Public Duties of the Physician

Public Duties of the Physician Chapter 7

Public Health Records andVital Statistics • Vital events in person’s life • Used by government to determine population trends and needs • Public duty of physicians to report vital events

Births • Physician must sign certificate of live birth • Certificate is filed at county clerk’s office in state birth took place

Deaths • Date and time of death • Cause of death • How long deceased was treated before dying • Presence or absence of pregnancy • Whether autopsy took place

Deaths • Coroner: public health officer holds inquest if death from unknown or violent cause • Medical examiner: physician who investigates unexplained deaths and can perform autopsy • Autopsy: examination after death to determine cause of death

Communicable Diseases • Diseases transmitted from one person to another—considered threat to public • Reportable diseases • National Childhood Vaccine Injury Act

Child Abuse • All abuse must be reported by teachers, health professionals, law enforcement and day care personnel, and social service workers • Physicians have been held liable for not reporting cases • Person reporting is protected by law from being sued by parents and others

A young child explaining her injury to physician Figure 7-1

Elder Abuse • Older American Act (1987) • Includes physical abuse, neglect, exploitation, abandonment, and financial abuse of adults 60 and older

Spousal Abuse • Laws governing the reporting vary by state • Local police may have to become involved when spousal abuse is suspected • Court may order restraining or protective order prohibiting abuser from contact with victim

Signs of inadequate nutrition Venereal disease and genital abrasions Makeup to hide bruises Sunglasses worn inside to hide blackened eyes Repeated injuries Bruises and unexplained swelling Unexplained fractures Bite marks Unusual marks Bruising or swelling in genital area Signs of Abuse

Substance Abuse • Abuse of prescription drugs is reportable immediately according to law • Violation of controlled substances laws is a criminal offense

Gathering Evidence in Cases of Abuse • Precise documentation of all injuries, bruises, and suspicious genital fluid deposits in children is critical • Court may subpoena records at later date • Evidence includes • Photos • Urine specimen • Clothing • Body fluids • Various samples • Foreign objects

Other Reportable Conditions • Physicians required to report certain medical conditions to maintain accurate public health statistics, including • Cancer • Epilepsy • Congenital disorders

Controlled Substances Act and Regulations • Food and Drug Administration (FDA) • Drug Enforcement Administration (DEA) • Controlled Substances Act of 1970 • Bureau of Narcotics and Dangerous Drugs (BNDD)

Prescription of Controlled Drugs • Only those with DEA number may issue prescription for narcotics • Number must appear on all prescriptions for controlled substances • Schedule II drugs require triplicate form • Schedule II drug prescription cannot be refilled • Must take written inventory of drug supply every two years • Narcotics dispensing records must be kept for two years

Protection of Employee and the Environment • Employee assistance program (EAP) • Confidential counseling and referral service • Helps employees and their families assess a problem • Develops plan to resolve problem • Determines appropriate resource to assist in process

Medical Waste • Solid • Chemical • Radioactive • Infectious

Public Duties of the Physician