Board complaints

[F0nzie]

Read an interesting article about board complaints. http://www.medscape.com/viewarticle/853911.

"According to a 2009 report[2] about the California board, 1 of every 8 physicians in the state was being reported to the board each year. About one quarter of complaints to the board were investigated, and about one quarter of investigated complaints led to disciplinary proceedings against the physician, the report added."

I had no idea complaints were this common. 1/8 seems like a high number-- I wonder how common it is in psychiatry. Did you guys ever talk about how to handle board complaints in residency?

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[hamstergang]

I've been an attending for 5 months. No complaints yet. We did not talk about then in my residency or fellowship.

 

[wolfvgang22]

We talked about it in both residency and fellowship. Mostly was told never to ignore letters from the board and meet all deadlines if you value your license. If 1 in 8 physicians are getting complaints to the board, I would say people are abusing the system. I've had patients threaten to report me to the state medical board for refusing to prescribe benzos, but never follow through as far as I know.

 

[F0nzie]

We talked about it in both residency and fellowship. Mostly was told never to ignore letters from the board and meet all deadlines if you value your license. If 1 in 8 physicians are getting complaints to the board, I would say people are abusing the system. I've had patients threaten to report me to the state medical board for refusing to prescribe benzos, but never follow through as far as I know.

1 out of 8 does seem high. I wonder if they are increasing in numbers because of the availability of the "file a complaint" button. Writing a formal letter was the old standard.


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[OldPsychDoc]

It may have most to do with regional variations in litigiousness--but other than a few patient rep calls, I haven't experienced this.

 

[sweetlenovo88]

Second on threats to report because of benzos and one threat to report from inpatient gig for prescribing a child prozac. Mother came in faking mental health with an associated outpatient clinic to yell at me during the intake on how I could have given her preteen prozac. And by yell, I mean at the top of her lungs until she was escorted out. Luckily the outpatient was telepsych and I just flipped the camera off. Nothing ever reported.

 

[wolfvgang22]

Second on threats to report because of benzos and one threat to report from inpatient gig for prescribing a child prozac. Mother came in faking mental health with an associated outpatient clinic to yell at me during the intake on how I could have given her preteen prozac. And by yell, I mean at the top of her lungs until she was escorted out. Luckily the outpatient was telepsych and I just flipped the camera off. Nothing ever reported.

So did she get billed for the intake?

 

[Shikima]

I hope so.

 

[daru1]

This is the reason that Texas took away anonymous reporting a few years ago.

 

[wolfvgang22]

I have heard that the Texas board can be a pain sometimes, though.

I know a physician who was asked by the ER informally if they should give a psychiatric patient who was abusing illicit drugs and who was already prescribed opiates a benzo. The physician, who had never met the patient said "no, generally we shouldn't prescribe benzos in these types of situations."

The patient then reported the physician to the board for failing to treat his anxiety. The board then required immediate lengthy documentation and explaination. After that seemed to meet their satisfaction, they then wanted to reinvestigate a 20 year old incident that the board had cleared the physician of any wrong doing some 20 years ago. The physician was understandably exasperated and unnecessarily stressed about the whole thing.

 

[Shikima]

Good reason to start a SSRI at a low dosage and given resources to follow-up or had the SW on site get him enrolled into IOP.

 

[Merovinge]

I have heard that the Texas board can be a pain sometimes, though.

I know a physician who was asked by the ER informally if they should give a psychiatric patient who was abusing illicit drugs and who was already prescribed opiates a benzo. The physician, who had never met the patient said "no, generally we shouldn't prescribe benzos in these types of situations."

The patient then reported the physician to the board for failing to treat his anxiety. The board then required immediate lengthy documentation and explaination. After that seemed to meet their satisfaction, they then wanted to reinvestigate a 20 year old incident that the board had cleared the physician of any wrong doing some 20 years ago. The physician was understandably exasperated and unnecessarily stressed about the whole thing.

Yikes, I can only imagine how the ED doc spun this. "Psychiatrist A says to not give you benzo's because he/she knows that you abuse illict drugs. My hands are tied."

 

[PistolPete]

Yikes, I can only imagine how the ED doc spun this. "Psychiatrist A says to not give you benzo's because he/she knows that you abuse illict drugs. My hands are tied."

Ugh, this is why I hate "curbside" consults from ER/FP/IM. I had this happen many times at the VA, only to see "Dr. PistolPete said...."

 

[Merovinge]

Ugh, this is why I hate "curbside" consults from ER/FP/IM. I had this happen many times at the VA, only to see "Dr. PistolPete said...."

It's really bad because curbside consults could be a way to deliver better pt care in an affordable way that doctors and patients appreciate.

 

[Jules A]

Ugh, this is why I hate "curbside" consults from ER/FP/IM. I had this happen many times at the VA, only to see "Dr. PistolPete said...."

I was called to do a medical floor consult for "back-up" that a morbidly obese patient, with OSA, recent cocaine abuse and cardiac issues shouldn't get Valium increased from 10mg tid along with the round the clock opiates they were receiving. I try to avoid curbside for this particular style of ridiculousness because I know how its going to be presented to the patient. Although I'd rather not have to go in this case I went the bedside to address it myself because I knew "back-up" was code word for "I'd love to give it to you but that meanie JulesA said no" and if I'm going to take a pounding I'd at least like some eye contact, lol.

 

[thoffen]

Shoot. I can't recall being thrown under the bus like that, but maybe I just never found out about it. Neuro would consult us to break the news for PNES patients, and we would try to ensure they did their part first. The only consult I ever refused as such was a surgeon consulting me to evaluate for SI in a patient because they had a hx of this in the chart. When I asked if the patient was currently suicidal, the surgeon was confused. Then I asked what the patient said when she was asked if she was thinking about suicide. The surgeon never asked. I said I would be happy to help if she did not have confidence in her assessment or management, but that she needed to try first.

 

[northernpsy]

one threat to report from inpatient gig for prescribing a child prozac. Mother came in faking mental health with an associated outpatient clinic to yell at me during the intake on how I could have given her preteen prozac. And by yell, I mean at the top of her lungs until she was escorted out.

How lovely. Thank you for the illustration of exactly why child psychiatrists are such a rare and precious breed.

 

[FlowRate]

Ugh, this is why I hate "curbside" consults from ER/FP/IM. I had this happen many times at the VA, only to see "Dr. PistolPete said...."

If it's about a specific patient, it's not a curbside and you have established a physician-patient relationship.

Curbside questions should be phrased "In an otherwise healthy patient with xyz, how would you approach q problem, generally?"

If your ED docs are "curbsiding" you and then documenting you as a *consultant*, that needs to change.

 

[nancysinatra]

***

 

[nancysinatra]

Thanks for sharing your story. That sounds like a nightmare. Sorry to hear you went through that...

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Thanks Fonzie. I don't suppose you'd be so kind as to edit out my quote, but if you would, I would appreciate it. I have thought about posting that for a long time. I shouldn't have, of course, but too many times I've wanted to and didn't. It is impossible not to get bitter and jaded after that and want to vent when any remotely related subject arises.

At the same time, there's another side to things. I know people here think I look down on psychiatry, but I don't. Actually I just want it to be better than it is. I want for there to be treatments for everything we diagnose, and for the diagnoses to be correct, and for the treatments to work, so patients get better. Not just the ones we see in clinic - but everyone out there who needs help. Somehow we need to reformulate a lot of what we do. It shouldn't take someone six years to get rediagnosed from the ubiquitously incorrect bipolar to the more likely PD or PTSD, which is what happened with my family member. (Who also has juvenile onset diabetes, and was put on lithium, and has mild kidney impairment now, despite being younger than me. For a long time I was worried that one of these days, I'm going to be asked to be a donor, or told I'm not a match - not sure which is worse. Fortunately the lithium has since been stopped.)

I didn't mean it when I said I would not help people in that state. Of course I would. But it felt good for a minute to publicly express my anger. Still I wish I hadn't posted that. Yet I'm not totally sorry either. It really happened, and my program seemed to be willfully unhelpful. That has always been more upsetting to me than the actual board problem. Because those were people ahead of me in the profession, whom I looked up to at the start. What happened to me could have happened to them, but they didn't care.

I'm guessing a lot of people who have been through a board complaint have had the experience of realizing that colleagues and peers don't care - until it happens to them.

 

[Shikima]

If you really look at it from a historical perspective, the board was the only check point for physicians. In today's age, you've got insurance companies, hospital administrations/residency training, and our own professional society which adds the pressure "to be good" at all times.

 

[F0nzie]

Done.


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[nancysinatra]

Done.


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Thanks, I appreciate it!

 

[nancysinatra]

If you really look at it from a historical perspective, the board was the only check point for physicians. In today's age, you've got insurance companies, hospital administrations/residency training, and our own professional society which adds the pressure "to be good" at all times.

Not to mention Google searches! Yikes the climate is so unfriendly to doctors nowadays. I wish we could organize and stick up for ourselves better.

 

[northernpsy]

I'm guessing a lot of people who have been through a board complaint have had the experience of realizing that colleagues and peers don't care - until it happens to them.

What would you suggest doing to be helpful if a peer has this kind of experience?

 

[Shikima]

What would you suggest doing to be helpful if a peer has this kind of experience?

Let them rage with your support and buy them a beer.

 

[PikminOC]

This is the reason that Texas took away anonymous reporting a few years ago.

Do you know why? One of their own board members was turning in competitors anonymously and then disciplining them. They found his fingerprints on the complaints.

 

[nitemagi]

My malpractice company gave me stats when I first signed with them -- orthopedic surgeons are sued on average every 3 years. Psychiatrists? Every 33 years.

 

[PikminOC]

How about number of board complaints?

My malpractice company gave me stats when I first signed with them -- orthopedic surgeons are sued on average every 3 years. Psychiatrists? Every 33 years.

 

[nitemagi]

Good Q.

 

[PsyDr]

@F0nzie

Am I reading this wrong? 100 out of 800 physicians have a board complaint in a given year. 25 of those are investigated. 6.25 have disciplinary action. So .007 are disciplined a year.

 

[Shikima]

@F0nzie

Am I reading this wrong? 100 out of 800 physicians have a board complaint in a given year. 25 of those are investigated. 6.25 have disciplinary action. So .007 are disciplined a year.

James Bond is pleased with this result.

 

[wolfvgang22]

Most people don't even know what a specialty board is.

 

[Blitz2006]

My malpractice company gave me stats when I first signed with them -- orthopedic surgeons are sued on average every 3 years. Psychiatrists? Every 33 years.

Is this nationwide or stats for a particular state?