said:
People are getting their panties in a bunch excessively I feel. It's some stupid free clinic, and according to most states, boards leave the question of scope of individual practice to the practitioner himself. I mean, if you mess up doing nerve blocks as a family practitioner and get complaints about it, you will probably be cited by your board for it and they will place that formal "don't do this" in your file (and maybe more). I don't think it's inappropriate for a pathologist to be starting someone on lexapro 10mg qd for a garden variety depression. isn't all of this tested on step 3? besides, if there are baseline parameters to monitor and follow, the doctor shouldn't be dumb enough not to look into those and learn about them... and follow up on this patient with a standard note to see how the depression is doing. I have heard of doctors who have been busted for having non-MD's (or like foreign-trained MD's) seeing patients at their clinics, but that was without any oversight... if the real MD is going in after the patient or at least agreeing w/ h&p (as what happens in the vast majority of medical schools, don't kid yourselves), then it doesn't seem too bad. so so many family practices i know employ medical assistants w/o degrees who place patients in rooms and obtain a brief h&p from the patient to populate in the EMR. it isn't far-fetched to suggest an a&p, i mean, i'm sure that MA has only seen it a million times, and maybe your patient may know that he always needs some penny G for his chancre. of course at the end of the day, a licensed doctor should have some oversight and look over, but anything else seems like various shades of grey that can be presented in a legit light.
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I don't think this is reasonable.

We're not talking about a situation where a licensed doc gets dinged by the medical board for going outside his scope, we're talking about a person who is not licensed practicing medicine. In that case the board just refers the case to law enforcement and says "This guys got no license. He's your responsibility, not ours."

You point about what MAs do is true but the OP isn't functioning as an MA, he's functioning as an unlicensed midlevel.

Trying to "present in a legit light" is going to be an uphill fight. You're either licensed or you're not. It would be ashame to risk a whole career over this which is the point most of us have been trying to make.

To the OP I don't think you have to quit. I do think you need to make sure you are functioning as a medical assistent rather than a midlevel or a doctor. Take some steps to make sure you are in that role and it's clearly defined (don't introduce yourself as "doctor," make sure a midlevel or a licensed doctor sees every patient you see and signs everything you scribe for them) and you could continue to volunteer and keep your skills up.
 
I agree with docB. I've worked at a free clinic too, but this was after I had done residency (didn't have board cerfication, but had finished residency). The clinic did verify my credentials, that I had a license and had finished residency, and then did cover me under their malpractice insurance. The OP really shouldn't be seeing patients independently, or semi-independently. Helping out at the pharmacy and/or putting patients in rooms, taking blood pressures, etc. would be OK but being the main one seeing the patient really isn't, legally speaking. I think he/she should not do it, although realistically speaking he/she is probably unlikely to get into any trouble in the next few months. As far as the OB/gyn supervising, I don't see a problem with that as long as the things being treated are general primary care things that she/he is familiar with. The OP essentially practicing with no license is somewhat of a problem, and I'm really surprised the clinic would allow this, and I'm pretty sure the malpractice insurance company wouldn't be good with this if they understood that the OP isn't a student or resident...
 
thedrjojo said:
As far as "what I did in medical school" medical students notes are not legally part of the chart... The only part of a medical student note that can be referrenced as part of the chart is the history, and even that is limited I believe. Nothing in regards to physical exam, laboratory data, or especially assesment and plan counts unless the physician actually does it and record that they did it (and no, Agree with above doesn't count).
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Medical student notes, if put in the chart, are legally part of the chart. What a medical student writes in the chart can definitely hurt the attending. You are generally right, though, that only limited parts of the med student note can be referred to for BILLING purposes.
 
michaelrack said:
Medical student notes, if put in the chart, are legally part of the chart. What a medical student writes in the chart can definitely hurt the attending. You are generally right, though, that only limited parts of the med student note can be referred to for BILLING purposes.
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From my understanding, while legally part of the chart, it does not count as anything in the chart... the dieticians, nurses, pasture can all put stuff in the chart that counts as the chart... if a lawyer looked at the chart and only saw a medical student note for the day saying lungs examined and clear, and an attending/resident/whoever wrote "seen and examined with the student, agree with above" then there is no documented proof that the patient was examined and the doctor is liable... there is no distinction if a medical student verses the patients mother wrote it in the chart... student notes are only for the educational purpose. Atleast that is what is taught to us in my school, and what was further explained to us by an attending who yelled at a resident because mine was the only note in the chart
 
Agree with others that this sounds like a high-risk situation. Would recommend that you simply shadow or look for non-clinical opportunities to help the clinic (chart organization, EHR implementation, workflow improvement, etc.). Would suggest that you avoid writing in a patient chart.

The other option to consider (once again, risky but probably less risky than what you're currently doing) - is to work as a medical assistant. You don't need to be certified to work as a medical assistant, but you also need to be very familiar with the rules/boundaries of an MA role.
 
Didn't mean to bring in DO vs. MD here. I was actually just interested in the difference between a student who had just graduated vs. an intern.

So, what it seems like is: A) Some states give you a "learning" license when you're an intern or resident which has limited privileges. B) Some states won't license you, but because you're working as an intern or resident, your training program accepts that risk. A licensed doctor must co-sign all prescriptions, notes, etc. to make them valid.

Is this about right?
 
GoodmanBrown said:
Didn't mean to bring in DO vs. MD here. I was actually just interested in the difference between a student who had just graduated vs. an intern.

So, what it seems like is: A) Some states give you a "learning" license when you're an intern or resident which has limited privileges. B) Some states won't license you, but because you're working as an intern or resident, your training program accepts that risk. A licensed doctor must co-sign all prescriptions, notes, etc. to make them valid.

Is this about right?
Click to expand...

A is correct. However, in states that do not issue training (or restricted) licenses, residents usually work under the umbrella license of the institution.
 
thedrjojo said:
From my understanding, while legally part of the chart, it does not count as anything in the chart... the dieticians, nurses, pasture can all put stuff in the chart that counts as the chart... if a lawyer looked at the chart and only saw a medical student note for the day saying lungs examined and clear, and an attending/resident/whoever wrote "seen and examined with the student, agree with above" then there is no documented proof that the patient was examined and the doctor is liable... there is no distinction if a medical student verses the patients mother wrote it in the chart... student notes are only for the educational purpose. Atleast that is what is taught to us in my school, and what was further explained to us by an attending who yelled at a resident because mine was the only note in the chart
Click to expand...

A medical student note can't substitute for a doc's note, but it is still part of the chart (if placed in there). IF the attending is sued for some reason, a med student note can't help him very much, but it can definitely hurt him. For example, if the attending's note states that the patient is alert and oriented, and the med student's note states that the patient is confused; and the patient gets out of bed and falls- the med student's note can be used against the attending by the malpractice lawyer (the court and the malpractice attorney aren't going to buy your arguement that the med student's note is only for educational purposes). If, after the fall, someone takes the med student note out of the chart, that is tampering with the chart and will probably result in the attending losing the case if this is discovered. Once a medical student note is put in the chart, it is legally part of the chart- but it is not the same as a doc's note and can't substitute for a doc's note.

Not all schools have med students put notes in the chart. But if it's put in there, it is forever part of the chart.
 
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