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
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.