Medicine Can Be A Taunting, Vicious Profession At Times

Discussion in 'Emergency Medicine' started by Birdstrike, Feb 24, 2017.

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  1. Birdstrike

    Birdstrike 5+ Year Member

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    Medicine Can Be A Taunting, Vicious Profession At Times
    By Birdstrike MD


    Not too long ago, I was busy at work seeing patients. The secretary yelled, “Dr. Birdstrike, there’s a phone call for you.”

    “Alright,” I said. “Transfer it over.” I answered the phone.

    “Hello, Dr. Birdstrike, this is ***** ****** from the ****** State Medical Board,” said a jabbing, deep military sounding voice.

    “Uh…hello,” I said. I felt a jolt of electricity in my chest. This wasn’t a phone call I expected nor wanted. The state —-ing medical board? What, the…?

    “I’m calling to notify you, we’ve received a formal complaint about your medical practice and I’ve been assigned as the lead investigator.”

    At this point, the adrenaline was pumping through my veins, and my heart beating fast enough, that I didn’t hear much of what he said after that. He might as well have told me I had brain cancer and had 6 agonizing weeks to live. Although I have been sued before, though never convicted by a jury, of medical malpractice, I’d come to realize that whole process was more about one group of lawyers fighting with another group of lawyers, to get money from an insurance company, with a doctor and a patient as mere pawns in the game. It’s a game that can feel very personal, but ultimately isn’t, and is mostly about the trophy hoped for by the plaintiff’s attorneys: Award money. But a complaint from the medical board? It’s honestly something I never thought I’d have to face, having been someone that’s always performed at a very high level during my career, at all of it’s stages, not every having faced any significant concerns regarding my performance. Also, in my personal life, I am, for lack of a better word, a rule follower.

    After, the initial shock dissipated, his words gradually faded back into the ear of my consciousness. He gave me the name of the patient and the stated complaint. I remembered the patient, but I didn’t remember any particularly bad outcome, or any negative interaction or administrative complaint at the time. The accusation appeared out of place and baseless. He explained the process: I was responsible for providing a written response to the medical board within 15 days. After that, there would be an investigation. After an undetermined period of time, the complaint would either be dismissed outright, dismissed with a non-disciplinary letter of warning which would go in my medical-license file, or if neither of those, then I’d have to go before the medical board for a hearing. A licensing hearing? The entire thought of any of this was horrifying. News headlines of doctors who had lost their licenses for egregious and horrible misconduct flashed like shocking, intrusive, strobe-light banner-notifications across the home-screen of my brain.

    I did nothing wrong. Why is this happening to me? This is insane? What the —-? Am I going to lose my license? No way, I’m going to lose my license. I did nothing wrong. Nothing even happened. Wait, what happened? Did anything happen? No, nothing did. But what if I get some rogue medical board or the case is reviewed by someone with an axe to grind or from a totally different specialty? Miscarriages of justice happen all the time. Don’t they? Questions bounced around my brain like a silver pinball.

    I slowed my breathing down. I logged into the medical record scanning through charts and reports like a DVR player on fast forward. Wait….They have no case.



    THEY. HAVE. NO. CASE.



    I started to get angry, very angry. Just like my lawsuit, where I was falsely accused of malpractice, never committed malpractice and was ultimately dropped from the case, because I didn’t commit malpractice. There was also nothing wrong here. I took a deep breath, slowed my breathing down, and dug further into the chart.

    It was a patient I’d seen on more than 1 occasion over several weeks. I had ordered an X-ray. On the same day the patient had my X-ray done, the results of which were largely unremarkable, the patient had another imaging study done, that had been ordered by another doctor, of a different specialty. It was an imaging study I knew immediately was not ordered by me, and could not have been ordered by me, because it’s an imaging study I don’t even order. But wait a minute….WAIT A MINUTE.

    I looked closer at the report. “Ordering physician: Dr Birdstrike.”

    What?! I don’t order this type of test. Literally, ever. I scanned through the order section of the EMR just to make 100%, double-triple-infinitely sure I didn’t order it, and there was none.

    I went back to see my waiting patients, doing my best to block this out of my brain for at least the next 3 hours so I could finish my shift. That was an impossible task. When I did finish my shift, I stayed about two hours lately, obsessively coming through page after page of my notes, nurses notes, vital signs, imaging reports, other physicians' consults and other physicians’ orders, printing page after page, making notes.

    THERE IT IS!

    The order. Dr. ******* ordered it. I went back to my chart. I had even noted the results of the study at the time. The patient knew the specialist had ordered it, and had a follow up plan in place to see the specialist. That’s it! That’s it! That’s it! This is open and shut! The patient was seeing the specialist Dr. *******, who ordered this imaging study around the same time I did. I had seen her for another issue. Although the study he had ordered was abnormal, the patient had no outward signs of complications from it’s findings at the time, no acute emergency medical condition nor any on the day I saw her at all. I documented that, and that she had the appropriate specialist to follow up with, and proceeded to treat her for what she was seeing me on that given day.

    Further review of records indicated she had even seen the specialist in question again, after I had seen her. He noted that he had assessed the problem in question, and I never saw her again. What happened to her after that, to this day, I don’t know. Was she alive and well, and just upset that “something was missed”? Was anything even missed? Had she decompensated, gotten sick or had a bad outcome at some point later? ( I sure hope not.) To this day, I still don’t know.

    None of the available records answered any of those questions. But what the medical record made clear was, that she had a test ordered by another physician, that showed an abnormality within his scope of practice, and outside the scope of my practice, and I was falsely labeled as the ordering physician. This presumably may have happened because of an X-ray I had ordered at the same facility, on the same day. The patient presumably had my x-ray first, and then had my name put on the second study, by accident from someone in the radiology department who assumed I ordered both tests.

    I spent an entire weekend, approximately 24 hours over 3 days looking through charts, compiling records and writing my response. I was a bundle of tension, and barely saw my family that weekend, at all. But after finishing my response, I was confident, I would have and could have, done nothing different. This should be easy to clear up, I thought to myself.

    I sent my response, with all 120 pages of medical records to the medical board. (It’s amazing how electronic medical records can create volumes of records from only a few simple patient encounters.) A few days later, I called to confirm that the investigator got them. I asked how soon I’d hear something. He said it would be a “few weeks.” Deep breath…..exhale….

    A few weeks went by. A few more weeks went by. Summer became Fall. Fall crept into Winter.

    What on Earth could be taking them so long?

    During the entire process, 7 months and counting at this point, I felt a dark libelous cloud hanging over head, even when I worked, played with my kids, or laid down to go to sleep at night. I imagined every possible wrong-headed, misguided and misinformed decision a medical board could ever hand down. I wondered if that the fact that it was taking so long, was a bad sign. Was the hammer soon to fall? Could I soon be fighting to save my career due to some confusion and unjust decision?

    Of course not, I told myself. There’s literally nothing here. Nothing they could take or even suspend your license for. There’s nothing to even give you a warning about, or even make you take remediation classes for. Your name got placed falsely on someone else’s imaging study, that they were responsible for following up on, and may or may not have. Clearly there’s nothing to worry about, at all, on my end. Right?

    As I waited to hear from the state medical board about their decision, the thing that hit me the hardest was how much different a board complaint or action, is from a lawsuit. During medical school, residency and practice, every talks about potential lawsuits, and the need to practice defensive medicine. The threat is omnipresent, and constantly talked about, openly so. But rarely does anyone speak about, or even mention the threat of complaints or actions handled by the medical board. Is it because they’re more rare? Simply more taboo? I’m not sure.

    What finally hit home, that I hadn’t spent much if any timing pondering before, is that a medical board issue has the potential to be far, far worse than a lawsuit. In a lawsuit, they truly just want your money. The lawyers don’t want to take your medical license away. They can’t and won’t even try. Although the attorneys will try to convince a jury you’re Satan incarnate, so as to increase their chances of winning the suit, once it’s over they’re happy to walk away and let you keep practicing medicine, in their community. The medical malpractice lawyers are happy to sue as many doctors as possible, but certainly don’t want to stop all the doctors from practicing medicine. If they did, there’d be no one left to sue!

    But what really hit home, is that with a medical board complaint, they don’t want your money at all. The person filing the complaint wants to take your license away. They don’t want you to be able to be a doctor anymore. They want to place in motion a process that can truly ruin your life. You can lose your job, not be able to make your house payment. And pretty much everything you’ve worked for your whole life, potentially, is destroyed if the complainant gets their way. At a minimum, the medical board at least has the power to make all that happen, if they want to. A state medical board is much more dangerous than your ten most aggressive medical malpractice attorney’s put together and has far greater power, over you and I, if they choose to wield it. Medicine can be a vicious, taunting, profession at times. They don't tell you this when you're a medical student.

    So, after 3 seasons, 5 holiday’s, one kid’s birthday, a spouse’s birthday, and seven months over which the cloud of this whole process hung, I couldn’t take it any more. The silence was killing me. As much as I tried to put the whole affair out of my mind, reminding myself of the strength of my defense and complete lack of actionable mistake or misconduct, I must admit the prospect of the whole process weighed on my mood like heavy, hanging, dark-grey clouds. Part of me hoped it would go away, and that I’d never hear a word about it again. The other part of me was tortured by that idea, wanting a quick resolution, regardless of the outcome. I picked up the phone and called the investigator.

    There was no answer.

    I left a message. A few hours went by, and there was no return call. Maybe I had the wrong number? Hmm…I don’t know. I’ll give it until tomorrow.

    Tomorrow came. Still no return call. Oh, forget it! I wish I’d never called. Just leave me alone. So what if it takes another 7 months?

    At that moment, I heard the familiar sound of a piano playing in the background. It was my phone’s ring tone. I ran around the corner and answered. Deep breath.

    “Hello?”

    It was the deep voice, “I’ve been meaning to call you back. The medical board voted 3 weeks ago…”

    Three weeks ago, and you’re just calling me now? What the heck?! Don’t you know that not knowing is what make this torture?

    Deep-voice continued, “…and the medical board voted to dismiss the complaint against you.”

    Dismiss. DISMISS. And with that, I felt the air start to leak out of the tension that had built inside of me, that was starting to become so permanent, that I almost had forgotten it was there. I was starting to feel lighter already.

    “Okay, wow. I guess that’s it then. Is there anything else I need to do?” I asked.

    “No,” said the deep voice. “I’ll be sending out a formal letter soon.”

    “Okay, thank you,” I said. Although, I wasn’t sure exactly who I was thanking, exactly why or what for. I was wishing so badly, right then and there, that I would have loved to have been a fly on the wall while the board met and discussed this meritless complaint that weighed on me unnecessarily for the better part of a year. It was also unfortunate that the medical board had to spend seven months investigating the wrong person, due to the mislabeling of an imaging study, when they likely had more pressing issues to deal with. “On more thing,” I asked. “Do I have the right to find out who filed the complaint?”

    “Yes you do. By state law, you have that right, but you must request that information in writing,” he said, and he gave me his address.

    “Thanks for that information, Sir,” I said. “You’ll be hearing from me again, soon. Very soon.”


    TO BE CONTINUED


    [/I]

    Update: I found out today, it was the patient who filed the complaint. I'm actually very okay with this. If it had been another physician, particularly the one who ordered the test in question that I was blamed for (and who was ultimately responsible), it would be an entirely different story. But for a patient to blame the physician whose name is on a diagnostic test, presumingly not knowing the ordering physician was mislabeled, is understandable, particularly after seeing several physicians in a short period of time. I'm now at peace with this, and feel I'm very much able to move on.
     
    Last edited: Mar 15, 2017
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  3. bravotwozero

    bravotwozero Chronically ambitious 10+ Year Member

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    You sure know how to pile on the suspense lol


    Sent from my iPhone using Tapatalk
     
  4. msgsk

    msgsk 2+ Year Member

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    Thanks for sharing and nicely written. I wonder if you have to report this now whenever you recredential or get a new state license? I had a similar albeit much less dramatic thing happen where I was mistakenly named and learned the hard way that I had to report the silliness every time I apply for a new state license.
     
  5. Birdstrike

    Birdstrike 5+ Year Member

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    In my state, you only have to report license suspensions, revocations, board actions or if you surrender a license. Dismissed complaints are truly "dismissed." It may vary in other states.
     
  6. Saddleshoes

    Saddleshoes 7+ Year Member

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    I had a buddy of mine that had something like this brought against him. Further investigation discovered that the patient was running a scam. He was so upset he filed a civil suit for defamation of character and won. It cost him big bucks in legal services! But the only thing he demanded, and got, was a court ordered, full page ad in the local newspaper apologizing for accusing Dr. M----- of poor care.
    My buddy felt that that one of the most satisfying professional expenses he ever made. (He claimed it was all tax deductible too!)
     
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  7. Birdstrike

    Birdstrike 5+ Year Member

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    Interesting.

    What was the scam?
     
  8. Saddleshoes

    Saddleshoes 7+ Year Member

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    The patent claimed that he aspirated a piece of broken instrument during treatment. He had the chest x-ray as proof. HOWEVER my buddy's lawyer discovered a pre-employment spine x-ray showing the same metal object in the guys lung taken years before! CASE CLOSED!
     
    tifflove13 and Birdstrike like this.
  9. EMGui2017

    EMGui2017

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    If you ever write a book, I will buy it.
     
  10. Birdstrike

    Birdstrike 5+ Year Member

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    I've been thinking about doing exactly that, lately, actually. Thanks for the inspiration.
     
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  11. Birdstrike

    Birdstrike 5+ Year Member

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    We need loser-pays, so badly. Perfect example.
     
  12. FutureDOdr

    FutureDOdr

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    I've also read your previous posts and thought you should write a book. Do you have a blog or submit any of your stuff to any of the well known physician blogs?

    Sent from my Nexus 5X using SDN mobile
     
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  13. Birdstrike

    Birdstrike 5+ Year Member

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    I don't have my own blog, but have guest posted on the below three, though not much recently. All were first posted right here on SDN and can be found here scattered around, usual as their own threads with matching title. Some are on more than one blog, and some with changed titles. Kevin MD always writes his own title for some reason. I think it's because a unique title won't lose clicks to the original site the pieces were posted on. Kevin also drops the disclaimer I put at the bottom all posts, for some reason.

    http://www.kevinmd.com/blog/post-author/birdstrike
    http://epmonthly.com/?s=birdstrike
    http://drwhitecoat.com/?s=by+birdstrike
     
  14. Vandalia

    Vandalia 2+ Year Member

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    Absolutely agree. Except I would expand it out even more.

    If you make an accusation you had better be able to prove it. If not, there should be consequences including in criminal cases. If a prosecutor files charges, and you are not convicted, you should be reimbursed for all of your expenses. Let the money come out of his budget. The same thing if a civil forfeiture is reversed. Or if there is some sort of administrative allegation ranging from the Board of Medicine to zoning issues.

    Who knows? Maybe if we take it that far, it might even diffuse into politics.
     
  15. Birdstrike

    Birdstrike 5+ Year Member

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    Thumbs up to this
     
  16. GeneralVeers

    GeneralVeers Globus Hystericus 10+ Year Member

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    Never gonna happen. Lawyers make bank from our current system of nuisance litigation. They hope that companies/individuals will settle a lot of baseless claims rather than fight. On the flip side lawyers make a ton defending these baseless claims on behalf of the accused. Given that lawyers run the government and make the rules, it will never change.

    #draintheswamp
     
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  17. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner SDN Moderator 10+ Year Member

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    surely likes this.
  18. WilcoWorld

    WilcoWorld Senior Member 10+ Year Member

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    Do you worry that this could make it prohibitively high risk to charge wealthy people with wrongdoing?
     
  19. Beezlebub

    Beezlebub Guest Banned

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    Need to reform this system. They played with your feels for over a year!
     
  20. BAM!

    BAM! Senior Member 10+ Year Member

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    while I totally agree and wish it were a loser pays system, it's not going to happen. One of the backbones of our country is the justice system. If you had to pay loser-fees, people wouldn't take injustices to court for fear of losing. We have too much pride as a nation that if you feel wronged, you could take your case to a judge. If someone is running a scam, like the above, then you have the right to counter sue them.
     
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  21. clibby

    clibby 5+ Year Member

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    While we may be veering off topic, I disagree with the idea of "loser" pays models. All this does is disincentivize those who can not afford a lawyer from seeking justice when they are wronged. You would be hard pressed to find a physician or a medical student after their clinical years who thinks a lay person could serve on a jury and determine a standard of care, but that doesn't mean we punish the poor for not being able to hire a decent lawyer.

    I think the compromise is holding the lawyer responsible for bringing the case forward, but again this incentivizes lawyers to only take easy cases or cases where the patient can pay their fees.

    This case in particular calls for more transparency in medical board review, not punishing the poor for not being able to afford a better lawyer than the physician.
     
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  22. DissocativFugue

    DissocativFugue 5+ Year Member

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    I'm just a few years out of residency and have already gone through this. Mine was actually regarding my care but my documentation was rock solid. Their grievance was outside the scope of our practice and I got a nice shiny letter (PDF) stating I had definitively met the standard of care, excluded an emergent condition, and referred to the definitive consultant which the pt did not follow up with. Summarily dismissed and in Texas if it's dismissed it does not have to be reported on future applications. Luckily, I only had 2 months of questioning myself and my actions. I found out that no matter how rational you are and well documented your reasoning is, it's the shadows of your mind imagining baboons sitting in a circle deciding your fate in a profession that you have dedicated your livelihood to but not many seem to appreciate.


    Sent from my iPhone using Tapatalk
     
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  23. Birdstrike

    Birdstrike 5+ Year Member

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    This is exactly my point. Thank you.
     
  24. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    Whelp... THIS thread has officially scared the p!ss out of me.
     
  25. Birdstrike

    Birdstrike 5+ Year Member

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  26. littlejuan

    littlejuan 7+ Year Member

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    Seriously, just as I am about to put on my big-boy pants. :(
     
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  27. GonnaBeADoc2222

    GonnaBeADoc2222 7+ Year Member

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    Yup. Terrified. T-minus 5 months to attendinghood. Learn the EMR. Learn the system. Run on the hamster wheel admin has set. Dodge incoming fire from some of the people we are trying to help. Check, check, check, check...got it.
     
  28. Arcan57

    Arcan57 Junior Member 10+ Year Member

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    Anyone can report to the board. Pissed off patient, bad outcome with lawyer looking for a free investigation, cousin that you were abrupt with because they kept harassing the nurse. Dismissal rates in TX for EM run in the high 90s which is good but also means the chances of being targeted with a complaint is pretty high.
     
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  29. Birdstrike

    Birdstrike 5+ Year Member

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    Am I correct in assuming that the silver lining is that if a complaint is investigated & dismissed by a state medical board, and an eventual lawsuit comes, having that dismissal on file ahead of time would be very helpful and protective in a suit?


    Sent from my iPhone using SDN mobile
     
  30. Arcan57

    Arcan57 Junior Member 10+ Year Member

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    It would certainly create an uphill climb for the plaintiff. They could argue that the board didn't have all the facts or make a run at a pure emotional appeal. It would be damn difficult (especially in TX) to prove gross negligence with a medical board that's known to be relatively punitive saying they did not find evidence of a standard of care violation. Regarding lawsuits in TX, I discovered an intriguing interaction between significant tort reform and oversupply of litigators. If you do happen to be sued, the chance that the plaintiff's counsel is incompetent is pretty high. There just isn't enough money to be made going after docs to attract the top of the class but there are too many lawyers that are underemployed to be safe from frivolous suits.
     
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  31. Vandalia

    Vandalia 2+ Year Member

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    Two separate questions:

    1) Will it happen? No way.

    2) The UK and other European countries have been going on for thousands of year with such a "loser pays" system and they seem to be well regarded for access to justice.
     
  32. Birdstrike

    Birdstrike 5+ Year Member

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    What you also need to take from this thread, and this is coming from the guy that started it, that despite having gone through what I've gone through, my experiences have strengthened the belief that what we've all been told about documentation is true. If you document well, and your thought process was reasonable (not necessarily perfect) you'll be able to fall back on a strong defense nearly every time. I think you can rest easy on this, and in the fact that good documentation, if you're consistent with it, will reduce any potential damage from such situations to a point where, although distressing, you'll ultimately be able to look back at these experiences and say you weathered the storm with strength and grew from them. Remember, in each case presented in this thread so far, the person involved in each case was justly cleared.


    Sent from my iPhone using SDN mobile
     
  33. GeneralVeers

    GeneralVeers Globus Hystericus 10+ Year Member

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    I got a complaint to the NV medical board a few years ago. I told a patient with "itchy ears" who was demanding antibiotics, that it might have been more appropriate to go to her primary care doctor, as ED visits are expensive. I was cleared of any wrongdoing but counseled about my "demeanor" in the board's response letter, despite none of them being in the room with me to determine if my demeanor was in fact an issue.
     
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  34. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    I think it would be appropriate for you to write the NV board back, pointing that fact out. Or, write a complaint letter about one of the board members s accusing them of some unverifiable act. Would they other board members counsel the member in question?
     
  35. Arcan57

    Arcan57 Junior Member 10+ Year Member

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    Picking a fight with the medical board is a special kind of stupid. It's (probably) gotten better, but look into the history of the Tx medical board some time.
     
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  36. GeneralVeers

    GeneralVeers Globus Hystericus 10+ Year Member

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    I don't pick fights with people bigger than me.....which is almost everyone.
     
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  37. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 7+ Year Member

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    So you're saying that we have a board, and it makes the rules, and it can't be questioned when it is objectively wrong ?

    I've read this book before...
     
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  38. VA Hopeful Dr

    VA Hopeful Dr Senior Member 10+ Year Member

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    It can but that involves taking the case before a judge and they tend to respect the board's decisions unless it was wildly inappropriate
     
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  39. Birdstrike

    Birdstrike 5+ Year Member

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    Also, to go after a medical board when they dismissed the complaint, in the hopes of getting them to reword the cautionary portion of the dismissal letter which only you will ever see, is pointless except to maybe soothe a bruised ego. What are the damages? You haven't missed work, it hasn't affected your job prospects or even your public reputation. Only hurt feelings. It seems the chances of backfire are higher than any potential benefit.


    Sent from my iPhone using SDN mobile
     
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  40. TooMuchResearch

    TooMuchResearch i'm goin' to Kathmandu... Lifetime Donor 7+ Year Member

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    Good post. Too drowsy for more complex thoughts.
     
  41. Birdstrike

    Birdstrike 5+ Year Member

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    I found out today that the one who filed the complaint was the patient. I'm actually very okay with this. If the complaint had been filed by the physician who actually ordered (and was responsible for) the test I was blamed for, I would not have been okay with it, at all. I'm now at peace with this, and feel I'm able to move on.
     
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