Rules, Exceptions & Double Standards

First, let me say I don’t know Dr. Tony and absolutely have no reasons to doubt or question his sincerity or abilities — but!

Second, I’m in a very large multi-state Emergency Medicine group with many partners that are neither residency trained or board certified in Emergency Medicine. Several of my past and present partners (where I work) are in these categories — which is not the issue. Neither is the notion that a specific physician with specific training and specific certification is better than another the issue. These are always put forward, not necessarily intentionally, but nevertheless put forward to hide the true issue.

Third, Emergency Medicine¹ is the only one of the twenty-four recognized medical specialties² in the United States that is routinely challenged by those not certified in Emergency Medicine as being monopolistic and “not the only path.” No one ever complains about the monopolistic behavior of ABS³, ABP⁴ or ABFM⁵.

Fourth, all specialties took a similar path to residency training and board certification by their respective boards as the fundamental and absolute requirement for “Board Certification.” Many of these specialties also had for a limited time a practice track (to allow the grandfathering of current practitioners). Emergency Medicine’s practice track was widely advertised for ten years and closed in 1988. It is a sheer feign of ignorance that anyone would claim not to know that the practice track for Emergency Medicine has been closed for 17 years!

Fifth, there are not enough board certified emergency physicians (BCEPs) in the U.S. to meet demand. Many BCEPs do not and will not work in certain practice settings (e.g., rural or low volume ERs). Board certification in any speciality does not imply quality of work product or success or happiness in one’s chosen or adopted specialty! Many non-BCEPs working in ERs are just as good and productive as BCEPs. And, now for the resounding — so what! The “rule” always gives birth and defines the “exceptions,” but only with Emergency Medicine do some take the exceptions and challenge the validity of the rule. There are not enough neurosurgeons in many more communities in the U.S. than there are communities lacking BCEPs. Under the logic being examined here, gynecologists and pediatricians should be able to perform neurosurgery if they had one month rotation (perhaps two) in neurosurgery during medical school or residency.

Sixth, the true issue is of a double standard. Dr. Tony states, “I am board certified in Family Practice, Sports Medicine ….” What this tells me is that the very parent entity, ABMS, that gives validity to his board certification in Family Medicine by ABFM and his subspecialty certification in Sports Medicine is somehow less when it comes to ABEM and board certification in Emergency Medicine. In similar logic the lock that ABMS has on ABFM board certification in Family Medicine is not monopolistic, but for Emergency Medicine is monopolistic. AAPS⁶ is always trotted out to buttress the double standard — because it is used to question the validity of ABMS.

The irony of this double standard logic is that to stand taller in their adopted specialty (EM), the self-disenfranchised will call into question the very certifying body that gives validity to their chosen specialty and certification. Emergency Medicine is historically and by necessity a big tent, those that have adopted our tent as their home are welcome — but don’t detract from those that have built the tent and have always called it home.

The vast majority of physicians and healthcare institutions in the U.S. understand that we have specializations in medicine. Less understand the many reasons why this occurred. Still fewer understand that non-medical reasons are at play in these specializations as well. Emergency Medicine is one of twenty-four recognized specializations in the U.S., recognized by the vastly prevailing certifying organization ABMS. All have post-graduate training requirements. All have board certifying examinations. All derive prestige, respect, and position within healthcare’s echelons because of their exclusive certifications. Emergency Medicine is not greater than the other twenty-three, and it is not any less …

Perhaps George Harrison said it best in It Don’t Come Easy:

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1. American Board of Emergency Medicine: along with the sister board of ABOEM are the nationally recognized certifying bodies for Emergency Medicine in the United States.
2. American Board of Medical Specialties: a not-for-profit organization comprising 24 medical specialty boards, is the pre-eminent entity overseeing physician certification in the United States. For more than 70 years, ABMS’ mission has been to maintain and improve the quality of medical care by assisting its Member Boards in developing and implementing educational and professional standards to evaluate and certify physician specialists. Through its coordination of Member Board activities, ABMS also serves as a unique healthcare industry influencer, bringing focus to issues involving specialization and certification in medicine. ABMS is recognized by the key healthcare accreditation organizations as a primary equivalent source of board certification data on medical specialists for credentialing purposes.
3. American Board of Surgery: certifying organization for surgery, a member of ABMS.
4. American Board of Pediatrics: certifying organization for pediatrics, a member of ABMS.
5. American Board of Family Medicine: certifying organization for family meidicine, a member of ABMS.
6. Association of American Physicians and Surgeons

VoIP 911, 1.0

911 Rule Weighed for VOIP Providers | LAT | 4.27.05

Federal Communications Commission Chairman Kevin J. Martin said Tuesday that he would soon propose requiring Internet-based telephone providers to offer their customers emergency 911 dialing services.

After hearing reports of consumers having trouble getting through to police when dialing from an Internet telephone — which uses a technology known as voice over Internet protocol — Martin said he wanted to address the problem quickly.

Calls to 911 with traditional phones provide emergency service dispatchers with the caller’s number and address. Internet-based phone providers have limited access to the systems connecting those calls to primary emergency lines and location information isn’t always available. …

Very valid concerns, especially when cellular services for many areas are replete with 911 problems. Most cellular systems have not even moved up to enhanced 911. VoIP has magnitudes of more complex issues to resolve.

Blogging PRN 1.0

Hospital prescribes blogging | News & Record | 4.26.05

HIGH POINT — Marilyn Morin used the Internet to research and prepare for her mini-gastric bypass surgery. Now she’s a resource and part of the research.

Morin shares her story about the weight-loss procedure with others daily through a patient blog on the High Point Regional Health System Web site. …

Blogging PRN. Very similar to other patient-help/support sites, e.g., HysterSisters, a hysterectomy support forum with 67,430 member.

Subliminal Rx

Doctors Influenced By Mention Of Drug Ads | WP | 4.27.05

Offbeat Study Finds Familiar Brand Name Can Evoke Diagnosis

Actors pretending to be patients with symptoms of stress and fatigue were five times as likely to walk out of doctors’ offices with a prescription when they mentioned seeing an ad for the heavily promoted antidepressant Paxil, according an unusual study being published today.

The study employed an elaborate ruse — sending actors with fake symptoms into 152 doctors’ offices to see whether they would get prescriptions. Most who did not report symptoms of depression were not given medications, but when they asked for Paxil, 55 percent were given prescriptions, and 50 percent received diagnoses of depression.

The study adds fuel to the growing controversy over the estimated $4 billion a year the drug industry spends on such advertising. …

What they failed to report is that their Press Ganey scores improved markedly.

The Uninsured

Cover the Uninsured Week (PDF) | May 1-8, 2005

Today, 45 million Americans have no health insurance, including more than 8 million children.

Eight out of 10 uninsured Americans either work or are in working families. Being uninsured means going without needed care. It means minor illnesses become major ones because care is delayed. Tragically, it also means that one significant medical expense can wipe out a family’s life savings. …

April 27, 2005

Working But Uninsured: Millions of Employed Americans Uninsured and Unable to Get Medical Care

State-by-State Analysis Shows 41% of Uninsured Adults Unable to See a Doctor When Needed Due to Cost:

• Press Release (PDF)
• Report (PDF)

Podscoping

Podscope FAQ | Podscope | 4.17.05

What is Podscope?

Podscope is the first search engine that actually allows you to search for spoken words within any audio or video file. We’re starting with podcasts and will be adding all types of multimedia in coming months.

How does it work?

Just like any other search engine. You enter a word or phrase in the input box, and we’ll show you a list of results. By clicking on the (+) sign next to each result, you can select snippets of audio to help you decide whether to listen to the whole podcast or even subscribe. If you know about Search Inside the Book^TM, that’s what we do for audio/video.

Podscope blog.

URL for indexing an RSS feed.

This is going to be the next very big “thing” — the indexing of spoken content. Can you imagine what spoken content search engines will do? We’ve seen the fundamental changes the WWW has wrought for textual content. SEO will be segmented into meta tags SEO/T and SEO/S. A role for the folksonomies (and other social bookmarkings): del.icio.us, Technorati, etc.? I would love to have all our hospital dictations searchable by a podscope-equivalent process …

FO*

So Who Did the Disimpaction | Chronicles of a Medical Mad House | 4.25.05

…who did the manual disimpaction:

1. “The Attending”
2. The Resident
3. The Nurses
4. The Intern

At 0300 in the community ER! Emergently reconsider?

Fear of Liability

PointofLaw referring to Kevin, M.D.

So true. See Portland Craigslist (origin), code: theWebSocket, GruntDoc, and here.

Deck Chairs

Number of Uninsured May Be Overstated, Studies Suggest | LAT | 4.26.05

WASHINGTON — The number of Americans without health insurance — one of the most watched and worrisome indicators of economic well-being — may be overstated by as much as 20%, according to research conducted for the government.

That could mean 9 million fewer uninsured, reducing the total to 36 million from the 45 million reported for 2003, the latest year for which data are available. …

“I call it the body count,” Reinhardt said. “Instead of addressing the problem, we say we must count the uninsured. It is literally, in my view, like making sure we know how many deck chairs we have on the Titanic.” …

Or life boats, both of which are insufficient; but that will be lost in the notion that the count is wrong — what else is wrong?

Malaysian Ratios

Private Sector Encouraged To Set Up Nursing Colleges | Malaysian National News Agency | 4.26.05

…

Dr Rozaidah had wanted to know the steps taken by the ministry to overcome the shortage of nurses in hospitals nationwide.

She said the nurse-patient ratio was 1:436, lower than the ideal ratio of 1:200.

She said Malaysia needed about 8,000 additional nurses annually but could only make available 3,000 more each year. …

via:

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