Maine Medicine Weekly Update - 11/20/2017  (Plain Text Version)

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In this issue:
•  Current News Moves MMA to Remind Physicians of Guidance on Boundaries in Physician-Patient Relationships
•  Webinars on Improving Opioid Prescribing and Patient Safety: 12/5 & 12/13
•  Health Insurance Marketplace 2018: 3 weeks left for Open Enrollment
•  MMA Leadership Listening Session in Portland on Tuesday, December 5
•  Improving Opioid Prescribing and Patient Safety: Wednesday, 12/6 in Portland
•  House Passes CHIP Reauthorization
•  2018 Another Transition Year for Quality Payment Program
•  News from the 2017 AMA Interim Meeting
•  2018 Medicare Physician Fee Schedule Provides Regulatory Relief for Physicians
•  Legislative Calls to Resume When Legislature Returns
•  SAVE THE DATE: MMA Legislative Committee Meets December 11th to Prepare for Next Legislative Session
•  Highlights of Recently Enacted Legislation: L.D. 479 Requiring a Opioid Prescribing Policy
•  Online Learning Opportunities Offering CME Credits - from the Northern New England Practice Transformation Network
•  New Free CME on Alzheimer's Risk, Detection, and Management
•  Chief Executive Officer
•  Clinical Cardiology Opportunity
•  Family Medicine Physician/Clinician Leader
•  BC/BE Physician - C.A. Dean Memorial Hospital
•  VA Psychiatrist
•  BE/BC Family Practitioner - Lewiston, ME
•  Primary Care Physician - Eastern Maine Medical Center
•  Relocate to Beautiful Southwestern Maine - Medical Director/Family Practice Physician
•  Outstanding full-time opportunity for an experienced Physician Assistant or Nurse Practitioner with Central Maine Heart Associates in Auburn, Maine
•  Palliative Care Provider
•  Gastroenterologist - Brunswick, ME
•  Hospitalist - Brunswick, ME
•  DO or MD Physician - Augusta, ME
•  Family Medicine Physician - Pittsfield, ME
•  Outpatient Only - Internal Medicine with Loan Repayment & Sign-on Bonus
•  Anesthesiologist - Augusta/Waterville
•  Physiatrist - Brunswick, Maine
•  Opportunities at the VA for Volunteer Physicians


Current News Moves MMA to Remind Physicians of Guidance on Boundaries in Physician-Patient Relationships

The MMA has become aware of several recent complaints to the Board of Licensure in Medicine against physicians by patients for alleged "boundary violations."  Legal practitioners who regularly represent physicians and other health care practitioners in licensing matters also report an increase in complaints of this type.  Accordingly, the MMA reviews here the ethical and legal guidance in this high risk aspect of a physician-patient relationship.

The AMA Code of Medical Ethics includes three opinions in the category of "Sexual Boundaries:"

  • Opinion 9.1.1, Romantic or Sexual Relationships with Patients;
  • Opinion 9.1.2, Romantic or Sexual Relationships with Key Third Parties; and
  • Opinion 9.1.3, Sexual Harassment in the Practice of Medicine.

Opinion 9.1.1 provides very clear guidance that, "[r]omantic or sexual interactions between physicians and patients that occur concurrently with the physician-patient relationship are unethical."  Opinion 9.1.3 also states that sexual harassment is unethical and points out that sexual harassment includes "other verbal or physical conduct of a sexual nature."  

The Board of Licensure in Medicine and the Board of Osteopathic Licensure have jointly issued Rule Chapter 10, Sexual Misconduct which may be found on the Board of Licensure in Medicine's web site here.  The rule defines "sexual violation" and "sexual impropriety," both of which are grounds for discipline.  A "boundary violation" need not involve physical contact, as communication may be deemed offensive by a patient.  The definition of "sexual impropriety" includes the following:

"inappropriate comments about or to the patient, including but not limited to making sexual comments about a patient’s body or underclothing;  making sexualized or sexually demeaning comments to a patient, criticizing the patient’s sexual orientation (homosexual, heterosexual, or bisexual); making comments about potential sexual performance during an examination or consultation (except when the examination or consultation is pertinent to the issue of sexual function or dysfunction); requesting details of sexual history or sexual likes or dislikes when not clinically indicated;"

A physician must, of course, act with caution and common sense in his or her interactions with patients, but the Code of Medical Ethics also suggests the use of chaperones to help prevent misunderstandings between physicians and patients.  Please see Opinion 1.2.4, Use of Chaperones.

If you have any questions about any of this guidance, please contact one of MMA's attorneys or your own private counsel.