Request for Advisory Opinions Sent to Licensing Boards

Sent to three licensing boards. 

I am licensed in medicine by your board. I request advisory opinions on the following scenarios with patients. To make things easier for you, I request that you rate the conduct described as unprofessional (U) or acceptable legally and regulatorily (A). You should expect that any opinion you send will be shared with others.

1) A child patient has behaved well with parent earlier, and during an exam. Doctor gives him a lollipop, saying, “This is for your good behavior today.” The cost of the lollipop is 50 cents.

2) A state mental hospital doctor pays an eager mental patient $10 for washing his car, while the car is in the state hospital parking lot, during work hours. Both parties are satisfied by the result.

3) Patients in a program are raising money for an activity. They organize a bake sale or a car wash. A doctor who works there pays $100 for a cake with a $5 charge tag, or a car wash costing $10.

4) A doctor needs computer services. A current patient is unemployed, and desperate for any income. The doctor pays his full fee, for a contract worth $10,000, mutually benefitting both parties. There is no contract dispute, where abuse of private knowledge can be used.

5) Same as 4), but there is a private, not a public contract dispute. The doctor uses personal knowledge about the weak spots of the patient to bully a favorable settlement from the patient.

6) A doctor “friends” a patient on Facebook.

7) As a Facebook “friend,” he sees messages on the page of the patient that he has begun drinking alcohol again, and stopped his blood pressure medication. The patient does not reveal these changes, actually denies them,  during a routine visit to the doctor. The doctor confronts and berates the patient (politely, yet firmly) about non-adherence to treatment. This is a reverse scenario as a violation of confidential health information. It uses public information in a private medical encounter.

8) As a Facebook friend, the doctor sees the patient plans to commit suicide or to kill his parents. The patient also says, he has collected a number of working guns. These intentions are denied in medical follow up sessions. Is there a duty to warn under the Tarasoff doctrine? Again this is the use of public information, superceding confidential denials during medical visits in the office.

9) The doctor and a patient fall in love. The doctor refers the patient to another doctor in the same specialty. They have sex, and eventually get divorced from their respective spouses and marry each other. (Please, review this question in light of two cases, Lawrence v Texas at the Supreme Court of the US, and Long v Ostroff decided at the Pennsylvania Superior Court).