Advertising the truth about who’s a physician

One can hardly fault patients for feeling confused — and more than a little cheated.

A billboard advertises the house call services of a nurse practitioner by using the abbreviation “Dr.” before her name. A nonphysician introduces himself to a patient as a doctor because he has a PhD in a field completely outside of medicine. Patients are discharged from the hospital with follow-up care instructions for their primary care physicians, only to find out at that point that the doctors aren’t really doctors at all.

These are some of the documented examples of midlevel health professionals and other nonphysicians misrepresenting themselves to patients, either directly or indirectly. They also are compelling reasons why a dozen states have enacted legislation prohibiting such misrepresentation. Now the rest of the states need to follow their leads.

Nonphysician misrepresentation is no trivial matter. When patients think they are talking with or receiving care from a physician, they are assuming that person has received years of intense education, training and clinical experience that nonphysicians never have. When they subsequently fail to receive the level of care and expertise that is commensurate with a physician’s background, the result can be more than unfulfilling to the patient; it can be extremely dangerous to the patient’s health.

That’s why the American Medical Association launched the Truth in Advertising campaign in 2009 (link). The effort provides model legislative language and other resources for states to use to ensure that nonphysician misrepresentation does not occur. In large part because of the campaign, half of the states have introduced such legislation, including the 12 that have passed their bills into law.

For example, in Pennsylvania, a law enacted in 2010 requires state health professionals during all patient encounters to wear standardized identification badges that clearly state their professional credentials. The state is drafting final regulations for the statute, but one mock-up of the badges includes large type at the bottom stating whether someone is, for instance, a physician, physician assistant or registered nurse. The ID would be color-coded to help provide another immediate visual signal to the patient about the credentials of the person with whom they are interacting.

These state measures are designed to protect the health of patients and ensure the transparency of the medical advice and care they receive, especially at critical treatment moments. And patients are very much on board with these efforts. According to a recent survey conducted by the AMA for its Truth in Advertising campaign, the vast majority of patients believe that only a medical or osteopathic doctor should be permitted to provide such care as diagnosing and treating heart conditions, performing eye surgery with a scalpel, and writing prescriptions for complex drugs that can be dangerous if misused.

Truth in advertising is something appreciated by consumers receiving all manner of services, but it is something that should be mandated in medicine. Most people would not be comfortable hiring a plumber, electrician or roofer who boasted about unearned credentials. They should have absolutely no comfort level with a midlevel health professional doing the same.

There is no question that nurse practitioners, registered nurses, physician assistants, certified nurse-midwives and other midlevel health professionals provide valuable patient services under the supervision of trained physicians. For many health needs, patients and physicians respect and trust in these professionals to provide high-quality, compassionate care.

But respect and trust are two-way streets. Nonphysicians who deliberately or passively allow patients to believe they are physicians when they really aren’t are abusing that well-earned trust and impugning the good work they and their colleagues are capable of doing. Moreover, they are endangering their patients’ health in cases where patients need to confide in or receive care from a physician. Full transparency should be something desired by everyone working in the health care field.

Happily, states are getting the message, in large part due to the work of the AMA Truth in Advertising campaign. Once everyone is on the same page when it comes to disclosure, patients will possess the full facts about the care they are receiving, and the physician-health professional team will be able to operate at its fullest potential to make them healthy again.