SP of Record vs. Alternate SP: A day in the ED

[PACdan]

Well, one test the courts have made is whether a particular belief system is sincerely held.  If you want to declare yourself an adherent of the Flying Spaghetti Monster and only practice with a colander on your head (Wikipedia it), you're going to have a harder time establishing that than if you're a registered tribal member asserting that hallucinogenic mushrooms ingested as part of traditional Native American religious practices do not make you an impaired provider despite Peyote being Schedule I.

 

Many secular objections to religious conscience clauses fail to address this--that only a sincerely held religious belief counts, and even if you make up your own religious body (e.g., the Church of Body Modification) to try and claim a religious accommodation, the courts are not idiots and don't let everything go with an "Oh, ok, well, it's a religion then, so all hands off, right?"  In order to obtain conscientious objector status in the U.S. at various times one had to demonstrate membership in an establish religious denomination which had an historic objection to armed service--one couldn't simply be a conscientiously objecting Roman Catholic, but one could as a Seventh-Day Adventist, Mennonite, or Jehovah's Witness.

 

The study of ancient religion is fascinating just to see the developments and incorporations of similar themes over time. I know of FSM, and as we jest today, it might be a serious deal in 1,000 years.

 

I'm thinking that the majority of objections in modern medicine from religious practitioners are going to be ones involving what they consider the taking of life. Specifically abortion and physician assisted death for terminally ill patients who request it. We're not going to resolve those debates here or anytime soon. And I'm okay with that. One can have those ethical debates, with or without a religious basis.

 

My goal is to do right by the patient based on what I have learned/am learning/will learn. I will try to do that as objectively as possible. And love unconditionally.

[db_pavnp]

The easiest solution is to simply terminate the SP with the personal belief system that interferes with reasonable patient expectations.  Just right-to-work drop him and be done with it.

[PACdan]

The easiest solution is to simply terminate the SP with the personal belief system that interferes with reasonable patient expectations.  Just right-to-work drop him and be done with it.

 

I would not take that approach. If he or she is a competent provider who has an area like this, where they KNOW they will not be able to meet the needs of the patient due to their beliefs, they should have a developed contingency in place. Refer, as others have said. Have another physician co-sign for the PA, etc.

 

In this story the physician would not sign the script and then essentially sat on his thumbs. That goes from conscience objection to obstruction. That's not doing your job. Have your own beliefs, follow them, and go get the other provider with beliefs not in conflict.

 

I think that preserves their right of conscience while still performing their duties.

[gbrothers98]

First job had an EM attending whom would not write for morning after prior to it being OTC.

He would refer pt to pcp instead, tell pt they had up to 72 hours.

He also said he would not cosign any PA charts that included this as a treatment plan and did not want the PA on to prescribe.

There is no statute in my state asking for cosign of prescription.

The statute also is clear that not all of my charts needed cosignature, only a site determined percentage. 

He did feel that since he was supervising the PA on duty, that he was ultimately responsible for the care and outcome of all patients. Morally he felt he was taking a life.

 

It was eye opening because when the actual statute was read and discussed at our monthly meeting when we reviewed this concern, that moral issue aside, there were quite a few erroneous assumptions concerning the physician-PA relationship that came to light. 

It was very apparent that no one in the room (including me and the other PA at the time) had spent anytime reviewing the actual law but instead had been abiding by locally set policy that really had nothing to do with the law.

Out of that came a more collaborative relationship that everyone involved was more comfortable and happy with.

 

The bottom line is that if under the PA state statute, a PA has full prescriptive power and there is no contractual stipulation nor a facility or medical staff bylaw prohibiting prescribing morning after pill then a properly licensed and credentialed PA can write that prescription.

Physicians whom think they can direct the minutiae of treatment are not ideal SPs particularly since they are confusing the supervision of medical care (which they are misinterpreting with that view) with the morality of medical care, which is an individual practitioner consideration.

 

Then there is the aftermath of this decision. The patient whom is refused morning after complains to the hospital admin and also to the state med board. Now the PA gets dragged into that morass. Will that SP be supportive and take the heat? A question whose answer is unknown. Plus, even if they do, does that absolve the PA of being a participant in that decision? No one on review may care about the maintenance of a day to day working relationship. They will care (or interpret) that this patient should not have been refused a legitimate legal request by either the PA or the SP. History is full of individuals whom have used direction and coercion from others as an excuse but still found themselves being held accountable for the results of their actions.

 

What has to be understood is that healthcare is a commodity in this country, we buy and sell it just like any other service or product. Many consumers wont understand nor care about a moral argument concerning treatment because it is not their argument. They feel that the morning after pill is on the same level as buying a burger at McD's or a TV at Best Buy. So feel free to have your moral standards. Just realize that many times extending them outside your personal sphere can be fraught with conflict.

 

BTW, if you do refer a pt to the pharmacy to buy otc morning after pill but they state they are broke but if you prescribe, insurance will cover, how are you going to handle that conflict?

 

Good luck

G Brothers PA-C