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Does Increasing State Medical Board Power Help Patients?
A Comment on AMNEWS April 26, 2004

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"A government that's big enough to give you everything you want is big enough to take it all away."
Barry Goldwater

Your front-page article about increased state board discipline (April 26, 2004) raises very serious concerns unappreciated by non-physicians. State medical boards are often just another complex anti-doctor entity.

For example, many physicians hold licenses in multiple states. These states follow different practices on key issues: Florida disciplines doctors for not prescribing necessary pain medication, and Pennsylvania only disciplines "inappropriate" or excess narcotic prescribing. Many boards have no meaningful and clear position on the treatment of chronic non-cancer pain which causes gross under-treatment, as thousands of physicians hear and read about the newest "discipline." The research shows state board members are woefully behind on basic pain medication treatment.

State boards are increasingly used as free attack dogs on physicians by those with dubious agenda's: insurance companies who do not want to pay for costly "experimental" medication or dosing, individuals with political agenda's, annoyed nurses or pharmacists, and even merely patients who do not want to pay their bills. Indeed, some state boards have sided with trial lawyers in removing licenses for physicians unable to pay for massive malpractice insurance. Any state board taking authoritarian positions on tort reform is enforcing politics, and acting as "Big Brother."

The State Board prosecutors are making decisions with the input of free medical consultant evaluators who offer what they are paid. Or in other states, fulltime professional "experts" are eagerly used, even if they do not practice in the specialty of the accused. They speak for the hand that feeds them.

The article might give the impression that speeding to discipline is good, but this means a physician has to promptly put their family on hold for nuisance complaints, and spend thousands of dollars for counsel. Also, discovery, due process and "expert" accountability do not exist in some state board proceedings.

Impaired physicians who truly endanger patient health occasionally exist. Impairment does not include poorly spelled notes, nor off label dosing and prescribing. Increased funding of the current system of state medical boards does not improve medicine -- it merely increases the perception of state board aggression. The result? Increased physician defensiveness and the abandonment of difficult patients needing complex care. It results in a shift in patient care priorities, from connecting personally with patients to keeping utterly meticulous notes. This confuses business accounting with the intimacy of and art of medicine. And no, we are not Gods who can do everything. Many state boards have no sense that physicians have been crushed from every angle, and do not sense acting as zealous prosecutors is actually adding to the decline of medicine.

James Schaller, MD
Naples, Florida

Bank Towers, Tamiami Trail, Naples, FL
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