Should Physicians Face Disciplinary Actions for Misinformation?

[MUSIC PLAYING] Welcome, everyone. You're watching Coronavirus in Context. I'm Dr. John Whyte, chief medical officer at WebMD. We know that everyone is not following guidelines, wearing masks, physical distancing. There's a lot of misinformation out there.

Sometimes it's doctors that are promoting this misinformation and not following guidelines. Should they be disciplined? Should they risk losing their license? To help provide some insights, I've asked my friend, Dr. Hank Chaudhry, the president and CEO of the Federation of State Medical Boards. Dr. Chaudhry, thanks for joining me.

Thank you, John. Delighted to be with you.

Let's start off and remind our viewers, what does the Federation of State Medical Boards do?

So the Federation of State Medical Boards is the umbrella agency for the nation's state medical licensing boards. And we were founded in 1912. So we've been around a long time.

People don't always know what a state medical board does. Sometimes physicians don't even know. We're not involved in specialty certification, for example, but we do issue the initial legal right to practice medicine to our nation's physicians and to PAs.

It's been reported that some physician offices are not following CDC guidelines as it relates to mitigation strategies-- wearing masks, physical distancing, not letting people crowd in a waiting room. You've been quoted to talk about what the role of a state licensing board should be. We know that, as you talked about, the state licensing boards license physicians. But they're also responsible for disciplining physicians. Should physicians who don't follow the CDC guidelines be disciplined by their state medical boards?

Well, John, you bring up a very important point. The primary mission of a state medical board by law is to protect the public. And as harrowing as this pandemic has been, it's been a challenge for the state licensing boards, because there is considerable leeway, as you and I know as physicians, that are allowed.

We can use off medications that are approved for off-label use, for example, as long as there's some basis in science. Guidelines serve a purpose. And certainly national guidelines from federal agencies like the FDA and CDC, just to name two, are critical to helping address this pandemic.

But we've had a number of issues this past year with physicians, for example. It's one thing to recommend a particular therapy. It's another to promise a cure. We don't do that in medicine.

American people are being asked to wear masks and social distance. And we have heard complaints from state licensing boards of patients saying they're doing what they're supposed to be doing. How come their doctor isn't? And that's been a concern that we've had to address in some cases by statute, in some cases by regulations.

But it's a dynamic process. And I suspect it'll continue as more issues happen, like with the variant of the virus as well. There's a lot of misinformation out there.

So explain it in practical terms to our viewers. Does that mean licensing boards are engaging with the physicians who aren't complying with guidelines? It can be challenging, because usually, we're talking about therapeutic treatments or diagnostic abilities, not necessarily following public health guidelines in the practice of medicine. So what has-- or have there been some cases that have been out there in public that people are aware of?

There have been. And it's a challenging situation for the state licensing boards, because, obviously, we are not in the room when a doctor or a provider is meeting with a patient. So it's a complaint-based system. The state boards don't know what they don't know.

So if they get a complaint, however, they are obligated to follow up on every complaint. Not every complaint warrants an investigation. Many do. And so the state boards have received complaints, for example, of a lack of social distancing in waiting rooms of doctors, for example, or in some extreme cases we saw in Oregon, where there was a physician who outright refused to wear a mask at all on ideological grounds. Now it's one thing to--

Ideological? Is that-- what's that? So what--

It's one thing to have your beliefs. But when it impacts the care of patients, that's when it becomes an issue.

Or science, too.

Yes.

In that case, do the medical boards typically get involved and counsel the physician?

Well, as I say, it's happened in several states. And the good news, I suppose, is that every time that I'm aware of, in most cases, the state boards, when they reached out to the doctor and said look, we've gotten a complaint, this is a concern, the state-- the physicians have done the right thing. I think they recognize at the end of the day, the license to practice medicine is very important to them. And patient safety is important.

And sometimes a nudge or a reminder from a state licensing authority can be quite effective. And that has been the case. It's been rare that a physician has had to have their license suspended. That's happened just once that I'm aware of. But we'll have to see how the months ensue.

Let's talk about misinformation on the web, misinformation on social media, the public. We've seen instances where people have advocated for certain types of cures for which there is no data. We've heard talk, let's just put it out there, about alien DNA. We've heard lots of information that's just not accurate.

What's the role of the medical boards in terms of physicians who are voicing an opinion, a belief on social media? Do medical boards have authority there to intervene? This can be dangerous in terms of giving misinformation from a physician to the public.

Absolutely, John. And we always fall back on is it a patient safety issue? Does it impact the welfare and health of the general public? And if it does, the state boards will reach out to the doctor, the licensee, try to work it out if they can. And if not, they'll have to take action.

Currently right now, what we're dealing with, you may be aware, several governors of states, as we talk about vaccination, are warning doctors with their licensing boards beside them that if guidelines are not followed, then their license could be at risk. So that's sort of the ultimate thing we can do, the state licensing authorities, is to threaten to suspend or revoke a license to practice medicine. Most of the time we prefer to chat with a licensed provider to see if we can work out what the issue is. But accuracy, science-based advice is critical. People are entitled to their opinions, but not when it impacts patient safety.

So it's in the practice is one thing. But what about when they're going on social media with their attribution of being a physician or in the press and spreading misinformation? Let's address kind of the elephant in the room. People have suggested that Dr. Atlas be investigated by the medical board, because the belief is that he has spread misinformation. I'm not going to get into the merits of that.

But what about that issue in terms of-- medical boards notoriously have been criticized for not being aggressive in investigating physicians. You've done a lot to help broaden the scope of medical boards, especially in terms of quality of care, focusing on it that way. But what about going after physicians who are spreading dangerous misinformation either online or in the media?

Excellent point, John. We have seen issues and concerns with a number of doctors who are using social media and other public platforms to make certain claims. And we have received complaints. As I say, every complaint warrants a follow up, in many cases.

And each case is handled differently. The ones that make the news are when a license is suspended or revoked. But that doesn't mean there isn't other action that can be taken behind the scenes. And so you hear about the license revocations in the newspapers and the media. You don't always hear about the steps that are taken behind the scenes to try to get the doctors to do the right thing.

There have been complaints about a number of public figures, and I should add not just physicians. We've had complaints about public officials practicing medicine without a license. There's limited jurisdiction there. But when it comes to doctors, we are happy to follow up and communicate with them, because one of the biggest examples we've had is doctors claiming, for example, some months back that hydroxychloroquine was a cure.

The Texas Medical Board, as one example, had to issue a public statement reminding doctors that we don't make claims of cures, especially without some scientific backing. And so those kinds of statements, if necessary, will be issued. But if stronger action is needed, the state boards will take action if a complaint is warranted.

Do lawyers do a better job of policing their profession than the medical community?

My father's an attorney. My son just graduated law school. So I can't really comment on the legal profession. But we do have very close working relationships, I should mention since you bring it up, with our colleagues in the nursing, pharmacy, physical therapy, and other partner agencies.

And they're struggling with the same issues as well, with misinformation is one thing. But there's also disinformation, where people may have ulterior motives or certain beliefs. Misinformation sometimes also happens when it's hard to keep up with the science. It changes daily, as you know.

Even with this new variant, the B117, every day, literally, there's new information coming in. And some of that is understandable. People are well intentioned. But doctors need to recognize that they have a platform, a megaphone.

And whether they realize or not, their words matter. And it's not just a free speech issue. It can impact patient safety.

Are there guidelines for physicians for the use of social media?

There are. Several years ago, the Federation of State Medical Boards partnered with the American College of Physicians, which, as you know, is the world's largest specialty organization, more than 130,000 members, and put together a guideline of how to stay out of trouble. And a lot of it was to remind doctors that when they post a tweet or a text that's publicly available, there's a permanence associated with such a statement, and that it can be taken out of context. It can be used in ways that are not intended.

So it's a guideline about how to stay out of trouble. But it's also a guidance for doctors about how to stay within professional bounds. You certainly don't want to see social media being used for inappropriate claims or for inappropriate contact with patients either, which we've had some issues with.

And what if patients have a concern about the behavior of a physician? What should they do? Usually the first remedy isn't necessarily to contact the medical board. Or is it? Is it to engage in the physician? Is it simply to leave the practice?

What should listeners do if they have a concern about a post that they think is inaccurate on social media from an account that identifies with a physician? Or they go into the office for an actual visit and they're concerned about the number of people in the waiting room or the doctor may not be wearing a mask? What counsel do you have up to viewers, recognizing that we're trying to do this from the perspective of protecting everyone and improving quality of care.

Absolutely, John. And I think the vast majority-- there's a million licensed physicians in the United States, about 120,000 physician assistants. I think whenever there is confusion during an encounter with a licensed provider or if something doesn't make sense, it's perfectly appropriate, in fact necessary for the patient to speak up and ask for clarification, clarity.

We believe in patient-centered medicine. That's just not a catchphrase. Doctors really believe in that. And so they have every right to ask about the diagnosis or treatment that they're getting or if they have questions about whether guidelines are being followed. And if they have a concern that's not being addressed by either the doctor, or in the case of a hospital or other institution, by an employer, then certainly, the state medical board is available to address those complaints as well. That's why they were created, to allow for those kinds of interventions on behalf of patients if necessary.

Dr. Chaudhry, I want to thank you for taking the time today for providing your insights, for being a leader and really talking about how do we make sure we get the best information to consumers from the medical profession, as well as how do we keep everyone safe-- physicians, other health professionals, and the public.

Well, thank you very much, John, for this opportunity. These are uncertain and trying times. But it's important for us to stay connected and for the profession to do what's right on behalf of its patients. Thank you.

And I want to thank you for watching Coronavirus in Context.