Ethical Question

[Miaow]

If you had a work colleague in your group who was an "APC" (that's what we're called now) and had a business card that clearly stated their name and title but looked like this:

This Person, NP/PA/CNM (Certified Nurse Midwife)

OBSTETRICIAN/GYNECOLOGIST

Would you think that this was a misrepresentation of their credentials? I am under the impression (from the dictionary) that an obstetrician/gynecologist is a physician.

Thoughts/opinions?

 

Thanks!

[karebear12892]

I think this is a misrepresentation of their credentials. Maybe not to others who work in healthcare but I think patients would be easily confused. If he/she wants to list their area of expertise on their business card, I'd recommend changing it to "obstetrics/gynecology" or "women's health." 

[sas5814]

^^This. Most states have laws about representing yourself as a physician and this could certainly be looked at that way. At the very least it is intentionally misleading and, IMHO, unethical. Personally I'd let a board or licensing agency decide. It makes life hard for all of us when people do this kind of stuff.

[camoman1234]

23 minutes ago, sas5814 said:

^^This. Most states have laws about representing yourself as a physician and this could certainly be looked at that way. At the very least it is intentionally misleading and, IMHO, unethical. Personally I'd let a board or licensing agency decide. It makes life hard for all of us when people do this kind of stuff.

I agree 100%. It makes all APPs life harder and more to explain that is not needed. You work in that specialty, but you are not the MD/DO.  

[thinkertdm]

Drop it in the mail to the medical board.  I'm sure they will have an opinion.

[Miaow]

30 minutes ago, thinkertdm said:

Drop it in the mail to the medical board.  I'm sure they will have an opinion.

Medical Board or Nursing Board? 

[thinkertdm]

Both, but the medical board would probably get the most upset; you could write a note, stating you saw this card, and it's confusing; could they elaborate if this person was an MD?  No need to sign it.  

[ventana]

NO NO and NO

 

 

you are going to cause a HUGE ordeal by just "dropping this in the mail to the board"

 

That is cowardly at best and down right mean at worst.

 

Stand tall, call the person, ask for a direct conversation with them.  Explain you points.  Have a discussion like a professional.

 

Personally I do not believe physicians own the name of every specialty.  We practice medicine in a specialty and deserve to be identified as such.

[Cideous]

I agree with Ventana.  Dropping it in the mail to the medical board is kinda a d*ck move IMO.  Now if you want to drop it in the mail back to them and write an anonymous letter or post card explaining your concerns? That would prob do the trick and keep you from getting involved..... 

[Miaow]

44 minutes ago, ventana said:

NO NO and NO

 

 

you are going to cause a HUGE ordeal by just "dropping this in the mail to the board"

 

That is cowardly at best and down right mean at worst.

 

Stand tall, call the person, ask for a direct conversation with them.  Explain you points.  Have a discussion like a professional.

 

Personally I do not believe physicians own the name of every specialty.  We practice medicine in a specialty and deserve to be identified as such.

Hey now, no one said that this is what I intend to do! It's for the sake of argument and for the ethical dilemma that it presents. Tell me this, hypothetically, if this was someone you really disliked and who had gone out of their way to cause you professional harm, would it change the way you feel?

[thinkertdm]

I would think that the certifying board in question retains the right.  Why do we get all upset at physicians just saying, hey, I'm a physician assistant?  Or, "assistant physician".  Or anyone calling themself anything?

In my mind, handing out a card that says "I'm an obstetrician" indicates that you have completed a formal training in obstetrics. The same with gynecology In fact, the name itself is meaningless without the training.  

True, we practice medicine in a specialty, but until there is a real board certification for PA's, you can't just take the name.  Why can't a social worker say they are a psychologist?  Or a mental health PA say they are a psychologist?   

The state medical board is there to license medical doctors, some other jazz, and purportedly to "protect the public against incompetent providers"; to essentially establish a method for which a person who has undergone the appropriate training to gain the right to do what they do.  Whether you agree with that purpose or not, thats what it should be doing.  

So here is So and so, who has not clearly gone through any training that we know of, saying, hey, I'm an orthopedist!  I'm a psychiatrist!  I'm a lawyer!

I suppose the issue may be in the way to approach this; I guess maybe they didn't realize what they were doing.  Maybe if they don't need their charts co-signed they think they are a cardiologist.  I'm still not going to take my wife to them.  But some people may.  Their advice may even be correct.  And good.  But it may not.  I feel it's the state medical board to do this.

[sas5814]

I'm going to be the odd man out here. Using those titles are intentional and intentionally misleading. I think having the conversation with the individual would be fine. If they push back, and I suspect they will, then I'd send it upstream for a board opinion. This isn't a matter of semantics...it is either accidental or intentional. The person's response will be the decider.

I am as pro PA and, somewhat NP, as one can be without being on the lunatic fringe. There is still right and wrong and representing yourself as an obstetrician or a gynecologist when you are not a physician is just wrong.

We have  our place in this medical world and having respect for physicians and their training is an intricate part of that. Everyone has their lane of traffic and we need to stay in ours and promote who we are and what we are in an honest way while brooking no obstruction. This seems to be obfuscation. Patients deserve honesty from all of us and should not be casualties in a confusing war of words. 

[EMEDPA]

I think this is ok depending on the specialty. if you do full scope practice AND state you are a pa.

for example: "Hi I'm John, one of the intensivist/ hospitalist PAs here"

ob or other surgical fields...not so much.

[DizzyJ]

The verbage is misleading.  It's okay to say I'm a psychology PA, but not a psychologist.  I can say I'm gynecology PA, but not gynocoligst.  

[kargiver]

Talk with them directly - start there.

I practice in EM. My card(s) say "Emergency Medicine PA-C" and I see no issue with it.  In the above mentioned scenario, I think "practicing in" preceeding OB/Gyn would be acceptable, but otherwise I see it as misleading.  It sends the wrong message personally and for us as a profession.  But they would get the benefit of making it right before I would go "up the chain."

[lkth487]

On 3/7/2018 at 2:31 AM, EMEDPA said:

I think this is ok depending on the specialty. if you do full scope practice AND state you are a pa.

for example: "Hi I'm John, one of the intensivist/ hospitalist PAs here"

ob or other surgical fields...not so much.

Not that it really applies since most neonatologist don't do much outpatient (or individually advertise their services as much) but it would be weird to call yourself a neonatologist if you're not a physician.   It would definitely be confusing to people in the hospital too.  Regardless of how independent that person was. 

 

[lkth487]

Like there are small NICUs managed purely by pediatricians, without neonatology trained physicians available.  One of my friends does this.  They manage that nicu but would never call themselves a neonatologist even though they clearly practice - 100% independently - in the field of neonatology.  

I fully support PAs practicing to their full potential without unnecessary oversight or regulations, but I don't think misleading people is the way to go.  And I think it WOULD be misleading.

[lkth487]

On 3/7/2018 at 2:31 AM, EMEDPA said:

I think this is ok depending on the specialty. if you do full scope practice AND state you are a pa.

for example: "Hi I'm John, one of the intensivist/ hospitalist PAs here"

ob or other surgical fields...not so much.

I think that would be fine regardless of the field.  

I think it's wholly appropriate to say "I am John, I'm one of the OB/Gyn PAs here" or "I'm one of the neurosurgery PAs here". 

I introduce myself as "Hi, I'm John, I'm one of the pediatrics residents". My attending introduces themselves as "Hi I'm John, I'm the pediatrician in charge of Sally's care in the hospital, etc"

I think all of that is completely fine. 

[sas5814]

How about "I'm John and I'm a Gynocologist"? I know we are parsing words here but context matters. There is a big difference between "I practice gynocology" and "I'm a  gynocologist." We could argue the semantics but it is, at least somewhat, about being honest with the patients as they understand all of us. If we confuse and mislead them...we are in the wrong.

[lkth487]

Agreed.  I wouldn't be ok with that. Should anyone who does a certain amount of gyn in their practice call themselves gynecologists?  Some of my adolescent attendings only see teenage girls and pretty exclusively much do things like gyn exams, birth control, reproductive health stuff etc.  But they wouldnt and shouldn't call themselves gynecologists.  Same thing with the pediatricians and neonatologist example above.  I know people who are 100% practicing neonatology independently.  Like there is a 10 bed level II nicu in my city run purely by neonatologists and a 12 bed level II nicu run exclusively by pediatricians without neonatal fellowship training.  Their practice is EXACTLY the same, they do the same things, are both completely 100% independent but I know the pediatricians don't introduce themselves as neonatologists.  And they shouldn't. 

[katieo]

This mentality bothers me. I was attracted to the role of APP because I felt fairly confident that I didn’t want to be a physician. I also will never know if I could have gotten in or made it through med school unless I decide to try.

I don’t understand why some PAs and NPs blatantly oversell themselves. It’s totally absurd to me for DNPs to introduce themselves as “Dr.” in the clinical setting. I heard an interview on the PAINE podcast where a PA student said something about going for PA so she could basically be a physician without all the schooling or something along those lines, and the interviewer (a PA-C and PA school instructor) agreed with her. Whaaaaaat! It also bothers me when people say PA school is harder than med school or harder to get into than med school. I haven’t attended either, but I don’t buy it. It’s one thing to say, “I think I had a good chance at getting into med school,” but it’s another to just assert that you would have gotten in.

I get that it’s sometimes difficult to describe the role of PA to laypeople and the shorthand explanation can get a bit sloppy. I also understand that PAs are all too often undersold and the “physician assistant” title is not helping. But the overselling bugs me and IMO does the profession no favors.

I agree that honesty is much more important than ego. I think that business card is unethical and I agree that it would be best to address it directly.

[sas5814]

Katieo that is called sophistry. We have a profession and a group of peers worthy of respect and maybe a bit of outright pride. People who think they have to make spurious statements or arguments to "elevate" us end up hurting us.

We have a very important role in the delivery of health care and we need to promote it  and define it and practice is proudly. We don't need artificial "improvement".

[TWR]

I think using ""ist" at the end of the medical word clearly implies or at least trying to imply that you are a medical professional that you really are not.  Whether intentional or otherwise I think it is wrong, forget "ethical"  It just isn't true.  I would first talk to the person and go from there.  IMHO

[Lexapro]

Another thing to keep in mind is if this was a mistake. Is the card a personal card that the APP had made or was it done by their healthcare system? I know that my cards initially stated “psychiatrist” (and they also had 'psychiatrist' on my door) despite the fact that I had made it clear on my paperwork that I was a psych NP. I had them change it immediately, of course. Our system still automatically assumes that providers are always physicians (see all the pill bottles that state “Dr. mylastname” automatically, for example). These mistakes happen.

Anyway, I think approaching the person and letting them know, giving them the benefit of the doubt that it could be a mistake, etc., is the way to go. Then if you get pushback or if they try to insist that they’re an obstetrician/gynecologist, I’d let them have it. That’s ridiculous.

[quietmedic]

honestly, I would call that misleading... At very least they should say something like "obstetrics-gynecology physician assistant" or even just "obstetrics gynecology PA"...