Question: I practice in a large health administration system of multiple hospitals and clinics. Patients who have already received prescriptions outside the system may have them filed within the system. Our leadership has mandated the ophthalmology department to review, validate, and rewrite the prescriptions from outside providers with our signature. We have never examined these patients, nor do we have a patient/physician relationship with any of them. I believe this is unethical and may violate our state medical practice act.
Answer: If you were to follow the mandate as described, you would be in violation of the AAO Code of Ethics Rules 6, 9, and 10. The full text of these Rules can be found at aao.org/ethics-detail/code-of-ethics.
Rule 6 addresses pretreatment assessment of patients and states, in part, that “If (the) pretreatment evaluation is performed by another health care provider, the ophthalmologist must assure that the evaluation accurately documents the ophthalmic findings and the indications for treatment.” Neither you nor your colleagues are able to “validate” prescriptions from other health care providers without examining the patients in person and determining whether other providers’ treatment recommendations are accurate and indicated.
Furthermore, signing prescriptions and documenting this action in patients charts without having examined these patients would violate Rule 9 of the Code, which states, in part, that “an ophthalmologist must not misrepresent the service that is performed” nor “alter the medical record.” Documenting an examination that was not conducted is misrepresentation of the facts, and removing the community health care provider’s name from the patient’s care history may be seen as an alteration of the record.
Lastly, without personal evaluation of these patients to confirm recommendations for treatment, involved ophthalmologists risk a violation of Rule 10, which states, in part, “Ordering unnecessary procedures or materials or withholding necessary procedures or materials is unethical.”
This mandate is simply not in the best interests of patients, and adherence to it will risk violations of the AAO Code of Ethics.
To read the Code of Ethics, visit https://www.aao.org/ethics-detail/code-of-ethics
To submit a question, email ethics@aao.org