Ethics 101 – It’s Beyond My Scope of Practice

In medicine a lot of physicians categorize their patients as “good” patients or “bad” patients. Good patients are patients whose care is relatively easy for the physician to handle. The patient is compliant with recommendations, is motivated to get better, and is thankful for the doctor’s care. Bad patients are generally those patients who do not follow physician recommendations, who behave in a way detrimental to their own health, who are extremely high demand, and who threaten litigation. Good patients are more likely to do better with treatment. Bad patients are very likely to have a complication.

Some of these things are within the patient’s control. Some of these are not. Unfortunately, doctors do not always distinguish between difficult and complex medical problems and difficult and complex social problems. It is not uncommon for these patients to be homeless, poor, or with chronic health problems that are not properly cared for.

One scenario that occurs relatively frequently is when a physician passes a patient on to another physician. Often the doctor says that the patient’s medical problem is “beyond the scope of his practice.” Meaning that he is not comfortable treating the patient’s problem and that he recommends that patient see a “specialist.”

Sometimes this is a legitimate reason. Often times the doctor just does not want this patient in his practice. In the medical profession this is often referred to as “poaching” — when a doctor selects the “best” (often the ones who have good insurance) and leaves the other patients for other doctors to see.

As you can imagine, this practice is fraught with questionable ethics.

Should doctors have the right to pick and choose who they take care of? Should doctors be able to refuse care based on “scope of practice” even though the patient’s problem is a basic problem that any board certified physician must be able to handle to be licensed?