In this thread, I somewhat facetiously mentioned the possibility of a doctor’s license being revoked retroactively, thereby voiding his diagnoses and making his patients officially (but not actually) un-sickened.
That got me to thinking, however. If a “doctor” practices medicine without a valid license (e.g. no license at all, an expired license, a license from a foreign jurisdiction whose licenses are not cross-recognized, a license obtained via bribery, a certificate of merit in flower arranging that has been photoshopped to look like a medical license, etc.), are his diagnoses valid?
In most cases, the officialness of a diagnosis isn’t important if the treatment works, but there can be some circumstances (primarily medicolegal in nature) where the fact that a person was diagnosed with something can have an official and/or legal effect. For example, pilots in the US are obligated to report many medical diagnoses to the FAA.
What would happen if, say, a pilot was “diagnosed” with an FAA-disqualifying condition by a Cambodian doctor unlawfully practicing medicine in Florida, given some “surgery” (which wasn’t legally considered surgery anyway since it was not performed by a licensed physician), released, and ended up more or less ok. Would the pilot have to report that, or would he be able to legitimately claim that he had never been diagnosed with such a condition, since the opinion of an unlicensed “doctor” counts as much as the opinion of a ten year old child with severe behavioral issues (i.e. not at all)?
Should be pretty much the same for any legal determination made by someone who turned out not to be a valid medical professional (including causes of death rendered by a corrupt or unqualified medical examiner).
Someone who objects to a diagnosis in such a circumstance would almost certainly have a valid case to have another examination and diagnosis made.
I’d say he would be morally obliged to report it; saying he’d never been diagnosed would be a flat lie - he may or may not have been correctly diagnosed , but the suggestion had been made (the opinions of someone who has even an unrecognised medical qualification are surely worth something more than that of the completely unqualified) and treatment (which would be surgery, even if unnecessary and illegal) carried out (which may or may not have helped or hindered his fitness to fly).
The answer is for the FAA to determine whether any further action is needed, not to pretend it never happened - that in itself would raise questions as to his sense of responsibility towards the job. Of course, he’d be wise to accompany his report with an up-to-date report on his condition from a properly qualified doctor.
Yes, that makes sense, but are there any known rules or cases on where the threshold is between totally unqualified, utterly void diagnoses and irregular-but-reportable ones? After all, if any and every armchair “diagnosis” had to be reported, then that could be used as a means of abuse - e.g. if I was unhappy with a pilot’s rough landing, I could “diagnose” him with aggressive liver cancer, paranoid schizophrenia, and obstructive bowel disorder and send him into a living nightmare of license suspension, specialist visits, and invasive testing as he struggles to disprove my diagnoses.
I’m neither a lawyer, nor knowledgeable in the airline industry, but I would say that even if a (reasonable) medical layperson (for instance an airline employee or the copilot) alerts a pilot to the possibility that something could be wrong with him (the pilot) medically, he has to do something about this.
At first, that seems reasonable, but if I, in a fit of anger, scream at a pilot “Your landing sucked! You’re a manic bipolar with a herniated colon and stage-4 cancer all throughout your bad-pilot lungs, liver, kidneys, and stomach, and, uhh, you have rabies! Get lost!”, what would he be obligated to do? Could he simply disregard my statement as the rantings of an unhappy customer and go on with his life, or would he need to schedule a checkup with his doctor to verify that I (somehow) did not actually perceive a medical problem in him? After all, for all he knows, maybe I do have some medical diagnostic skillz, just not enough to be fully licensed to practice. Would visiting his regular general practitioner be enough, or would he be ethically obligated to get evaluations from a psychiatrist, bowel specialist, oncologist, and an infectious disease specialist certified by the American Rabies Association?
Another way to phrase the question is: To what extent can someone other than a licensed healthcare practitioner cause a medico-legal nightmare, whether or not intended in good faith? E.g. I see a CDL truck driver walking with a limp, and want to get this reported so that he gets evaluated for fitness to drive. Can I just pick up the phone, say some magic words, and force him into a doctor’s office under pain of license suspension, or would I need to hire my own forensic doctor or something to assess the “patient” and make an official report?
BTW, this is beyond the scope of the original question, but there was a case last year in Germany in which a prominent forensic psychiatrist, a university professor, who had been a frequent expert witness at high-profile criminal trials suddenly suffered a serious psychotic episode himself. Out of the blue and completely out of character for this respected man, he attempted to kidnap a child from the street. The press speculated that the courts would have to revisit the cases he worked on in the past. I don’t know what came of it.
Thank you! That is still within the spirit of what I was asking about. Even if the doctor was licensed to practice at the time, a doubt has arisen over whether or not his diagnoses ought to be considered valid.
Is there precedent in any jurisdiction for retroactive revocation of a medical license (thereby voiding diagnoses that were once valid), or are licenses only revoked with respect to barring future practice?
I think you’re mistaken to focus on the validity of diagnoses. It’s meaningful to ask if a diagnosis is accurate or reliable, but less so to ask if it’s valid. Valid refers to legal effect - a contract may be valid or invalid, for example, or a marriage ceremony. But a medical diagnosis has no legal effect; it’s simply a description of an objective reality, and it’s either an accurate or reliable description or it’s not.
Does it become less accurate or less reliable if the medic’s licence has lapsed, been cancelled or is (hah!) invalid? That must depend on the reasons for the lapse, cancellation or invalidity. If he forgot to send off the renewal form plus cheque for the annual registration fee, I don’t think that calls into question the accuracy or reliability of his diagnoses. Or if it was cancelled because, say, he overcharged his patients or engaged in some other professional misconduct not having implications for his competnence as a practitioner. Conversely, if he displays signs of delusional mental illness or dementia, that does call into question his [recent] diagnoses, even before any steps are taken to suspect or cancel his licence.
Those are good points, but I’m interested in whether or not the borderline has ever been litigated, reviewed, or formally defined.
For example, has an FAA official ever “thrown the book” at a pilot, claiming, “No, that person you bumped into on the sidewalk that day was not a licensed physician under local law, but he was a highly skilled Tibetan shaman healer with forty years of experience in traditional countryside eye therapy, and you should have listened to him when he told you that your left eye looked a bit odd. Five years of license suspension for failure to report early-stage glaucoma. Next case!”