Can a nurse practitioner (NP) send referral and imaging orders for their spouse?

Nurse Practitioners Should Not Send Referrals or Imaging Orders for Their Spouses

Nurse practitioners should not send referrals or imaging orders for their spouse due to ethical concerns, potential conflicts of interest, and legal implications related to self-referral laws.

Legal Considerations

• The Stark Law prohibits physicians from referring Medicare patients for "designated health services" (including imaging) to entities with which they have a financial relationship, unless that relationship meets specific exceptions 1.
• While the Stark Law specifically mentions physicians, the ethical principles and concerns about self-referral apply equally to nurse practitioners and other advanced practice clinicians 1.
• The law defines "referral" broadly to include requests for items or services, and a service is not considered personally performed if provided to someone with whom the provider has a close personal relationship 1.

Ethical Considerations

• Treating family members creates potential conflicts between professional obligations and personal interests that may compromise clinical judgment 2.
• When acting as both healthcare provider and family member, there's an inherent conflict between these roles that can affect objectivity in clinical decision-making 2.
• Healthcare providers should maintain clear boundaries between their professional role and personal relationships to ensure unbiased care 2.

Practical Concerns

• Advanced practice clinicians (including nurse practitioners) have been shown to order more imaging tests than primary care physicians for similar patients (2.8% vs 1.9% of episodes of care), which raises additional concerns about appropriate resource utilization when personal relationships are involved 3.
• Family members often have ethical concerns about their healthcare that they may not feel comfortable discussing openly with a provider who is also a relative 4.
• The dual relationship creates challenges in maintaining appropriate confidentiality and respecting patient autonomy 2.

Best Practices for Healthcare Providers

• Healthcare providers should treat interactions with relatives or friends with the same professional expertise and judgment as they would any patient 2.
• Be aware that performing a physical examination or charging a fee strengthens the establishment of a legal provider-patient relationship 2.
• Respect the family member's autonomy and confidentiality, conforming to HIPAA requirements where applicable 2.

Alternative Approaches

• Refer your spouse to another healthcare provider who can objectively assess their condition and order appropriate imaging or referrals 2.
• If providing simple factual information to family members, be clear about the limitations of your role and avoid establishing a formal provider-patient relationship 2.
• When discussing healthcare matters with family members, maintain clear boundaries between your roles as a healthcare professional and as a family member 2.

Potential Pitfalls

• Ordering imaging for family members may create pressure to interpret results outside your scope of practice or expertise 1.
• Self-referral concerns may trigger legal scrutiny, especially if the imaging or referral results in financial benefit to you or your practice 1.
• Personal relationships may lead to either over-ordering of tests due to heightened concern or under-ordering due to minimization of symptoms 2.