Medicine

The DMV and the state medical board, part II.

By Chris Rangel MD ⋅ June 4, 2006 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

Although there were some excellent comments to part I, no one really addressed the inherent question in my analogy; Why do we let first time speeders off so easily and throw the book at every physician no matter how minor or correctable the complaint? Why don’t we throw the book at first time speeders? Why are first time DWI violators allowed to keep their licenses (in almost all cases) even though statistically 1/3 of those will commit a second DWI?

I call the actions by the state medical board purely political because (sadly) there is no evidence that this type of piecemeal disciplinary activity improves patient care or increases patient safety (even from physicians who are rightfully punished!).

Ironically and part of the answer to my analogy question is that tough punishment alone has NOT been shown to decrease dangerous driving habits or driving under the influence. Nor has pushing punishments to ridiculous levels been shown to work. Over the last several decades traffic deaths, both speeding and/or intoxication related, have fallen and the most consistent reason (besides safer cars) has been education and awareness. Anyone who has ever been to defensive driving (*raises hand*) knows this!

And yet this basic fact that education and awareness works has apparently completely eluded most state medical boards. You might be skeptical. It’s not intuitive. After all who was not aware of the dangers of speeding and drinking and driving 20 years ago and yet now even booze commercials tell us to “drink responsibility”.

In Texas, physicians are required to have one hour of ethics CME each year but there is no requirements on just what type of ethics it should cover. There could be a second hour of CME specifically addressing the issues of “problem physicians”, substance abuse, physician stress, inappropriate behavior, etc. etc. etc. It would probably NOT surprise you to learn that in our high stress job very few physicians get regular education on these topics either in or after training. The state board could regularly mail out pamphlets and information on these topics (something that does NOT happen in Texas) to MD offices.

In our society the physician “God complex” in which patients and physicians believed that doctors are infallible in the practice of medicine has been largely eliminated (rightly so but taken advantage of by lawyers). HOWEVER, people (and many docs) still believe that physicians by virtue of their extensive education and (mostly) above average intelligence are supposed to be infallible in every other aspect of their lives. I.e. we are NOT supposed to suffer mental illness (mostly depression), have substance abuse issues, suffer from stress, have broken relationships and broken families, make bad judgments and decisions, or consider or attempt suicide. This myth about the infallible physician without personal problems is busted time and again. Most recently this myth was painfully invalidated by the murder-suicide deaths of Dr. Edward Van Dyk who killed his two sons before jumping off a Miami Beach hotel balcony.

Physicians clearly have higher rates of suicide than the general population and even though there is no clear evidence of increased rates of substance abuse over the general population, physicians are more likely to abuse prescription medications like opiate analgesics and sedatives. Even so, if rates are similar to the general population this means that there are still tens of thousands of physicians out there who have substance abuse problems or are at significant risk for these problems.

It is my impression that the state medical board system is antiquated and broken. It is overwhelmed with paperwork and burdened by inefficiency. It is a purely reactive agency with few if any preventative or monitoring capabilities (except after the fact). Because it is tasked with enforcing all regulatory aspects of medical practice (from physician behavior to limits on physician advertising) there appears to be problems with prioritizing (see inefficiency). It is dependent upon complaints mostly from the general public, which is about as effective and statistically representative as a survey on Drudge Report or FOXnews. There is almost no emphasis on education and awareness (as stated above), at least in Texas and the board appears to be almost totally politically driven without regard to the lack of any evidence of the effectiveness of its tactics.

Worst of all and because of this increased responsiveness to political pressures the board appears to be moving towards the position that what is in the best interests of physicians is NOT in the best interests of the general public. This has lead to an increasing gap in contact and cooperation between the board and state medical associations and local medical societies. The assumption on the part of the board is not to appear as if they are “protecting” physicians. And of course, once again, this assumption is total crap. It’s politically based and not grounded in evidence.

Physician rehabilitation exceeds 70-80% which is far better than the general population. These numbers would likely be even better if unified (and non-punitive) efforts are made at education and awareness and screening for physicians with depression and/or substance abuse problems. These efforts are clearly lacking.

It is in the best interests of the general public to have happy and healthy physicians. It is in the best interests of the general public to have a proactive licensing agency that looks out for the health and welfare of physicians. It is in the best interests of the general public to attract competent physicians to serve the population of that state and not “scare them off” with a board that has a reputation for physician hostility and making bombastic statements about protecting the public good. The interests of physicians and the public are much more closely linked than the board currently realizes.