Fam Pract Manag. 1999 Feb;6(2):50.

Legal risks of giving a reference


My office manager recently resigned. She argued with patients and did not get along with other staff members. She applied for a similar position with a colleague, who would like my opinion about her qualifications. How should I respond?


Generally, the best policy for reference requests is to confirm dates of employment and give a general description of the former employee's job responsibilities. To be safe, don't give information about the final salary without signed consent from the former employee. Giving additional information may violate equal employment opportunity laws and the employee's right to privacy. And it may put you at legal risk from a claim of defamation by your former employee.

The number of employees filing defamation suits against employers is rising. Defamation is the publication of a false oral or written statement that harms the reputation of another person. Although truth is an absolute defense against a claim of defamation, you should not communicate truthful but negative information about a person under the following circumstances:

  • You do not believe the truth of it,

  • You believe the truth of it, but have no reasonable grounds for your belief,

  • The person asking for information doesn't have a need to know it,

  • The information is not responsive to the inquiry,

  • The information is given out of malice, not for legitimate purposes.

Defamation laws vary by state, and you should consult an attorney in questionable situations.

Since your colleague is asking your opinion, you may be tempted to tell this person the whole story, both good and bad. Just remember that “silence speaks volumes”; if you don't give a glowing recommendation punctuated with positive comments, your colleague can read between the lines and realize you had problems with the employee.

Teaming up physicians and midlevel providers


Our practice has three doctors, two nurse practitioners (NPs) and one physician assistant (PA). We currently have the NPs and PA working separately on acute care problems, but we've discussed pairing them with doctors to create teams. How can we set this up to help our physicians as well as our acute care patients?


It depends on your practice's requirements for supervision of midlevel providers (MLPs). However, if we assume that a midlevel provider functions as part of a team that is supervised by a physician, certain principles might follow.

Patients should be assured that they will have a personal physician but that some of their visits will be with well-trained MLPs who work closely with their physician. Complex problems and questions should always be handled by the physician.

Many simple conditions or visits are amenable to using protocols, which standardize the MLP's approach to conditions, facilitate standing orders and pre-signed prescription use, and ease physician concerns regarding how these cases are handled.

While most acute, walk-in or triage cases can be handled by an MLP or a physician, some are better handled by a physician. Since it is often difficult to decide who should take which case, it is helpful to create a protocol to guide triage decisions. This can help determine who sees the patient when. I have described such a protocol in FPM (see “Using Midlevel Providers: One Clinic's Approach,” April 1995).

By agreeing to an appropriate team structure, reassuring patients about the structure and thereby “selling” the concept to them, a working relationship between physicians and MLPs has the potential to improve efficiency and increase productivity. In my experience, assigning a particular MLP to a particular physician is more likely to be successful than a global, loose association of physicians and MLPs.

Medicare HMOs and “teaching physician” rules


If an elderly patient is covered by a Medicare HMO insurance product rather than by traditional Medicare, do all or some of the HCFA “teaching physician” rules for a family practice residency program still apply?


The Medicare teaching physician rules govern the conditions under which a teaching physician may bill Medicare and receive payment for services that also involve the use of a resident. In the case of a Medicare HMO patient, the physician typically does not bill Medicare. Instead, Medicare pays the HMO monthly based on the number of members signed up, and the HMO negotiates its own arrangement with the physician. Accordingly, the Medicare teaching physician rules would not ordinarily apply in the case of a Medicare HMO patient.


Copyright © 1999 by the American Academy of Family Physicians.
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