By Pamela Miller, OD, FAAO, JD
Serving children in your practice is a vital and enjoyable part of the family practice—but protocols for interactions between doctor, staff and young patients must be defined and followed.
Most optometrists hope to increase the number of patients whose whole families they see–children and teens included. That means understanding the laws a doctor must follow when treating minors and the legal rights of the minors’ parents. Here are my top tips for protecting your practice when seeing minors and keeping your family optometric practice on track. As with all legal matters, it is best to first consult with your attorney and state optometric board before taking any action.
Disclose Diagnosis and Treatment
When seeing minors, you must disclose to parents the child’s diagnosis and recommended treatment, but beyond that, you can use your discretion to do what is best for the child. For instance, let’s say a teen comes into the office with lice in her eyelashes, a condition that is usually only contracted from sexual relations. To ensure the teen takes precautions so the same condition doesn’t arise again, you explain to her how she probably got it. The teen asks that you not discuss the likely cause of the lice in her eyelashes with her parents. You will not violate your legal responsibility to the minor or her parents if you simply explain to the parents that their daughter has lice in her eyelashes and explain the treatment you have prescribed. When the parents ask if you know what caused the issue, you could safely respond, “Well, we don’t know for sure what caused it, but if you follow the treatment I prescribed, it will clear up and your daughter will be fine.”
Get Written Permission to Treat and Charge Without Parent Present
It is not uncommon for minors to come in for an appointment without a parent–whether it’s a teen driving there on his own or a younger child brought to the office by a nanny. To ensure you don’t run into any disagreement about treatment or payment with the parents, have a signed consent form on file that gives your office the right to treat, prescribe and charge for services in the parent’s absence. Such a consent form also comes in handy for teens who may come into your office on their own with an eyecare emergency that requires immediate treatment–when waiting for approval from a parent could endanger the child’s eye health. Signed authorization for payment is important when ordering eyeglasses for a minor, especially if there is a lens treatment such as A/R that is not covered by the parent’s vision benefit. The last thing you want is for a parent to receive a credit card statement or an explanation of benefits report from their insurance company noting that some of the products ordered at your office for their child were prescribed or paid for without their approval.
Have a Staffer in Exam Room with You and Child
If a parent can not be present in the exam room, or if the parent and child agree that it would be best for the child to see you without the parent, it is safest to have a staff member in the office with you. Having a staff member in the room with you ensures that if the child misinterprets something you said or did, you will have a witness to back up that you did not do anything inappropriate. This is especially a good idea for male doctors seeing teenage girls–a situation that can easily become problematic with an arm on the shoulder or an innocent compliment taken the wrong way by the teen.
Act–But With Caution–If You Suspect Child Abuse
If you suspect child abuse, you are legally obligated to report it to the authorities. Since this kind of report will turn the suspected parents’ lives and the life of the child upside down, be sure you feel strongly about your suspicion. For example, one summer when the weather was over 100 degrees, I saw a little girl who came to my office buttoned oddly from head to toe with clothing. She had been referred to me by her school. The child wouldn’t speak at all unless the parent first spoke for her, and she stayed seated far back in the chair. When I asked the parent after the exam if it was OK if I sent the exam report to the school, they said “no.” The child’s appearance combined with the parent’s and child’s behavior and the parent’s unusual request that I not send the report to the school raised enough red flags in my mind that I filed a report of suspected child abuse. Be careful not to jump to hasty conclusions. If a child has a nasty bruise, you might say: “Gosh, that looks like that hurt. How did that happen?” If the child comes in repeatedly with injuries like broken bones and bruises, you should first look at the child’s medical records to see if there is a medical condition that might make their bones brittle and likely to break or cause them to bruise easily.
Patient Academic Performance Check
You do not have a legal responsibility to ask a child and her parents how that child is doing in school, but it is to the child’s benefit if you ask about this at each annual examination. Here are a few tips for drawing out academic performance from a child in the exam room:
Don’t just ask how the child is doing in school (they usually will simply say they’re doing fine); ask what classes they took last semester and what grades they got.
It is not enough to note the child has 20/20 vision. The child may have accommodative insufficiency so that they may see 20/20, but need a prescription for reading or distance because their eyes are taking too long to focus and re-focus.
Once you determine that the child’s eye health and vision (or other issues like learning disabilities or attention deficit disorder) are not barriers to their school success, ask the child to do better. You could say something like this: “I’m not happy with Cs and Fs. You’re too smart for that. I want to see some As and Bs next year.”
Talk to parents about your concern about their child’s academic performance and let them know that you challenged the child to do better–most parents will be happy that you reinforced their message.
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Pamela Miller, OD, FAAO, JD, DPNAP,has a solo optometric practice in Highland, Calif. She is an attorney at law, holds a therapeutic license, is California State Board-certified and glaucoma-certified to prescribe eye medications, and offers comprehensive vision care, contact lenses, visual therapy and low vision services. To contact her: drpam@omnivis.
