ID for Doctors ?

[ArkansasRanger]

Once again, I'm placing a random question here since FM is my preferred specialty, if you will.

I ask this because, being a law enforcement officer, I at times identify myself via credentials instead of a uniform.

I've noticed in an array of movies and television shows that doctors have identified themselves as such and presented some type of ID card from their wallet. Is this "tv," or are physicians provided with some type of state licensure card or other identifying credential?

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[lord_jeebus]

My state medical board gave me a wallet card, but I don't know if all states have this or not.

 

[lowbudget]

When I'm outside of work, I don't want to be known as a doctor.

 

[deleted87716]

The only thing I have that looks "official" are my hospital ID badges, which I rarely have with me outside of the hospital.

If I'm ever asked for ID, I guess I'll just say, "Badges...?We don' need no steenking badges!"

 

[notinkansas]

When I'm outside of work, I don't want to be known as a doctor.

Amen to that!

 

[JackADeli]

My state medical board gave me a wallet card, but I don't know if all states have this or not.

Every state I have been licensed in (~4) issued a wallet card. The fine print (when I looked) on some say something to the effect that you should have it on you while practicing. One hospital made a big point that "we" needed to make sure we all had ours on us when the JCAHO inspector came to town. I left it home anyways.

I don't carry mine. I have never been asked to present it. Even at the hospital, I was only asked on one occasion to provide hospital ID/badge. The police have never asked me for physician ID. I don't try to run around town advertising I'm a physician either (i.e. no vanity plate "DRLUV", etc...).

 

[ArkansasRanger]

Same here. Idiots may walk around in a police t-shirt or something, but most of us try to distance ourselves as much as we can when we're off. I would imagine it's the same for doctors. I've never once seen any doctors I know at the store or anything, lol. I suspect I'd be the same way if I ever get there.

I'm with Blue Dog in that we don't need any badges.

 

[Leukocyte]

Docs is my state are not issued IDs. What benefit would an ID do anyway?
The ONE TIME where it could have done any "good", it did not. One of my fellow residents got a call from home that his continuity pt. came to the L&D, with no prior notice at 37 weeks, Multip., 9cm, 100% effaced, +2 station, and wants to push. He lives 5 minutes away by car. He put on his scrubs, his white coat that bore his name and attached his ID, then jumped in his car to try to get there as soon as he can. But, before he was able to get there, he saw the dreaded red and blue lights in his rear view mirror. Yep, he got hit with a speeding ticket, despite expaining to the officer the reason for his frantic rush. He missed his continuity delivery (the attending delivered it on his own). However, after showing the ticket to the attending, the attending agreed to let him count that continuity. God bless our friends in blue.

 

[Gastrapathy]

Docs is my state are not issued IDs. What benefit would an ID do anyway?
The ONE TIME where it could have done any "good", it did not. One of my fellow residents got a call from home that his continuity pt. came to the L&D, with no prior notice at 37 weeks, Multip., 9cm, 100% effaced, +2 station, and wants to push. He lives 5 minutes away by car. He put on his scrubs, his white coat that bore his name and attached his ID, then jumped in his car to try to get there as soon as he can. But, before he was able to get there, he saw the dreaded red and blue lights in his rear view mirror. Yep, he got hit with a speeding ticket, despite expaining to the officer the reason for his frantic rush. He missed his continuity delivery (the attending delivered it on his own). However, after showing the ticket to the attending, the attending agreed to let him count that continuity. God bless our friends in blue.

Not to be difficult, but why was this an emergency that required him to speed? Because if it was just so he could get the delivery, he deserved the ticket. Thats not the same as the vascular surgeon speeding into the hospital to bail out a general surgeon who got in trouble and has a clamp across the aorta.

 

[ArkansasRanger]

I'm not sure what good they'd be either. It was just a fleeting thought.

 

[JackADeli]

...He missed his continuity delivery (the attending delivered it on his own). However, after showing the ticket to the attending, the attending agreed to let him count that continuity...

So, let me understand this correctly, he violates highway rules/laws then proceeds to LIE about his number of deliveries... cause his attending was sympathetic with his endangering the rest of the community by speeding? Sounds great.

I am certain plenty of residents miss some deliveries. I am pretty troubled to hear residents are lying and taking credit for deliveries they don't perform. Makes you question how trained/qualified a resident is if you can't trust their numbers.

 

[lowbudget]

Sounds like you guys don't understand how continuity deliveries work & haven't been FM residents.

1. In community hospitals, OB & FP's don't stay in house in L&D like they do in academic med centers. So it's common practice to be called into the hospital at anytime even though you're not "on call" because of these continuity deliveries.
2. RRC requires 40 deliveries & 10 additional continuities. 40 or more is easy to get the delivery skill which BTW is NOT hard. The 10 is because you have to follow a lady for 9 months AND make the delivery so that you can count it towards graduation. Since pregnant ladies can deliver anytime after 36-40 weeks, you have to be ready to drop everything you're doing (including sleep & alcohol) so that you make that 1 delivery. This resident didn't miss out on anything technical. What s/he did miss out on is the experience of being part of something pretty cool, & not being there for a patient that counted on him/her. But it happens & it happens a lot in private practice, which is why most FP/OB's will introduce pregnant ladies to the other doctors in the practice "just in case I can't make your delivery" or they have a laborist/OB hospitalist.
3. In my state, cops will pull you over & ask if you were speeding because of an emergency. I've been stopped before en route to a continuity delivery but let go once I flashed my creds. If I was this resident, I would challenge the ticket, submit delivery record with attending affadavit as evidence that the ticket posed a threat to the mom & baby's life during a crucial part of pregancy & try to get out of the ticket.
4. Continuity deliveries are such a huge deal because if you miss it/them, you need to start all over with another patient. Kudo's to the attending for giving credit. Continuity deliveries are cool in concept from an academic doctor-patient standpoint, but awful from a logistical standpoint. It's even suckier to put residents up to this standard as a means for graduation.

 

[lowbudget]

The question to Gastro's comment is what is considered an "emergency". It's just my opinion FWIW, but in the eyes of the lay public any delivery of a baby can defensibly be considered an emergency.

In the eyes of doctors, despite the use of fetal monitors & prenatal care, we still are not very good at predicting imminent emergencies in obstetrics & the public doesn't tolerate the lack of effort. Therefore, in this situation, it turned out not to be an emergency only after-the-fact in retrospect. We do this exercise in peer review & QA, but at that moment, when you get a call that a multip is 100 pct effaced and 2+, you don't have all day to ask a bunch of questions to determine if this is analogous to a cross-clamping of an aorta. As a society, we hold our obstetricians, family doctors, & midwives to the standard that every normal SVD is a potential ruptured AAA.

 

[JackADeli]

So, RRC requires 40 + 10 or is it 40 total, 10 of which must be continuity? Cause then we could be talking about a requirement of 50 of which this resident lied and may only have performed 49.

Sounds like you guys don't understand how continuity deliveries work & haven't been FM residents.

2. RRC requires 40 deliveries & 10 additional continuities. ...The 10 is because you have to follow a lady for 9 months AND make the delivery so that you can count it towards graduation...
4. ...Kudo's to the attending for giving credit...

I understand the concept and how it works. I don't give kudos for lying or false representation. Giving credit when as you describe: "RRC requires... so that you can count it towards graduation". The resident was not there for the delivery and did not perform the delivery. I don't get logging it as if he/she had performed the delivery just because logistics are difficult. It is unfortunate he/she missed this one. However, all the FP/FM residents I know have a large enough pool with plenty of pregnant patients that they meet their required 10 without lying and stating they were there for a delivery they clearly were not.

...As a society, we hold our obstetricians, family doctors, & midwives to the standard that every normal SVD is a potential ruptured AAA.

Sounds nice... but, not really. Woman have and do continue to deliver at home, in cabs, etc... (some even deliver in the bathroom at the hopsital with their physician downstairs in the cafeteria). Can there be complications? yes. However, a ruptured AAA is always an emergency and I have never heard of one being dealt with in a cab.

 

[JackADeli]

...continuity pt.
...37 weeks, Multip., 9cm, 100% effaced, +2 station, and wants to push.
...He missed his continuity delivery (the attending delivered it on his own).
...the attending agreed to let him count that continuity...

Just another thought/aleternative to lying/fraudulent documentation of participating in a delivery. My friends in FP/FM always talked about these magical 10 continuity deliveries. While they always got more then the required 10, they were scared they wouldn't. They were proactive. These are continuity patients. They knew the woman/women were close to delivery. So, as delivery dates approached, they ended up staying near the hospital to avoid a miss. When they missed, they didn't try to blame society, police, weather, or anyone else. They surely did not log the delivery as their own when they didn't do the procedure!

 

[lowbudget]

Point taken about logging procedures. It's 40+10 and no, not every program can source those 10 no matter how proactive the residents are. It does put the program in jeopardy.

I address your points in the How Many Deliveries thread.

If I were king for a day, this resident would've gotten credit for "continuity OB patient" but no credit for "delivery".

 

[Leukocyte]

I am certain plenty of residents miss some deliveries. I am pretty troubled to hear residents are lying and taking credit for deliveries they don't perform. Makes you question how trained/qualified a resident is if you can't trust their numbers.

With the way our program is stuctured, I am almost positive the resident did not get credit for the Delivery. However, he should habe gotten credit for the continuity...What is fare is fare, he took care of the pt for 9 months, and took care of her post partum. No credit for the actual delivery, but credit for continuity...Quite frankly, at our program residents do more than enough deliveries during their intern OB months, and for most by the end of their intern year, they have logged more than 40 delliveries. In is very busy here.

 

[JackADeli]

...What is fare is fare, he took care of the pt for 9 months, and took care of her post partum. No credit for the actual delivery, but credit for continuity....

It really is a very simple question. Does credit for the 10 continuity OB cases require the delivery? You don't have to like it. Maybe the continuity part is not well defined. But, does it specifiy a requirement for the delivery?

The issue is did he meet the requirement for continuity OB case credit. If RRC specifies the continuity OB case to include the delivery, it is not a "fare is fare" issue. It is a yes or NO issue. That is not for you or I to decide but I suggest you check on the RRC listed requirements.

...Prior approval of the RRC is required for major changes in the curriculum...of the program...
...Each program must document the availability of a stable patient population of sufficient number and variety to ensure comprehensiveness and continuity of experience for the residents in the FMC...

...Total Deliveries​

Each resident must perform a minimum of 40 deliveries over the 3- year program, of which a minimum of ten must be continuity deliveries. At least 30 of the total deliveries must be vaginal deliveries. Two residents may be given credit for the same delivery if one of those residents is supervising. The experience of each resident must be documented as to the role played in the delivery...

Apologies, but, reads as if your buddy can NOT take continuity delivery/OB credit as he did NOT perform the delivery. The way I read the requirements is that the Prima facie requirement for continuity delivery credit is that there is a DELIVERY. The definition of what constitutes the continuity component may not be as clear. But, the delivery is a clear primary requirement. Yes, there is general medicine/clinic continuity patient panel. That is different from continuity DELIVERY.

I'm going to continue anything further on the number of deliveries thread as opposed to this physician identification badge thread.​