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Routine Procedures

A final problem area involves the extent to which medical students can perform routine work when not under the direct supervision of a licensed physician. This situation usually arises in the context of outpatient clinics or emergency rooms. The student may make the initial patient contact, take the history, perform the physical exam and recommend therapy. This is all proper (assuming that the medical student has been identified as such), but the supervising physician must make the final medical decisions.

The question is to what extent the supervising physician must verify the data provided by the medical student. At a minimum, the supervising physician must actually see the patient. Prudence would also dictate a few pertinent questions and a rudimentary examination. the supervising physician must satisfy the state's medical practice act (which may only entail seeing the patient), but the physician should also conduct enough of an exam to justify the student's diagnosis and therapy. This has great risk management significance. The supervising physician has the legal liability for the diagnosis and therapy of the patient, regardless of whether the physician has seen the patient. The medical student can create a provider-patient relationship between the patient and the health care provider who is responsible for the student. This responsibility must be carefully considered when a physician supervises a medical student outside the environment of a teaching hospital.

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