You can give out general health-related advice online even without a health degree. As long as you aren’t stepping into clinical medicine or offering nutritional advice, you are in the clear. What about the physician who wants to distance themselves from clinical practice?
A physician will have a more challenging time stepping into the physician health coach role, whether with or without an active medical license. Whenever you are talking about a particular disease or referring to any treatments, you’re throwing yourself under the jurisdiction of the medical boards.
If you interact with a patient online, one-on-one, any advice you give them could be considered medical care. Specifically, it might be regarded as telemedicine care. You’d be held to the same standards as any US telemedicine physician.
In this post, I want to talk about how physicians can protect themselves as they take on a more educational role and safely take on a physician health coaching role.
The Physician Health Coach
The issue of licensure and telemedicine, explicitly relating to practicing across state lines, was brought up to Congress as early as 1997. Since then, telemedicine has grown and captured everything from interpreting an X-ray to reading your heart monitor.
Soon, everything you do online as a health professional will fall under telehealth or telemedicine rules. As of 2019, the rules are still somewhat vague, and it’s up to everyone but you to decide whether you have broken the law. Legal advice is available, but very few lawyers are experts in such topics; it’s easy to get the runaround and waste your money on lawyers who don’t know this field adequately.
Physician Assistant Health Coaching
To touch on the topic of a physician assistant health coach briefly, the advice isn’t too different. You can offer general medical advice, and you won’t need to be under the supervision of a physician.
Because you are acting independently and not claiming to use your PA license, you can give general health-related advice–advice that is available in public channels such as the CDC.
Disease-Specific Health Coach
You’re an expert in diabetes and want to help patients come off of their insulin. You have a proven method where lifestyle, diet, and medications can be managed right, and the patient can achieve better control without insulin.
When referenced to diabetes (a medical diagnosis), all of these actions would fall under the practice of medicine. You will always be held to the clinical standard because you have a medical education, whether you still identify with or maintain an active license.
Recommending fasting or herbal remedies, or over-the-counter supplements are all clinical interventions.
If a disease-specific model doesn’t interest you, you can be a primary care physician health coach. There are so many habits and mindset themes you can work on with your client – the list is endless.
Existing Medical Degree
Denying your medical expertise or omitting your credentials won’t protect you. The content of your advice and your professional history can still be used against you by regulating bodies.
And what’s the point of being a Physician Health Coach if you can’t use your medical background and expertise to build your practice? There are legal ways around this, but don’t expect your medical board to support you in this endeavor.
You can mention that you are a physician, but you must make it quite clear that in this case, you are in no way acting as someone’s physician. You require your client to have their physician.
General Health Advice
By maintaining anonymity and offering general health advice, it is possible to circumvent some legal issues with being a Physician Health Coach.
This way, you don’t have to deny being a physician, and you don’t have to deny having an MD or DO or another clinician title. But you must notify your audience that you aren’t acting in the role of a physician.
According to Cohen Healthcare Law Group, it’s essential to emphasize your role as someone offering general education and information—focusing on servicing a group of individuals as opposed to an individual patient.
The Cohen Law Group recommends:
- avoid referencing specific diseases (‘managing blood sugar readings’ might be okay, treating diabetes is not okay)
- reaffirming to your clients that despite your MD/DO credential, you aren’t acting in a clinical role as a licensed physician
- adding a disclaimer on your website and letting clients know that they must consult their physician
- don’t mix standardized medical terms with vague clinical issues (don’t say “avoiding hypoglycemia”)
- don’t recommend or interpret lab studies or remote data
- offer webinars, courses, and tutorials that are informational and generalized
I will add that you shouldn’t refer to your clients as patients. You shouldn’t manage disease or make health statements that cannot be substantiated. If you want to act as a non-clinician, your advice must be very carefully worded.
To me, this seems silly. If you’re a physician and you want to be a Physician Health Coach, you want to offer general medical advice in the role of a physician. Let’s talk about that next.
A Licensed Physician Health Coach
Alternatively, you could be a full-fledged physician health coach and flaunt your license to those patients who are from your state.
The Group Model
Your clients can still be part of a group practice model for webinars and other group online sessions. You would need to get informed consent from each participant and may have to create a medical chart for each.
Your advice can still be generalized and individualized, but as long as you’re not making absurd claims or aren’t treating each patient individually, you aren’t placing yourself at high risk. There has to be a distinction between your group model and your patients.
Patients are routinely referred to group sessions in traditional medicine. People with diabetes will gather for their insulin-start classes. Or obese patients will be sent to group weight loss classes. As long as nothing individualized is addressed during these group sessions, you can still act in a physician role safely as a physician health coach.
As an upsell, you can offer individualized services for 1:1 patient care. Perhaps you want to help a patient better handle their blood sugars. Maybe they have peripheral neuropathy, which you want to address with them.
I would recommend having a lawyer help you tease out the lines between your group practice, where you offer general medical advice, and your individualized practice, where you see patients individually, whether online or in-person.
A brief word about practicing across state lines: this is a big no-no and considered a violation of FSMB’s telemedicine rules. If you’re going to be a licensed Physician Health Coach, then it’s on you to verify the location of your patient before starting a health coaching session.
As of this writing in 2019, asking the patient where they are located is adequate. You don’t need to capture their IP address and cross-reference that. I expect that this will change in the future.
Branding Yourself as an Educator
If the FDA or FTC or a medical board wants to come after you, they will genuinely look to see if you are genuinely in a role of an educator or if you’re dishing out quasi-medical advice.
It’s essential to pass the sniff test and be genuine about this, at least if you intend to transition into a non-licensed or non-clinical Physician Health Coach.
Steps to take:
- turn off your comment section on your website
- interact with a client only in a group setting
- don’t make claims about a particular disease
- don’t have clients report individual results to you
- don’t interpret lab results for clients
- discuss an illness but not the clinical management of it
- use consumer-directed sites such as CDC or WHO or FDA as references
The Nutrition Professional
When you browse IG or YT, there are a lot of non-licensed individuals who give out nutrition advice. They also often do one-on-one coaching or answer individual client questions.
Most states don’t allow this, but it’s a matter of oversight. The medical boards and nutrition boards cannot go after everyone who is sidestepping the already vague state laws.
If you choose to act in a non-clinical role, remember that you cannot give nutritional advice. Only nutritionist professionals can provide such advice. That includes MDs, DOs, DCs, DDSs, and NDs.
To touch upon this once again, you only need malpractice insurance if you are engaging in the practice of medicine.
If not, no insurance company would even offer you malpractice coverage. There is other professional liability insurance you can consider depending on your state. That’s best to discuss with your attorney.