Medical Students
Medical students are often enthusiastic about new clinical opportunities, and it is tempting to let them try their hand at patient care, particularly if the problem seems simple. This situation can jeopardize a student’s future. A medical student who is accused of practicing medicine without a license, even if it is at the instigation of a supervising physician, may not be allowed to complete his or her degree. Even if the school awards the student a degree, it may be difficult or impossible for the student to get a license, residency training, or malpractice insurance. Supervising physicians must protect themselves and their students from the temptation to delegate too much authority.
The practice of introducing a medical student to patients as “doctor,” “young doctor,” or a “student doctor” is fraud. A reasonable person introduced to a doctor in a medical setting assumes that this term denotes a licensed physician with a doctoral degree in medicine. Even holders of other doctoral degrees should not be introduced to patients as a doctor. A medical student who has a Ph.D. should not use the title in a medical setting in situations when it can lead to confusion. If a person with a Ph.D. is working in a medical setting, the difference should be explained to every patient. An example of a proper introduction might be introducing a clinical pharmacologist to a patient by saying the following: “This is Doctor Jones. Dr. Jones is a doctor of pharmacology who is trying to help us work out the problem with your medications.” This tells the patient that Doctor Jones is not a medical doctor and why a pharmacologist is involved in the patient’s care.
No matter how capable the student or how close to finishing training, medical students do not have the legal authority to practice medicine. Everything that a student does must be reviewed and checked by a licensed physician. The student should not be allowed even as much independence as a nurse or a paraprofessional. It may be permissible for a physician to delegate certain tasks to a nurse under protocol that should not be delegated to a medical student. The legal assumption is that the student is there to be taught. If the student knew the tasks well enough to be allowed to do them unsupervised, then he or she would not need to be doing them.
Under no circumstances should the student be used as a substitute for the physician in completing routine physician tasks. It is tempting to use medical students to do admission histories and physicals or to evaluate a patient without supervision, but it is very dangerous legally. If anything untoward happens to the patient, the physician will be responsible and will be in the position of having injured a patient by not fulfilling his or her medical duties. The attending physician must personally do the history and physical, not just cosign the work of a nonphysician.
The writing of orders and prescriptions is limited to physicians and other health care professionals who are properly licensed in the state. This may never be done by a medical student. A student may act as a transcriber of orders if it is the licensed physician who signs or approves them. Hospital and office staff should never act on an order from a medical student until it has been cosigned or otherwise endorsed by the attending physician. Even in an emergency, a nurse should follow established protocols and the orders of an appropriate physician, not the advice of a medical student.
It is particularly important to follow the laws of medical practice when prescribing or ordering drugs in a teaching situation. Most boards of medical examiners tend to be lenient toward physicians and medical students in the division of work. State and federal drug enforcement agencies are much less understanding. The rule is simple: only licensed persons may prescribe or dispense drugs. Those who violate this rule may be subjected to criminal prosecution and the punishments prescribed by law. The fact that the unlicensed prescriber is a student will only make prosecution politically easier.