Legislative interference in the patient-physician relationship
Awarded 2014
Complex Family Planning Fellowship Research
Sarah Wallett, MD
University of Michigan

In the United States, there is an ever-increasing burden of state-level legislation that interferes with the patient-physician relationship. A focus on forwarding a political agenda while ignoring established and evidence-based guidelines for care are hallmarks of this type of legislation. Major US medical organizations have raised serious concerns about laws that prohibit physicians from discussing with or asking their patients about risks factors that may affect their or their families’ health as recommended by evidence-based guidelines; laws that require physicians to discuss practices that may not be necessary or appropriate at the time of a given encounter according to the physician’s best judgment; laws that require physicians to provide diagnostic tests or medical interventions not supported by evidence; and laws that limit the information physicians can disclose to patients.
The impact of increasing legislation that interferes with the patient-physician relationship has not yet been studied.  Our study is a necessary first step to inform future research in this area while also providing a much-needed broad overview of the landscape of legislative interference across a range of medical specialties.
We systematically reviewed state statutes addressing the physician-patient relationship which specifically 1) limit or mandate physician speech, like state-mandated abortion counseling; 2) limit or mandate physician actions, like obligatory ultrasound testing; or 3) laws that limit or regulate how physicians provide particular types of services do to politically motivated TRAP laws or facility requirements.  The process of identifying the laws included numerous strategies to identify state statutes meeting our specified inclusion criteria, including utilizing state legislative websites and the proprietary databases of LexisNexis.  A total of 8,176 statutes were identified using our search criteria.  
The collected statutes were subsequently evaluated and categorized by health topic, including breast density notification, end-of-life counseling, HIV testing and consent, abortion provision, and firearm ownership. Using an iterative process, all state laws within a given health topic were reviewed and categorized into types of laws.   The typology was based on how legislation directed the delivery of medical services.  Pilot testing of our typology was performed with physicians to ensure clarity and appropriateness.
The typology created through our research regarding delivery of medical services will allow continued work in this area.  Physicians, researchers, and advocates can immediately use this process and methodology to compare legislation between states and health topics as well as for advocacy efforts.  This typology of laws will also allow for future research to address important questions related to the provision of medical care in the United States.  This work will continue to forward research efforts regarding the health effects of laws directing medical care and allow for identification of the effects this legislation may specifically have on the patient-physician relationship.