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Oklahoma Board of Medical Licensure and Supervision


Vol 12 No 1
January 2001

Fast Food, Pickled Peaches and Computers

By Gerald C. Zumwalt, M.D.

At a recent Sunday service in the Cathedral of Santa Fe the priest compared many of the present compressed, non-alarming, politically correct church services to fast food meals. They are adequate, filling and palatable. But he asked the question, "Have you ever had a truly memorable fast food meal?"

Several weeks ago Joanne Jacobs, a usually very liberal columnist appearing in the Tulsa World Opinion Section, wrote about a recent study that seriously doubted any educational advantage of having computers in elementary schools. The study raised earnest fears of inhibition of imagination, stimulation and original thought as a result of sitting before the monitors for long periods.

Other than the personal and patient observed health hazards of consuming fat-laden fast food and the tax burden of purchasing and maintaining multiple computer stations, is there any medical tie to the subjects of the above two paragraphs? Well it seems to me from reading journals and viewing the subjects of talks at local and national meetings that our profession currently is obsessed with bookkeeping, patient flow (the vision of green gowned bulky adult women swimming against a corralled stream cannot be suppressed), time management, telemedicine and electronic examination, diagnosis, treatment and record keeping. It's as if Michelangelo had been instructed to paint the Sistine Chapel ceiling with a sprayer overnight.

A large number of complaints are received at this office weekly and the majority fall into three categories. First is patients' difficulty in obtaining copies of their records (see related article on back page). Second is the promise, and then failure, to return telephone calls. Lastly is the brevity of time spent in personal doctor/patient encounters.

No physician wants to return to the days of sitting helplessly at a patient's bedside as they survive or die in a pneumonia crisis as portrayed in the oft-reprinted painting. But the fact that a simple telephonic order for an injection of antibiotic can prevent such a crisis does not satisfy the need of the patient for support, encouragement and promise of health.

When is the last time that you sat and talked to a patient about nonmedical matters? Do you know about their grandchildren, their hobbies, their hopes and dreams?

John and Abigail Adams exchanged letters of gentility and beauty written with quills dipped in slow drying ink that required a sand dispenser to dry. Then came Schaffer pens with rubber bladders that required blotters to prevent blurring and messages were urged to be brief and to the point. Following World War II, the ultimate corresponding weapon appeared _ ballpoint pens. "Write dry with wet ink!!" Even if the ink was ugly purple and the prose no better.

Today we e-mail spam that is as worthless and tasteless as the original canned meat Spam.

Maybe if we slowed down, viewed our patients as people instead of "healthcare consumers", practiced the art as well as the science of medicine and enjoyed them as friends instead of as enrollees we might again get an occasional gift of home canned fruit instead of malpractice suits and visits from investigators of this Board.

"Maybe if we slowed down . . . we might again get an occasional gift of home canned fruit instead of malpractice suits and visits from investigators of this Board."

Letter to the Board Secretary

Dear Doctor Zumwalt:

I have just come across a note I made reminding me to write you concerning an ISSUES AND ANSWERS piece you wrote quite a while back. The note is not dated, but refers to your piece titled Speaking in Tongues in a March issue. You mentioned pleasant medical terms you thought might have been appropriate names for your daughters. This brought to mind an incident in my medical training, having to do with a girl baby's name, though in this instance not a desirable name.

While a student in Jefferson Medical College, making a home obstetrical delivery in 1946, in downtown Philadelphia, I announced to my fellow student, whose turn it was to assist, that the newborn just coming into the world was a girl baby, and then exclaimed that I was seeing meconium, pleased to realize the newborne had a functioning GI tract. The infant's grandmother in the room observing all that was going on, overheard both statements, probably expressed with some enthusiasm, and exclaimed, "What a pretty name, we should name her meconium." We explained to the grandmother, and the mother, why it would not be a suitable name but a little later, as I filled out the birth certificate, the infant's mother affirmed the name, and would not be dissuaded, echoing the grandmother's opinion, "It's a pretty name."

I have at times recalled that incident, and wondered how the child coped with the name as the years went along. Surely there came a time when she learned the medical meaning of the word.

Let me thank you again for the informative and interesting articles you authored for us in ISSUES AND ANSWERS. Each time a new one came in the mail, I approached reading it with enthusiasm.

With sincere best wishes,

M.O. Lewis, MD (Ret.)

Physician Labeling Proposal

The Food and Drug Administration, on December 21, 2000, proposed a new format for prescription drug labeling that will help reduce medical errors, which according to the National Academy of Sciences may be responsible for as many as 98,000 U.S. deaths annually. FDA believes that this new, user-friendly format will reduce errors in drug prescribing.

"Today's proposal is FDA's latest initiative to improve the labeling of the products it regulates," said Dr. Jane E. Henney, FDA Commissioner. "This proposal is particularly valuable because it will make important information available in a clear, consistent, and readable format that is essential to proper prescribing practices."

Prescription drug product labeling, also known as the package insert, represents a primary means of providing critical information about drugs to practitioners. As part of the drug review process, FDA reviews and approves drug product labeling that is initially proposed by manufacturers.

An FDA study showed that practitioners found drug product labeling to be lengthy, complex, and hard to use. The proposed new format would provide user-friendly labeling that would allow practitioners to quickly find the most important information about the product. One major change is inclusion of a new introductory "Highlights" section of bulleted prescribing information. This section would include the information that practitioners most commonly refer to and view as most important, and it would provide the location of further details elsewhere in the labeling.

The proposed new labeling is expected to reduce practitioners' time spent looking for information, decrease the number of preventable medical errors, and improve treatment effectiveness. The information will be easier to find, read and use, and it should also enhance the safe and effective use of prescription drugs and reduce medical errors caused by inadequate communication. Because these labeling revisions represent considerable effort and are most critical for newer and less familiar drugs, the proposal will apply only to relatively new prescription drug products.

FTC Issues Consumer Alert on Lasik Eye Surgery

The Federal Trade Commission (FTC), together with the American Academy of Ophthalmology (AAO), have issued a consumer alert regarding Lasik eye surgery to correct refractive vision problems. The FTC cites an increasing number of complaints received regarding complications associated with the surgery and a lack of advertising disclosures about possible risks. A toll-free number, 877/FTC-HELP (877/382-4357), has been established for consumers to request a copy of the brochure, "Basik Lasik: Tips on Lasik Eye Surgery." The brochure, which is also available online at www.ftc.gov, discusses the risks and possible complications, how to decide if you're a candidate for the procedure, how to shop for a surgeon, and what to expect before, during and after surgery. Alternatives to Lasik are discussed and resources for additional information are listed.

Accepting Help

by Gerald Zumwalt, M.D.

In the April 10, 2000 (Vol. 43, #14) issue of the American Medical News is an Ethic Forum concerning attendings asking residents to do household chores. Not surprisingly the decision is that such personal requests are unethical primarily since the resident is not in a position to refuse.

This inequity of power exists not only in an attending/resident relationship but also in the more common relationships of parent/child, teacher/student, minister/parishioner, and more pertinently, doctor/patient. And, although few of us have ever asked a patient to paint our house, it is our responsibility to examine any social or business association we have with our patients. Considering the tendency of physicians and their spouses to be participants in the hierarchy of charitable and philanthropic organizations, it even behooves us to consider mailing lists and requests for money and other contributions made over our signatures. There is the danger of a patient recipient implying a connection between complying with such requests and continuing to receive care. Even worse, they may perceive a promise of "better" (i.e., more satisfying to the patient) care and medication as a reward for acceding to the "doctor's demands".

In an earlier column we wrote of the booklet from the General Medical Council for the United Kingdom (England) which detailed the responsibilities and privileges of practicing medicine in the U.K. Included in those pages was a prohibition against accepting loans or entering into business partnerships with patients. Although the Oklahoma Medical Practice Act does not list these activities explicitly, the Oklahoma Administrative Code Title 435:10-7-4(44) states as Unprofessional Conduct "Abuse of physician's position of trust by coercion, manipulation or fraudulent representation in the doctor-patient relationship."

Certainly this Board encourages and commends our licensee's efforts to support educational, religious, and community projects. We have nothing but admiration for those willing to undergo the risk of financial enterprises. We do feel that M.D.s as possessors of unique powers and position should be, like Ceasar's wife, above suspicion and be wary as to who and how we involve others in our efforts.

Sale of Goods from Physician Offices

A new policy that, in part, addresses the regulation of the sale of goods from physician offices was adopted by the Federation of State Medical Boards. The policy was adopted based on a report from the Federation's Special Committee on Professional Conduct and Ethics. The report also recommended state medical boards adopt and distribute guidelines to licensees outlining the board's expectation regarding the sale of goods from physician offices.

The report recommended, "To avoid appearance of impropriety, physicians should avoid the sale of products that can easily be purchased by patients locally."

Guidelines issued include:

  • Due to potential for patient exploitation, physicians should not sell, rent or lease health-related products or engage in exclusive distributorships and/or personal branding;
  • Physicians should provide a disclosure statement with the sale of any goods, informing patients of their financial interests; and
  • Physicians may distribute products to patients free of charge or at cost in order to make products readily available.

The report also recommended exceptions be made for the sale of durable medical goods essential to the patient's care as well as nonhealth-related goods associated with a charitable or service organization.

The entire committee report is available on the Federation web site at www.fsmb.org. The Oklahoma Board has plans to adopt its own version of the policy this spring.

Board Meeting - November 2, 2000

The Board met in regular session with the following actions. Two full licenses were issued after personal appearances by the applicants. One license was reinstated with an Agreement to continue treatment for substance abuse. One Special Training License was renewed for one year during which time Step 3 of the USMLE must be passed. One Special License was denied when the applicant failed to persuade the Board that he could make a unique contribution to the public health of Oklahoma.

Four Voluntary Submittals to Jurisdiction (VSJ) were accepted. Three were under terms of probation for substance abuse - one for an indefinite period of time and two for five years (one included a 90-day suspension). The last VSJ accepted imposed a Formal Reprimand and one year of probation for sexual misconduct and prescribing without medical records.

One license was surrendered in lieu of prosecution for filing an application containing fraudulent information.

One license was suspended indefinitely for sexual misconduct until the licensee can present evidence of satisfactory participation in counseling.

Access to Medical Records

Title 76 § 19 of Oklahoma Statutes allows patients the right to copies of their medical records. Section 19 was amended by the Legislature last year. It still requires doctors, hospitals, and other medical institutions to furnish copies upon the patient's request and allows a fee of $0.25 to be charged for each copy. The latest change allows a charge of $5.00 or the actual cost of reproduction, whichever is less, for x-rays or other photographs or images.

This law does not apply to psychological or psychiatric records. Patients are entitled to those only if the treating physician consents or a court of competent jurisdiction so orders.

Failure to furnish records or information as required by these statutes is a misdemeanor (Title 76 § 20).

For a copy of Title 76 § 19 and § 20, call the Board office or look at this newsletter on the Board's website - www.osbmls.state.ok.us - click on "Medical Professionals' Resources".