番茄社区

The Federation of State Medical Boards (FSMB) approved a policy at its annual meeting in New Orleans last weekend.

The guidance, written by FSMB's Ethics and Professionalism Committee, provides recommendations both for state medical boards when drafting their own policies, and for licensees regarding best practices.

"More than 2 years into this pandemic, the largest threat next to the spread of the virus itself is the spread of disinformation and misinformation," Humayun Chaudhry, DO, CEO and president of FSMB, said in an interview with 番茄社区.

Chaudhry noted that the first line of the document "sets the tone -- that truthful and accurate information is central to the provision of quality medical care."

"We acknowledge early on that [medical misinformation] isn't new," he said. "But it's important to keep in mind that when there is misinformed decision making, it can cause needless harm, including deaths."

The policy starts out by defining key terms, including misinformation and disinformation -- the distinction being that the latter involves intent -- and then by defining key principles including beneficence, non-maleficence, justice, autonomy, and professionalism.

It then jumps into recommendations for both boards and licensees. For boards, that includes adopting a policy, if they haven't already, that "clarifies board expectations regarding the dissemination of misinformation and disinformation by licensees."

Chaudhry said many boards believe they already have "adequate terminology and verbiage" within their statutes that enables them to take action against misinformation, as Oregon, Connecticut, and California have. But "not every state board has the necessary language," he added, and for those that don't, "a specific policy on misinformation is encouraged in light of the increased prevalence of and harm caused by physician misinformation in this ongoing pandemic."

Chaudhry noted that boards can consider the concept of informed consent in their policies. "Failure to adequately obtain informed consent by not providing adequate or truthful information to patients about proposed treatments could be a grounds for disciplinary action," he said.

But not all misinformation matters need to result in discipline, he continued. One recommendation specifically states that boards "consider whether there are options that do not involve disciplinary action."

Chaudhry said he's had conversations with state boards that have received complaints about physicians and misinformation, and when they reached out, the clinician wasn't aware of the misinformation.

"The physician didn't realize that what they were engaging in was actually misinformation, and made the necessary changes to the satisfaction of the state licensing board," Chaudhry explained. "We do encourage state boards, where possible ... to reach out and see if you can sort this out without having to resort to disciplinary action. Some of this misinformation could be unintentional."

Another recommendation states that boards "must retain their legislated authority to regulate the professional conduct of licensees in order to effectively protect the public."

Chaudhry noted that in the past 6 months, several proposed bills in state legislatures have sought to curb that authority, as policymakers pushed back against board stances on misinformation. Earlier this year, FSMB shared with 番茄社区 the list of proposed legislation that it's tracking in 14 states -- including Tennessee, where the debate has been particularly heated.

"State boards have legislative authority to regulate the professional conduct of licensees as part of their principal mission to protect the public that should be retained," he said.

As for recommendations for physicians and licensees, the guidance advises that proposed treatments must be supported by evidence or consensus, and if not, they must have an "appropriate scientific rationale and justification." Physicians need to be transparent about treatment recommendations, discussing the risks and benefits, as well as reasonable alternatives. The guidance also urges caution around off-label prescribing.

It also recommends against offering exemptions for vaccinations or other preventive measures not based on medical need, nor should doctors comply with requests to alter medical records or death certificates.

Doctors must also remain current with "evolving scientific evidence and practice standards," which Chaudhry acknowledged can be difficult during a pandemic. Licensees should also ensure they're up to speed with disciplines that may be a bit further afield of medicine, including statistics, epidemiology, and public health, the guidance notes.

Finally, FSMB recommends that doctors listen respectfully when confronted by misinformed patients. "Don't interrupt the patient and make sure you understand what the concern is before you offer guidance," Chaudhry said.

"I think there's an undertone throughout the document about the need for thoughtful, civil discussions among colleagues and with patients," he added. "Patients may come in with preconceived notions, but they should be engaged with respectfully and honestly."

Chaudhry noted that it's ultimately up to the 70 state member boards to amend or adopt their own misinformation policies.

"They don't have to do anything," he said, "but we know our policies are often influential, so we are very careful with every word and every punctuation because sometimes what we recommend does become state law."

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