AMA: Diagnosing disease and interpreting tests is the practice of medicine

  1. found at physician news digest, philadelphia edition 11/29/2006

    [font=verdana,geneva,arial,helvetica,sans-serif][font=verdana,geneva,arial,helvetica,sans-serif]diagnosing disease and interpreting tests is the practice of medicine, and physicians should be supervising any work by nonphysicians in that area, says a new ama policy.

    [font=verdana,geneva,arial,helvetica,sans-serif]delegates to the association's interim meeting in november said laboratory workers – including phd scientists – are getting more involved in new lab technologies that require specialized training and education, but such training does not include the ability to make a diagnostic interpretation for patients, reported american medical news. while specialty societies representing nonphysician lab personnel and phd scientists want to expand their scope of work to independent practice in clinical settings, physicians at the meeting said that patients are best protected when doctors assess clinical and laboratory data to make a diagnosis, amnews noted. the new policy states that a phd clinical lab scientist or other nonphysician lab personnel should work under supervision of a physician to perform tests that will be the basis of a diagnostic interpretation for a patient, and that the medicare physician fee schedule should pay only authorized persons for the diagnostic interpretation and should not provide payments directly to nonphysician lab personnel working under a physician's supervision, amnews added.

    [font=verdana,geneva,arial,helvetica,sans-serif]american medical news, december 4, 2006
    [font=verdana,geneva,arial,helvetica,sans-serif]read on...
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  2. 22 Comments

  3. by   augigi
    Gee, big surprise that the AMA thinks that....
  4. by   SharonH, RN
    and that the Medicare physician fee schedule should pay only authorized persons for the diagnostic interpretation and should not provide payments directly to nonphysician lab personnel working under a physician's supervision

    And thus we get to the real heart of the matter.......
  5. by   SmilingBluEyes
    indeed, Sharon.
  6. by   CHATSDALE
    nursing dx: nurses are trained to observe, with observation comes interpretion with will result in dx...but should not be put as a dx on chart but perhaps: to R/O ________


    sometimes MDs get a little full of themselves
  7. by   ICRN2008
    And the pathologists state that they are not trying to hold down salaries for medical technologists/clinical laboratory scientists...yeah right!

    It comes down to power and money. Beware any health care profession that tries to expand their scope of practice, because the physicians will be after you in a second!
  8. by   Indy
    Hmm. I think I agree with the physicians on this one. The person doing the test isn't the person seeing the patient. I don't want a diagnosis from someone who hasn't laid eyes/hands on me. And if they're trying to bill for something they legally aren't allowed to do, i.e. interpretation, well, wouldn't that fall under fraud?

    Unless one person's idea of what "interpretation" means, differs from someone else's idea, which, with insurance and all that, might very well be what they're talking about. Does "interpretation" mean putting results in a format that shows if they are high or low? If so, then pay them for it, 'cause that's what happens. If not, if it means actual diagnosis, then no, sorry, I'll go with the physicians on this one, that's their territory.

    I don't think this is at all related to nursing diagnosis, which, in my mind, is a system to teach nursing students to bang their heads into a concrete wall. We all know that we interpret lab results for ourselves, but we do it to have an idea of what to do with the patient; i.e., safety issues: Positive D-Dimer, add in our observations of the patient and we have a possible PE, well duh, of course we call the doc... We're participating in diagnosis every day but there is a LOT of patient contact. So I don't think it relates very well to the clinical lab issue.

    Other than the money issue, I sort of saw this article as an attempt to point out the obvious.
  9. by   oramar
    How do those NPs in all the Eckard drug stores that work independandly fit into this equation?
  10. by   SharonH, RN
    Quote from Indy
    Hmm. I think I agree with the physicians on this one. The person doing the test isn't the person seeing the patient. I don't want a diagnosis from someone who hasn't laid eyes/hands on me. And if they're trying to bill for something they legally aren't allowed to do, i.e. interpretation, well, wouldn't that fall under fraud?

    This is typical of how physicians attempt to confuse the issue and make people believe that nonphysicians are trying to encroach on their territory. They start off by saying "only physicians should diagnose disease and interpret tests" and people think "well gee that's reasonable, ya of course".


    But if you go on to read, they never actually state that clinical scientists are attempting to do that, their real issue is that they believe that a PhD clinical lab scientist or other nonphysician lab personnel should work under supervision of a physician to perform tests that will be the basis of a diagnostic interpretation for a patient thus they should be the only ones billing for the tests. Do you really think that a medical technologist needs the supervision of a physician to perform a test? If the physician orders it, they don't need to be "supervised" in the performance of the testing and there is no reason why they shouldn't be able to do the billing for their portion of the work which is the only REAL issue for the physicians.
  11. by   Indy
    Hmm. So what physician wants to supervise them? I'm guessing there aren't many signing up for that job, unless it's a position that involves printing the doc's name on the printouts as the lab director or something...

    And how do they expect the employees who perform the tests to get paid? I thought the facility bills for the tests... This is making less sense to me the more I think about it.
  12. by   jeffrey_rn
    We can spend our time criticizing the obvious power ploys that the AMA uses to protect its members or... we can learn the lesson: this is how a profession preserves itself. This is how a profession maintains its status and pay scale.

    We can try to pick apart the AMA (basically, it's the doctors' union) or we can follow its lead. We need a like-minded and determined ANA. One that protects and defends our territory with equal doggedness.

    I would even propose we have an "ARNA" that aggressively and exclusively serves the RN workforce and prevents it from being watered-down by low standards and other professional forces to the point of being severely lessened and thus liquidated.

    Here's to the American Registered Nurses' Association!!!
  13. by   Gromit
    Jeffs right on this. What the AMA is doing is protecting its' own interests. They aren't there to (nor are they interested in doing so) protect the interests of the techs or lab personnel (or even OURS). They are doing what they are supposed to do: Protect and further the interests of the docs.
    We would be well served if we did likewise. Sadly, there really isn't much unity in our ranks. We would be a powerful force to contend with if we were unified in a common set of goals.
  14. by   juan de la cruz
    I have to agree with the AMA on that. Diagnosing a condition is a process that involves knowing the patient's presenting complaints, medical history, physically examining the patient, and analyzing results of diagnostic examinations. Just because a diagnostic exam reveals a condition does not always mean that the condition is present. That is the reason why radiologists, who are physicians themselves, and are responsible for interpreting imaging films delegate the diagnosis to the provider that ordered the test.
    Last edit by juan de la cruz on Dec 8, '06

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