_ISSUES and ANSWERS

Vol 9 No 1
March 1998

Speaking in Tongues

by Gerald C. Zumwalt, M.D.
Board Secretary/Medical Advisor

Oklahoma has an official state motto, "Labor conquers all things." Not quite equal to Virginia's, "Thus even to tyrants" or Kentucky's, "United we stand, divided we fall," but certainly more understandable than Oregon's, "She flies with her own wings," or Washington's, "By and by."

Aside from poetic locations of pleasant words, the question comes as to why people speak in phrases and language without obvious meaning. One of the most frequently voiced complaints about doctors is their tendency to use "scientific" terms when commonly understood words are available. At times, this habit has produced formal complaints to the Board over misunderstood terms or phrases.

It is certainly more professional and more circumspect to refrain from the gutter language of "four letter" words when referring to bodily functions; but even here, if it is necessary to impart understandable information to patients, it may be necessary to utilize distasteful language.

The bigger problem lies in the use of euphemisms and obscure Latinate terms or psuedo-Latinate terms to elevate the user's self-esteem or confuse the unsophisticated listener. One wonders why "fever" is not preferable to "elevated body temperature" or why "oil gland" should be replaced by "sebaceous gland." The age of physicians dressing in zodiac imprinted gowns and wearing pointed hats fortunately has passed—although some aspects of "alternative" medicine would seem to drag medicine back several centuries.

Although, there is beauty in many medical words (I have always thought Fabella or Pityriasis Rosea would be appropriate names for my daughters), those expressions utilized in common laymen's language can accomplish more complete understanding by the patient. Utilizing foreign or polysyllabic words as a verbal smokescreen to hide ignorance or bad news is plain dishonest.

Using Okie language to address Okie folks is not necessarily a bad idea.

What Would You Do?

The Tennessee Medical Board alleged that a doctor licensed in Oklahoma but not licensed in Tennessee had been practicing medicine in Tennessee. They had obtained a consent judgment with issuance of a permanent injunction that the doctor would not engage in any medical practice until he obtained a Tennessee license. In addition he paid attorney fees and a statutory $1000 penalty.

Oklahoma charged him with unprofessional conduct and presented as proof the consent judgment and affidavits from patients in Tennessee that, indeed, he had treated them.

The defendant's attorneys argued that the doctor's name appeared on no medical records and that all prescriptions were issued in another doctor's name. They also presented the consent judgment which contained the phrase, "shall not and does not constitute an admission of guilt by the defendant." They quoted the doctrine of res judica (double jeopardy) which means once a matter has been adjudicated it cannot be retried. Since the Tennessee order did not have a finding of guilt, Oklahoma could not consider the evidence, the attorney argued.

From Last Time...

The Board's decision on the physician who was taking amphetamines from his own office store was as follows:

1) Suspension for 90 days

2) Evaluation and treatment by a psychiatrist

3) Five years probation. Terms included:

• No re-registration with DEA;
• No personal use of any medication unless ordered by another physician.

Board Meeting -

Jan. 22, 23, 1998

The Board met in regular session for matters of discipline and licensure. A total of ten full licenses were issued following personal appearances by applicants. Four applications were tabled and one was denied. Three applications were approved with terms of probation. These involved sexual misconduct, chemical abuse, and questionable clinical competence. Two special licenses were modified to allow practice in a new geographic setting.

Five disciplinary hearings were tabled until the next Board meeting as was the status of all special licenses for military personnel.

Five Voluntary Submittals to Jurisdiction were accepted. One resulted in a sixty-day suspension followed by a five-year probation due to aiding and abetting the unlicensed practice of medicine. One Voluntary Submittal contained standard posttreatment terms for chemical abuse and restrictions on prescription authority. One required affiliation with a 12-step program. One mandated certification of services performed and billed. The remaining one contained standard posttreatment terms for alcohol addiction.

One license was revoked due to fraudulent license application and gross negligence in performing surgical procedures.

Dead Man Talking

A recent issue of Medical Legal Lessons questioned who could authorize release of a dead person's medical records. There may be differences from state to state, but in general the release should be signed by the personal representative, executor, or administrator. Advice from your attorney may be needed if questions as to the propriety of such request arises.

Oklahoma Statutes Title 59 '509

(18) Engaging in physical conduct with a patient which is sexual in nature, or in any verbal behavior which is seductive or sexually demeaning to a patient.
The following was published first in the January 1993 issue of Medicine in Oklahoma. Due to an increase in inquiries, we offer it again.

Sexual Battery and Harassment—An Issue for the Board

by Daniel Gamino, Board Attorney

In the wake of the Anita Hill_Clarence Thomas Supreme Court confirmation hearings, it is not surprising to find that allegations of sexual harassment and battery are again an issue for physicians.

More and more female patients—and staff members—are making formal complaints of sexual battery and harassment against male physicians. Some of the more egregious cases may reach the level of formal, sworn allegations of unprofessional conduct against a physician. Those allegations may result in a lengthy, costly and public hearing before the Oklahoma Board of Medical Licensure and Supervision.

Most physicians routinely place a nurse or assistant of the same gender as the patient in the examination room with them for every examination or procedure. Yet, it remains amazing the number of physicians who do not follow this time-honored principle. Even if the physician's specialty is normally nonthreatening (psychiatry, hand surgery, foot surgery) such allegations may still result.

The best protection for a physician is fourfold.

1. First, a nurse or assistant of the same gender as the patient should assist the physician at all times on all examinations, tests, and procedures.
2. Second, any necessary touching of normally private areas should be explained to the patient before the procedure and in the presence of the aforesaid nurse or assistant.
3. Third, at all times in the physician's office, the physician and staff should refrain from any comments or joking or behavior that might be misunderstood as flirtatious or as an invitation to a social relationship.
4. Fourth, any setting up of social dates or relationships should occur outside office hours and off of the office premises.

From the AMA

8.14 Sexual Misconduct in the Practice of Medicine. Sexual contact that occurs concurrent with the physician_patient relationship constitutes sexual misconduct. Sexual or romantic interactions between physicians and patients detract from the goals of the physician_patient relationship, may exploit the vulnerability of the patient, may obscure the physician's objective judgement concerning the patient's healthcare, and ultimately may be detrimental to the patient's well-being.

If a physician has reason to believe that nonsexual contact with a patient may be perceived as or may lead to sexual contact, then he or she should avoid the nonsexual contact. At a minimum, a physician's ethical duties include terminating the physician_patient relationship before initiating a dating, romantic, or sexual relationship with a patient.

Sexual or romantic relationships between a physician and a former patient may be unduly influenced by the previous physician_patient relationship. Sexual or romantic relationships with former patients are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship.

CME 2000 Update

There are only three categories of physicians that are exempt from meeting the Oklahoma licensure requirement of 150 hours of Continuing Medical Education every three years beginning with July 2000 renewals:

1) Medical doctors in residency or fellowships

2) Medical doctors in the Physician Emeritus Status

3) Medical doctors that have the AMA PRA or Board approved equivalent.

CME Helping Hand

The Office of Continuing Medical Education at the University of Oklahoma Health Sciences Center has developed a service to help physicians keep track of their CME credits.* Credit Keepers will keep a yearly record of individual professional CME credits for physicians. Membership runs January through December and costs $89.

Services offered by Credit Keepers include:

— Computerized record keeping by social security number

— Prepaid postage envelopes for physician reporting

— Quarterly notification of total credit hours

— Transcripts on request

— Completion of the American Medical Association Physician's Recognition Award application (mailed to the physician for signature and payment of AMA's processing fee)

— Notification of upcoming University of Oklahoma accredited CME programs

For more information call the Continuing Medical Education Office at 405/271-2350 in the metro area or 1-888-OUCME4U.

*The Board of Medical Licensure and Supervision has no connection with this service and offers no endorsement. This is being made available for your information.

CME does not necessarily have to be in the physician's specialty.