There is no law that specifically prohibits a doctor from evaluating, diagnosing, treating or prescribing to a family member, employee or friend. However, the practice is discouraged. Laws regarding prescribing controlled medications without an exam or without documentation are Federal and do need to be followed for all patients.
Doctors form relationships with patients known as the doctor-patient relationship. As an employer, doctors form a relationship referred to as the doctor-employee relationship. When employees become patients, these relationships can blur. In the event that an employee needs to be terminated, it may be difficult to maintain the doctor-patient relationship. In the event that you need to dismiss the patient-employee from the practice, it may be difficult to continue the doctor-employee relationship.
Issues such as HIPAA privacy rules, special treatment and payments also muddy the waters when treating employees. Special care must be taken to ensure the privacy of the medical record. Patient-employee medical records should be marked as confidential. Electronic records should be locked allowing access only to the provider and paper records should be stored separately in an area that is secure. Waiving insurance co-pays and deductibles may be a violation of the terms of managed care contracts. Doctor objectivity can sometimes be difficult when treating employees and oftentimes employees' care may suffer if they are too embarrassed to disclose certain relevant health information to their doctor who is also their employer.
In rural or underserved areas seeking care outside of the employer's office is not always possible or practical. In the event that the practice elects to provide services to employees, it is always a good idea to have a strict written policy. This policy should be reviewed with employees upon hire from the prospective of a patient and also during their orientation process from the perspective of an employee handling other employees Protected Health Information. When creating a policy for your office, please consider including the following information.
- Regular audits of the medical record should include a report of who has accessed Protected Health Information.
- Employees should be treated like any other patient. They should be registered in the Practice Management system.
- Consider having another person present during a physical exam of a sensitive nature.
- The payment policy should address the issue of free care or waived co-pays and deductibles.
- Document all encounters to include complaint, findings, treatment, plan and progress.
- Make certain that Federal Regulations are consistent with the requirement for a controlled substance. Prescribing only for a legitimate medical purpose by a practitioner acting in the usual course of professional practice.