Every primary care doctor knows what we are up against. The obstacles are many: payers, licensing boards, MOC, CME requirements, coding for billing, access issues, and the changing clinical field. Sometimes these cause real harm. Fifty miles north of where I-95 ends in Maine, winters there are long. My friend Dr. J did locums and spent a winter there. He tries new things wherever he goes, like spearfishing on Maui. So he tried ice fishing with a northern colleague. Ice fishing is very popular. A recent ad had a guy raving about the best Christmas because he got augers, shelters, pop-ups, and other gear. Loading up a snowmobile on a frozen lake, setting up shelter, firing up a stove, drilling holes with pop-ups for when fish bite, one settles in. Ice fishing has a reputation. My friend brought some beer and Jack Daniels. He drank a little. Dr. L drank a lot. Later, Dr. L turned the snowmobile over twice. On shore, Dr. L left my friend in the cold while he returned for a solitary lost fish. Loading everything into the pickup, Dr. L insisted he could drive, then ran into a snowbank. Now, I met Dr. L a while back. As it turned out, I was reported to the Board of Medicine by a mentally ill friend of a patient. The board is necessary to protect the public. They must review every case, and since many are frivolous, they are overloaded. Boards are there to protect the public from bad doctors—a crucial function since medicine has a long history of being unwilling to police itself. The board requested notes on every patient I had on chronic opioids and benzos. While there were only a few, my notes had been reprinted, turned sideways, and re-paginated when I was called in. I couldn’t follow anything on them. So when the first thing Dr. L said to me was that I was giving Flonase, but it was on her allergy list, I was taken aback. I was told I had given Xanax inappropriately. The record was inaccessible; this was so ancient that I wasn’t prepared. Later, I saw that I had offered a taper after an inpatient stay, which went unfilled. All they had to do was check the PMP or allow me to. But there is no internet in the boardroom. The board is not collaborative. I was allowed to speak only before they “read” these assumptions to me. I was told M had come to me from rehab and that I had increased and increased her dose. She has never been in any rehab. We always titrate meds. On and on, but I was not allowed to refute anything. My lawyer waved me to hush. One physician looked me in the eye and said, “This physician thinks she’s a better doctor than she is.” Actually, I have never been a confident doctor. It was the other way around. One older guy proudly said he was a paper man. I am required to use an EMR. My EMR was with me — fully contained on the laptop. I did not have the courage to open it. The PMP would have been inaccessible without the internet anyway. The lawyer waved me to be silent. Are any of us perfect? Don’t we all look back at a note and think: “Was that all I said?” The board shared my case between two indicting physicians who alternated “reading” from my charts — assuming, not really reading. I was assigned to take classes, read, and write a book report. The lawyer belittled the report, making me rewrite it three times. My malpractice company paid her. It was too late to fire her when I realized that she just thought I was broken and was there to fix me. Later, I learned that the man who accused me of having Flonase on an allergy list was a drunk who endangered another person. Boards must defend the public from bad doctors. They do not need to assume guilt until proven innocent. They do not need to be hostile or insulting. They should read the records carefully and ask questions. After my first visit, I wondered if I should put my car into a tree on the way home. When the remedial work was done, I was called back. A risk manager from the malpractice company had helped me to refute. She was objective and concise. No, she wrote, there was nothing in the record that M’s husband was an alcoholic, the Xanax had never been filled, and the patient had never been in rehab. I returned, hating the lawyer for not being on my side and not knowing what would happen. The board threw slides up on the wall — there’s no screen, just poster-covered brick walls. They mumbled a few things and dismissed it all. The lawyer had said the best I could do was a letter of guidance, which meant a public record sent out to all docs. Nothing happened — it was dismissed. I cried for the doctors that have to go through this. Boards are there to protect the public, and we must have them. Doctors can improve and change and are best motivated to do so when someone walks alongside them. But we must have some right to be treated with dignity, not to be read lies by colleagues who have their own demons? Shouldn’t doctors be allowed access to their records in a way they can see? Shouldn’t you know what you’re up against before you go in so that you could look at the PMP and see that Xanax went unfilled because she was told it wasn’t in her best interest? I’m a grown-up. Look, these things happen. But we can do better. Boards are there to protect the public — they can do that without destroying doctors. Source
