Excerpt From Medical Ethics: Real-World Application By Afshin Nasser

State Medical Boards

The medical board’s duty is to protect the public, not the physician. State medical boards today focus on licensed physicians who violate professional ethics, and their mandate has significantly evolved to focus on disciplining physicians.

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The medical board’s duty is to protect the public, not the physician. State medical boards today focus on licensed physicians who violate professional ethics, and their mandate has significantly evolved to focus on disciplining physicians.

The state defines the license to practice medicine as a privilege, not a right, and the state medical board that grants a license can also revoke it. If the board, for any reason, suspects, a lack of professionalism in serving patients in a safe manner, the medical license is at risk.

Disciplinary Action
Physicians who hold their positions in society are invited to respond to patient complaints in a very subtle manner. This invitation unfolds in a way which strips the physician of everything they have worked for all their lives, and their dignity and pride are often seemingly shattered.
Unfortunately, the medical boards do not always use proper discretion with regards to media and release of information before a full investigation. Thus, the media has a field day, and it is open season on the physician and their families.

Boards are under increasing pressure to discipline violators. Ultimately, it is the board that makes the final decision, not the physician, and legal counsel serves as a witness to ensure a proper administrative procedure. Legal Counsel may present evidence on a physician’s behalf, and will be heard, but again, the board makes the final decision, and is not to be compared with civil courts.
Complaints against the physician can come from any source: patients, employees, hospitals, and pharmacists, to name a few. The medical board will primarily side with the patient, regardless of patients’ actions which may have led to the physician violation. The board may suspend a medical license until a hearing can be held, and if the violation appears severe, the board may choose to investigate using their investigative team, in the same manner and authority as a criminal investigation by the police. The board will work closely with state, federal, and local law enforcement when they deem necessary.

Once the board files a charge the physician and his/her attorney can request a conference. If a settlement is reached, the board will issue a consent order which precludes any appeals. Most physicians choose consent orders, as they are the quickest, least expensive path and allows them to get back on track. However, this settlement will be public record and may increase malpractice rates, and lead to being blacklisted with many insurance companies as payors.

In case a settlement is not agreed upon, a formal hearing will follow. An administrative judge presides over the hearing, where witnesses are questioned by both sides, and evidence is presented. The presiding judge does not hold the final decision but issues a recommendation which the board votes to accept or reject. Keep in mind, this is not a civil court, and there is no presumption of innocence. So, no matter how convinced one is that an accuser lacks proof for charges and that the evidence is in one’s favor, it is the board that will ultimately decides. There are limited rights of appeal, and they often prove to be unsuccessful.

Most physicians disciplined by the boards are convinced they have been treated unfairly. Over the years, the disciplined physicians succumb to the 5 stages of grief: denial, anger, bargaining, depression, and finally acceptance, that the ultimate decision regarding their livelihood lies with the state medical boards.

Medical boards may suspend a license for a period, or completely revoke it. Whether the violation is minor, which may lead to fines, or a formal reprimand, a physician’s license is not affected until a true suspension or revocation.

The medical board may require the physician to complete continuing medical education courses, or be evaluated for competency and medical aptitude, or undergo treatment at a state Physicians Health Program, before reentering medical practice. The return to practice may also be conditional, involving a mentor or a practice monitoring agency, or by having designated chaperones. Chaperones should be considered akin to medical malpractice insurance and having a chaperone at every visit provides the physician with a live witness. The medical board can revoke a license if the restrictions put forth are not followed.
Make no mistake: members of the medical board are regular people of different professions who may live next door. One of them may be an attorney, a doctor, nurse, engineer, social worker, or a businessperson, and they all have established opinions on ethics.
● The board’s duty is to protect the public, never the physician
● The board always sides with patients, known as “vulnerable parties”
● Boundaries are open to board interpretation.
● There is no consensual sex between a doctor and a patient.
● Patient trust is a professional duty and a condition of licensure.
● A “dual relationship” with a patient jeopardizes objectivity.
● The physician is responsible for managing the relationship with patients, the staff, and anyone involved in any way in the medical practice, regardless of behavior or motivations.
● Avoid disciplinary actions: once it starts, it does not end, and you will become a target.

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State Medical Boards

The medical board’s duty is to protect the public, not the physician. State medical boards today focus on licensed physicians who violate professional ethics, and their mandate has significantly evolved to focus on disciplining physicians.

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Boundary Violation

Boundaries create a therapeutic distance between physician and patient and clarify their respective roles and expectations. Boundaries define limits of the therapeutic relationship.

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Medical Ethics: Real-World Application By Afshin Nasser

You may have acquired this book as a result of conflicts with peers, administrators, patients, or State Medical Boards, where the outcomes of those interactions have left you wondering, “…what if I had done things differently?”

In that case, I hope that this book answers some of your questions and guides you with regards to any future quandaries you may encounter.


If you are a healthcare worker seeking to understand the subject of medical ethics, then I hope this book helps you acquire the clarity you seek.
If you are an individual simply curious about medical ethics, then I raise my hat to you for your pursuit of knowledge.