Yesterday I wrote a piece expressing some concerns about a physician’s practice featured in the news recently. Dr. John Crisler is a self-described anti-aging and men’s health physician. A couple of my concerns regarded his prescribing practices and his possible practice of distance medicine.
From closer perusal of his site it would appear that he may not require the use of his pharmacy, but he does charge his patients to send prescriptions to pharmacies other than his own. It’s not unreasonable to charge patients for the use of your time, but I feel very uncomfortable with what amounts to penalizing patients for preferring to choose their own pharmacy.
The next issue regards standards of care. In my last piece I wrote about being uncomfortable with the practice of clinical medicine long-distance when it is not significantly more beneficial than seeing a local doctor. Dr. Crisler has a consent form that explains some of his practices in more detail. It contains some curious content:
I hereby agree and authorize John Crisler, DO PLLC (abbreviated from now on as
“ATM”) to treat me for high serum estrogen levels and/or low endogenous testosterone
production, which is expected as a consequence of anabolic/androgenic steroid use.
Alternatively, I may be applying for Hormone Replacement Therapy. I understand that I
am contracting with ATM for treatment of these two specific conditions only, and that
any other medical problems I may experience now, or in the future, must be diagnosed
and treated by my own physician.
That’s just weird. Usually, we use a general consent to treatment, but here he seems to be acknowledging that he is: 1) doing something medically strange, and 2) exempting himself from diagnosing or treating anything else. I wonder how this is feasible. What if a patient develops liver problems or blood clots from the therapy? Is Crisler really not obligated to diagnose these conditions and treat or refer the patient as needed? I would find that hard to believe.
I understand that ATM may, at its discretion, accept a physical examination by my own PCP or medical specialist (or his/her agent) in lieu of a physical examination personally conducted by an ATM physician. If such is the case, I am agreeing that such a physical examination will be sufficient for the purpose of being treated by ATM, and that any
errors or omissions as a result of this agreement are in no way the fault of ATM.
I find this very difficult to understand. He is saying that he can treat a patient by relying on a third party physical exam and that he is not at fault for and mistakes.
So Crisler prescribes/sells medications based on on a physical exam done by someone else. That makes him sound more like a pharmacist than a doctor. But he claims to be acting as a doctor, and doctors have different ethics than pharmacists. Even with a signed release, it is not ethical to tell a patient, “I may not examine you, and I may rely on data provided by your doctor, and if it turns out something was wrong, it’s not my fault.” Patients have high expectations of us, and they expect us to use our skills to help them and to take responsibility for our work. If a resident of mine were to say, “I gave him that much potassium because the ER said his potassium was really low,” my resident would potentially be in a world of trouble (not to mention the patient’s own flat-line issue).
I agree it is my personal decision to use anabolic/androgenic steroids (for AAS Consults) and that ATM does not condone their usage. ATM has not given me any advice on how to use steroids, except to help protect my health or warn me of their possible side effects. I will not ask ATM for advice on how to use anabolic steroids, or for help in designing a steroid cycle.
This, in a word, is bullshit. If you are a pharmacist and are simply dispensing a medication, then this is fine. But if you are a doctor, prescribing a medication comes with certain responsibilities, and includes a tacit recommendation for its usage.
But my favorite part is this:
I understand that by signing this agreement I am giving up the right to sue ATM, its doctors, anyone connected in any way with ATM, or the pharmacy(s) which fulfill
ATM’s prescriptions FOR ANY REASON WHATSOEVER, FOREVER.
I have no idea if what Crisler does is legal or not, but in my opinion, it is extremely unethical.