Many physicians face the same dilemma: Should they personally provide medical care to their employees? Treating staff members and other nonpatients (defined as people treated outside the standard office relationship, usually without documentation) appears to be extremely widespread. Some studies have reported that nearly 100% of physicians engage in this practice.

At first glance, treating staff members would seem to be a straightforward, valuable employment benefit that physicians can provide for little cost. Certainly, the practice is convenient for employees of medical practices.

Expense is another plus, at least from the employees’ point of view. Some physicians provide care at no charge—or they charge only out-of-pocket expenses for supplies, injections and so on.

But once a physician begins to treat an employee, a patient-physician relationship is established, making the doctor legally liable for the interaction and its consequences.

And when sensitive issues are involved—as they often are with medical problems—relating to employees in this way can easily expose you and your practice to costly litigation.

Be Aware of the Pitfalls
Treating staff members can be rife with potential problems. Some prime examples:

• You may be tempted to keep less-than-thorough records of the care you deliver to your own staff. This can be especially true with regard to documenting psychosocial factors in appropriate detail, because you know that all of your employees have access to the record (regardless of the office rules).
• You may give an employee advice while you’re hurrying down a hallway or getting into your car. Again, nothing shows up in the chart, no vital signs are taken and your physician colleagues have no way of knowing which drug samples you may have given to the employee.
• Because of the confidentiality issue, your employees may be reluctant to use your services to the extent that they should. For instance, a female staff member may be willing to have you check out her cold, but be extremely reluctant to have you perform something as personal as a pelvic exam. As a result, that employee might not receive the care she needs to maintain good health.
• The issue of charging for your services can be fraught with problems. If one doctor in a group charges and another does not, guess which doctor the employees will gravitate toward?

  If you write off charges for one employee, shouldn’t all of your employees receive the same treatment? If you write off charges for all your employees and their families, how do you handle the chronically ill employee with four chronically ill family members who take up an inordinate amount of your time?

In light of all these issues, any decision to provide healthcare to employees should be given careful consideration. The American College of Physicians discourages the practice of treating staff members; the organization’s ethics manual asserts that “physicians should be very cautious about assuming the care of closely associated employees.”

The question every doctor needs to answer is, “Do I really want to treat my staff?” Remember, deciding not to provide such care is a perfectly acceptable position. You’ll never get into trouble by politely saying no, while you may get into all sorts of trouble by saying yes. Whatever you decide, make your policy clear in your personnel manual and stick to it.

Steps to Reduce Your Risk
If you do opt to provide medical care to your employees, you need to take measures to minimize the chance of problems arising:

• Limit your treatment of employees to minor medical problems or emergencies.
• Clearly communicate to all employees that such treatment is not mandatory and that they’re free to obtain medical care elsewhere whenever and wherever they want.
• Maintain high standards of care. Insist on the same criteria and procedures for evaluating and treating your employees that you use for your regular patients.
• Document all encounters as to complaint, findings, treatment plan and progress. Document any provision of medication samples to employees.
• Avoid prescribing controlled substances. Federal law states that a doctor must have a bona fide patient-physician relationship —including a written record of the relationship—before prescribing controlled substances. Some states require a documented medical history and a physical exam before prescribing any medication.
• Do not conduct sensitive physical exams on an employee without having a witness in the room.
• Be consistent. If possible, make sure all physicians in your group follow the same protocol with respect to taking care of employees.

By following the guidelines noted above, doctors who provide direct medical care to staff members will be less likely to find themselves in a court of law.