Position statement update
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The NCMB regularly adopts new position statements and reviews and, where appropriate, revises the existing official position statements of the Board to ensure that they remain relevant. We periodically publish a summary of recent revisions to position statements to help licensees stay abreast of changes. Full position statements may be found online in the Professional Resources section of the Board’s website.
Statement: Advance directives and patient autonomy
Date revised: November 2012
Changes: Minor changes only (changing physician to licensee throughout).
Statement: Referral fees and fee splitting
Date revised: January 2013
Changes: Changed physician to licensee throughout; The statement is revised to address licensee use of voucher advertising programs (e.g. Groupon, Living Social, etc.) The new section on voucher advertising reads:
It is the Board’s position that, so long as certain conditions are followed, advertising involving the utilization of vouchers does not constitute unethical fee-splitting or a prohibited solicitation or referral fee under North Carolina law. Those conditions include: (1) ensuring that the negotiated fee between the voucher advertising company and the licensee represents reasonable compensation for the cost of advertising; and (2) incorporating the following terms and conditions in a clear and conspicuous manner in all advertisements:
(a) A description of the discounted price in comparison to the actual cost of services;
(b) A disclosure that all patients may not be eligible for the advertised medical service and that ecisions about medical care should not be made in haste. Determinations regarding the medical indications for individual patients will be made on an individual basis by applying accepted and prevailing standards of medical practice; and
(c) A disclosure to prospective patients that, if it is later decided that the patient is not a candidate for the previously purchased medical service, the patient’s purchase price will be refunded in its entirety. If the patient does not claim the service, then the patient’s purchase price must still be refunded in its entirety. In the event that the voucher advertising company does not refund the purchase price in its entirety, it will be the sole obligation of the licensee to refund the entire purchase price.
Statement: End-of-life responsibilities and palliative care
Date revised: January 2012
Changes: Revises definition of palliative care; changes physician to licensee throughout.
Statement: Drug overdose prevention
Date revised: March 2013
Changes: Broadens the scope of the position statement to indicate Board support of all programs that attempt to prevent deaths from drug overdose through making available or prescribing an opioid antagonist such as naloxone to someone in a position to assist a person at risk of an opiate related overdose.
New Position Statement: Professional Use of Social Media
Date adopted: March 2013
Professional Use of Social Media
The Board recognizes that social media has increasing relevance to professionals and supports its responsible use. However, health care practitioners are held to a higher standard than others with respect to social media because health care professionals, unlike members of the lay public, are bound by ethical and professional obligations that extend beyond the exam room.
The informality of social media sites may obscure the serious implications and long term consequences of certain types of postings. The Board encourages its licensees to consider the implications of their online activities including, but not limited to, the following:
• Licensees must understand that the code of conduct that governs their face to face encounters with patients also extends to online activity. As such, licensees interacting with patients online must maintain appropriate boundaries in accordance with professional ethical guidelines, just as they would in any other context.
• Licensees have an absolute obligation to maintain patient privacy and must refrain from posting identifiable patient information online.
• A licensee’s publicly available online content directly reflects on his or her professionalism. It is advisable that licensees separate their professional and personal identities online (maintain separate email accounts for personal and professional use; establish a social media presence for professional purposes and one for personal use, etc.).
• Because privacy is never absolute, considerations of professionalism should also extend to a licensee’s personal accounts. Posting of material that demonstrates, or appears to demonstrate, behavior that might be considered unprofessional, inappropriate or unethical should be avoided. The online use of profanity, disparaging or discriminatory remarks about individual patients or types of patients is unacceptable.
• Licensees should routinely monitor their own online presence to ensure that the personal and professional information on their own sites is accurate and appropriate.
The Board also endorses the Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice adopted by the Federation of State Medical Boards. Further discussion of this issue by the Board’s Medical Director.
Statement: Advance directives and patient autonomy
Date revised: November 2012
Changes: Minor changes only (changing physician to licensee throughout).
Statement: Referral fees and fee splitting
Date revised: January 2013
Changes: Changed physician to licensee throughout; The statement is revised to address licensee use of voucher advertising programs (e.g. Groupon, Living Social, etc.) The new section on voucher advertising reads:
It is the Board’s position that, so long as certain conditions are followed, advertising involving the utilization of vouchers does not constitute unethical fee-splitting or a prohibited solicitation or referral fee under North Carolina law. Those conditions include: (1) ensuring that the negotiated fee between the voucher advertising company and the licensee represents reasonable compensation for the cost of advertising; and (2) incorporating the following terms and conditions in a clear and conspicuous manner in all advertisements:
(a) A description of the discounted price in comparison to the actual cost of services;
(b) A disclosure that all patients may not be eligible for the advertised medical service and that ecisions about medical care should not be made in haste. Determinations regarding the medical indications for individual patients will be made on an individual basis by applying accepted and prevailing standards of medical practice; and
(c) A disclosure to prospective patients that, if it is later decided that the patient is not a candidate for the previously purchased medical service, the patient’s purchase price will be refunded in its entirety. If the patient does not claim the service, then the patient’s purchase price must still be refunded in its entirety. In the event that the voucher advertising company does not refund the purchase price in its entirety, it will be the sole obligation of the licensee to refund the entire purchase price.
Statement: End-of-life responsibilities and palliative care
Date revised: January 2012
Changes: Revises definition of palliative care; changes physician to licensee throughout.
Statement: Drug overdose prevention
Date revised: March 2013
Changes: Broadens the scope of the position statement to indicate Board support of all programs that attempt to prevent deaths from drug overdose through making available or prescribing an opioid antagonist such as naloxone to someone in a position to assist a person at risk of an opiate related overdose.
New Position Statement: Professional Use of Social Media
Date adopted: March 2013
Professional Use of Social Media
The Board recognizes that social media has increasing relevance to professionals and supports its responsible use. However, health care practitioners are held to a higher standard than others with respect to social media because health care professionals, unlike members of the lay public, are bound by ethical and professional obligations that extend beyond the exam room.
The informality of social media sites may obscure the serious implications and long term consequences of certain types of postings. The Board encourages its licensees to consider the implications of their online activities including, but not limited to, the following:
• Licensees must understand that the code of conduct that governs their face to face encounters with patients also extends to online activity. As such, licensees interacting with patients online must maintain appropriate boundaries in accordance with professional ethical guidelines, just as they would in any other context.
• Licensees have an absolute obligation to maintain patient privacy and must refrain from posting identifiable patient information online.
• A licensee’s publicly available online content directly reflects on his or her professionalism. It is advisable that licensees separate their professional and personal identities online (maintain separate email accounts for personal and professional use; establish a social media presence for professional purposes and one for personal use, etc.).
• Because privacy is never absolute, considerations of professionalism should also extend to a licensee’s personal accounts. Posting of material that demonstrates, or appears to demonstrate, behavior that might be considered unprofessional, inappropriate or unethical should be avoided. The online use of profanity, disparaging or discriminatory remarks about individual patients or types of patients is unacceptable.
• Licensees should routinely monitor their own online presence to ensure that the personal and professional information on their own sites is accurate and appropriate.
The Board also endorses the Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice adopted by the Federation of State Medical Boards. Further discussion of this issue by the Board’s Medical Director.
Comments on this article:
The position statement of the Board, as it pertains to prescribing medications, indicates that ordinarily, we should not prescribe for patients we have not physically seen. One exception to this, which is not mentioned in the position statement, but which is commonly practiced, is the prescribing of colonoscopy prep agents (the dreaded “gallon jug”) as part of the preparation for screening colonoscopy, which is often arranged on an “open access” basis, whereby the patient comes in to the office and sees one of the office staff (nurse, medical assistant—but not the doctor) to be set up for the procedure. These colonic lavage solutions (e.g., Go-lytely and others) are by prescription only, but the doctor himself does not see the patient—the prescription is given to the patient by the staff member when other logistic arrangements for the procedure (scheduling, insurance pre-cert, instructions, etc.) are taken care of. Is this a problem? Should the position paper, when it is next amended, reflect this sort of practice as being an acceptable exception to the principle of not prescribing for unseen patients? Thank you for your consideration of this issue.
By Robert V. Buccini, M.D. on May 08, 2013 at 9:44am
