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Oklahoma Board of Medical Licensure and Supervision
Issues & Answers - September 2003

ISSUES & ANSWERS

September 2003

Tank Tops and Flip Flops

by Gerald C. Zumwalt, MD
Board Secretary/Medical Advisor

In the film “On Golden Pond”, Katherine Hepburn lovingly addresses Henry Fonda as “my old poot”. I acknowledge that I belong to that same category of mankind. Further more my children will collapse in a heap of helpless laughter when they find I have written a piece on clothing fashion.

But…

I recently addressed an incoming class of medical residents. I not only was greeted with bright shiny faces but also shoulders. And biceps. And knees. And tops of feet. And painted toenails. It was unclear whether this was orientation or a beach party.

To avoid being accused of disparaging just the young, I also must record the many times physicians have appeared before the Medical Board dressed in outfits more suited to a tennis court than to an administrative law court.

I was pleased therefore to note in an article from the AMA News (Aug 11, 2003 – “The Clothes Make the Doctor”) that there are studies done which confirm professional attire “inspires trust and projects competence.”

The article even gives specific fashion do’s and don’ts from the Emily Post Institute, most which would seem to be dictated by common sense. Admittedly, it does go on to point out that good clothes will not make a bad doctor into a second Schweitzer.

If a patient has enough trust and respect in you as a physician to place his life and health in your hands, you should have enough respect for him to present yourself in a professional manner. This may mean leaving the fashionably tattered t-shirt and faded denim trousers at home. It also means avoiding sarcasm, anger, and pseudo-intellectual jargon and addressing patient and family in quiet and understandable discourse. This may involve sitting down instead of leaning toward an exit or imperiously looming over crestfallen persons. It might even (gasp) require listening to a few questions, even though they may not be particularly pertinent.

If all this seems to be a plea to return to the ‘30s, let me hasten to extol the fact that there are no longer magazine ads where doctors smoke Camels. It is usually excellent that patients are partners in decision-making and ancillary professionals are utilized in treatments. It just doesn’t seem too much to expect pride, neatness, restraint and civility when a person is called “doctor.”


Big Rig Medicine

by Lyle Kelsey, CAE
Executive Director

Has your patient had a HEART SCAM lately… in the back of an 18-wheeler?

How funny… I mistakenly said scam… or did I? Not every capitalistic idea comes out of California these days. The latest caravan of mobile medical gypsies is coming from Florida. Over the last year, more and more people are lining up in church or Wal-Mart parking lots, plunking down $200 - $600 and having everything from heart scans, stroke screening, bone density tests to full body scans done, all in the convenience of their neighborhood refrigerated semi-tractor trailer! Fortunately, the truck is not moving at the time. Is the “patient” afforded follow up care? Yes, if they drive 60 mph on I-35 and flash their lights for them to stop. These mobile vehicles are impressive and have quality paint jobs complete with billboard artwork. Now, I will admit that we’re not talking about a refurbished 1963 Kenworth but rather a new customized, specialized, and sanitized semi-trailer that cost several hundred thousand dollars. Is anybody watching over these mobile facilities? Upon our investigation, some of these trucks had a state Health Department x-ray inspection certificate.

But alas, the real question is not “just” patient safety (important as that is)… the real question is “are the scan results (reports) meaningful to the patient’s primary care physician in Oklahoma?” Most physicians that I talk to say that the “diagnostic” reports their patients bring to them are rather meaningless. Doctors often end up requiring more specific and definitive tests anyway to make a proper diagnosis.

What is meaningful is that these mobile ministers of medical miracles are “making a lot of money” off the false sense of security people have when they step down from the truck with a piece of paper that reports that they don’t have heart disease, cancer, Alzheimer’s, etc., etc.

An article in CONSULTANT MAGAZINE (June 2003) says it very well. (See inset)

What does all this mean? My “opinion” is that the 21st century has given us High Speed Internet Medicine and new entrepreneurial gimmicks for the practice of medicine BUT nothing does or should take the place of face to face interaction between a patient and an educated, trained, competent, compassionate medical doctor who will spend adequate time to communicate, properly diagnose and prescribe appropriate treatment. (Gee, what a novel approach!) So when you have the opportunity to respond to someone as to whether they should have a diagnostic body scan in the back of a Big Rig from Florida… Tell them, let the truckers transport products, produce and animals but see a doctor for your healthcare! “10 – 4”


The Full Picture About Full-Body Scans

Several of my patients have asked me about full-body CT scans. Under what circumstances (if any) would such scans be indicated?
— MD

In my opinion, such scans are not indicated-unless a patient has obtained thorough and frank informed consent from a physician who has no financial interest in the decision. At the Mayo Clinic, we have been studying low-dose spiral CT screening and whole-body CT scans for lung cancer for more than 5 years. We have performed more the 6000 scans of 1520 participants in a study protocol funded by the National Cancer Institute and the Mayo Foundation. This research has yielded some interesting possibilities, but at this point there is no evidence that such testing reduces deaths from lung cancer or other causes. Moreover, more than 80% of participants in the study had a finding that prompted additional testing—and more than 95% of the results of these tests were false-positives.

Based on all the available data, it is unclear whether full-body scans would do patients more harm or good. I believe this is the primary reason why no professional society currently recommends whole-body screening or CT screening for lung cancer (except in investigative work).

The research currently under way should yield results that will allow us to make an evidence-based determination on this issue in the future.

—Stephen J. Swensen, MD
Professor and Chair
Department of Radiology
Mayo Clinic, Rochester, Minn


Medical Micropigmentation Act Revisions Effective Nov. 1, 2003

In 2003, the Oklahoma State Legislature enacted revisions to the Medical Micropigmentation Act, SB 340, which was signed by the governor on June 5, 2003. These changes do not become effective until November 1, 2003, consequently making rule changes impossible until that time. However, the following information is provided to inform you of the statutory changes included in SB 340.

Medical micropigmentation is a form of permanent cosmetics and requires a medical procedure in which any color or pigment is applied with a needle or electronic machine. The law authorizing medical micropigmentation does not include tattooing; thus, medical micropigmentation does not involve placing on the body any pictures, images, numbers, signs, letters of the alphabet or designs.

The physician in whose office medical micropigmentation is being performed shall determine the level of supervision. The law, as revised, could reduce the minimum number of hours of instruction to 300 hours. Current rules require a minimum of 450 hours or equivalent of competency based instruction for those wishing to enter the Medical Micropigmentation profession. As revised, the law allows other entities an opportunity to offer Medical Micropigmentation Training.

The Oklahoma State Department of Health, upon recommendation of the Medical Micropigmentation Advisory Committee, may approve applicants for certification by reciprocity if they have qualifications and training comparable to those under this act. Applicants would have to verify two years experience, a minimum of 200 procedures and successful completion of the Oklahoma Medical Micropigmentation Certification Exam.

It is important that all individuals apply to the Oklahoma State Department of Health for certification if they wish to provide these procedures under the supervision of their employing dentist, medical physician, and/or osteopathic physician. Without proper certification as a micropigmentologist, defined by the State Department of Health, only a physician may legally provide this procedure at this time.

Administrative penalties up to $5,000, allowed by the Oklahoma Medical Micropigmentation Regulations Act, are being imposed and enforced pursuant to the Administrative Procedures Act for those who violate these requirements.
For information regarding the regulations for certification as a technician, contact Rocky McElvany, Chief, Consumer Health Services, Oklahoma State Department of Health, 1000 NE 10th, Oklahoma City, OK 73117-1299 (405) 271-5243.


New Guidelines for Cosmetic Surgery

By Gerald C. Zumwalt, MD
Board Secretary/Medical Advisor

The American Academy of Cosmetic Surgery has issued 2003 Guidelines for Breast Augmentation and Liposuction Surgery and Sclerotherapy for varicose veins.

In general, each set of guidelines contains standards for training and education, preoperative evaluations, indications, surgical setting, expected sequelae, post-operative care and medications, documentation of care and recording adverse effects. There are individual sections on privileging for liposuction surgeons and recommended volume of suctioned fat as well as alternative treatments for varicose veins. The necessity of ALCS training and anesthetic monitoring is established.
Any Oklahoma physicians performing these services should obtain and utilize theses guidelines. Copies of all three are available in this office. Information from the Academy is available at:

737 North Michigan Avenue, Suite 820
Chicago IL 60611-6659 USA

Phone: (312) 981-6760
Fax: (312) 981-6787
E-mail: info@cosmeticsurgery.org
Web site: www.cosmeticsurgery.org


Board Meeting

September 11, 2003

The Board met on September 11, 2003 to consider licensing and disciplinary matters. Of interest to doctors not currently licensed or to those planning on dropping an active license, is the adoption of a rule implementing the recently enacted Volunteer License Law. This license may be used only to treat without remuneration “indigent and needy patients” and will become effective on November 1, 2003.

Five full medical licenses were issued after personal appearances. One special license was converted to a full license under indefinite terms of probation for past drug abuse. A physical therapy license and a respiratory care practitioner license were issued under agreements allowing monitoring for drug abuse and/or alcohol abuse because of past driving arrests. One medical license was denied due to problems in other states with sexual misconduct and drug abuse.

Two training licenses were issued after personal appearances. One training license was denied when it was discovered that the applicant had furnished false information and had a history of untruthfulness.

One MD was reprimanded and required to obtain anger management CME after striking a patient. One doctor was suspended for three months to be followed by indefinite probation due to relapse to drug abuse and violation of narcotics laws. One physician’s license was revoked after confessing to sexual misconduct with pediatric patients.