Letters: March 2009

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Letters - March 2009


Tex Med. 2009;105(3):5-6.

"Who Will Test the TMB?"

I am writing in reference to the commentary in the December 2008 Texas Medicine by Lee S. Anderson, MD, a fellow Texas physician (ophthalmologist) who served for eight years on the Texas Medical Board (TMB) and was its president for five years. (See " Why We Test ," page 3.) Dr. Anderson wrote a short article to explain the rationale (his?) of TMB to "test" incoming and any current Texas MD/DO physician.

"The whole reason is to be proactive in searching out physicians with cognitive, mental, or substance abuse issues that colleagues, family members, and patients are reluctant to address," Dr. Anderson said. He added that it "has been a board rule for many years that physicians relocating to Texas, regardless of age, must be tested if they have not taken a major proctored test in the previous 10 years or they are ineligible for licensure."

This is part of the guidelines of the Federation of State Medical Boards that standardize criteria for initial licensure and evaluation of physician behavior. The good news is that in this country, this is a physician-driven system state by state.

He further stated that with the passage of Proposition 12, attorneys have moved out of the plaintiff's business - good for doctors but bad for patients because there is no legal pressure "to influence physician behavior and identify people [?] at risk." Therefore, this duty falls upon the TMB.

 Dr. Anderson is concerned about doctors with dementia, doctors dealing with substance abuse, or incompetent docs identified by testing (my note: half of the doctors graduating this year are in the lower half of their class). He questioned whether the continuing education requirements or the active day-to-day practice to maintain skills is adequate. He said we "cannot tolerate a 'brotherhood of silence' without risking the health of the citizens of Texas."

Therefore, he said, the TMB's proactive hunt for mentally awake and qualified Texas docs is considered necessary. No credit is given to the physicians who provide health care. Their desire, effort, education, great expense, training, commitment, continuing education, and dedication to become a physician are not factors.

Because the TMB leadership may be tainted by reviewing only bad outcomes, complaints, impaired providers, and attorneys, they may not see the good care provided by the large majority of physicians. The "TMB testing-police" approach is not in our best interest and we will need a "Prop 12-like" legislative effort to safeguard from a zealous TMB. We do not need more tests, testers, regulations, regulators, unfunded mandates, attorney fees, and the tax increases to support them. Are not access to and cost of health care sufficient problems for now?

Let us ask: Who will test the TMB?




Lawsuits Don't Equal Good Care

Dr. Anderson's article indicates the belief that malpractice suits, or the threat of them, improve the quality of medical care. There is no credible proof of this to my knowledge.

In fact, some of the most flagrant malpractitioners seem to me to have increased the pace of their bad behavior to pay off their legal costs.

 Regarding a shortage of family practitioners, the situation will reverse when the public is willing to pay family physicians more so that they can make a living by not having to see so many patients an hour. (See " Primary Care Crisis ," December 2008 Texas Medicine, pages 14-23.)




Special Plates Not for All

I appreciated Dr. Zimmerman's column on the abuse of parking implements designed to assist those with handicaps. (See " Abuse of Handicap Tags and License Plates ," January 2009 Texas Medicine , pages 49-50.)

He lists four types of misuse of these devices. There is a fifth type. This is the person who meets the legal criteria for a tag or placard, but in reality doesn't need one. Most high school and college students on crutches temporarily for an orthopedic injury will get by fine with general parking, but some still ask. The duration of their need is often a fraction of the valid period on the device. 

 Although it's hard to deny these young people their earnest requests, I think of the burden on my patients with actual needs when they cannot find suitable parking. When these young people become confrontational, as they occasionally do, I describe the burdens of the people they wish to displace by taking their parking spot. Rarely, one of these sweet-faced but lazy youngsters takes their business elsewhere. I have not missed one yet. 




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