WHO Is Practicing Medicine?

This is not a silly or trivial question. Practicing-medicine-without-a-license is dangerous, costly and illegal. Yet people do it thousands of time every day without getting caught.

Yesterday at our clinical conference, the big problem was Baby X. We had done our research and found an out of state Hospital (A) had the highest success rate (98%) with the heart procedure that the baby needed. The insurance company refused to authorize payment to Hospital A and was demanding that Baby X go to Hospital B. The Medical Director of the insurance company said that Hospital B had an excellent success rate (91%) and was considerably cheaper. They planned to schedule surgery for Baby X at Hospital B.

What if our baby is one of the seven – 98 minus 91 – who die at Hospital B but would have survived at Hospital A?  Who is responsible? Who is accountable? What will the family think? Should they sue and if so, whom? Who is practicing medicine (and doing it badly)?

HIPAA (Health Insurance Portability and Accountability Act) was passed by Congress and implemented by several regulatory agencies. It makes it difficult to share medical information. Coupled with the medical malpractice litigation statutes interpreted by each Hospital Counsel, wide dissemination of medical information, especially about adverse outcomes, is virtually impossible. But isn’t that the way we learn how to avoid mistakes? So, mistakes continue – patients suffer, and whose fault is that? Who is practicing medicine here, and doing it badly?

Examples are endless. The fact is that medicine is a complex team sport. It is a process, not a mom-and-pop operation (forgive the pun).  Financial, managerial, legal, and operational decisions impact outcomes that patients experience at least as much as strictly medical decisions. Only those with MD after their names are considered to be “practicing medicine” and only they are held responsible.

How many “practice medicine” without a license?
Do they practice GOOD medicine?
What should be done about it?

System MD

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3 comments ↓

#1 John on 07.12.12 at 3:19 pm

My father practiced medicine for 50 years. After he passed away I was going through his papers and found a copy of a letter he sent to Blue Cross. It stated he was going to do what was best for the patient and Blue Cross could send him what they thought it was worth. He was not going to compromise the patients’ care.

The questions today are:

Is there case law allowing insurance companies to make these decisions without actually seeing the patient? Why haven’t state licensing boards taken this on (in Oregon a physician was issuing medical marijuana cards without an office visit, the board found out and he had to produce the nearly 800 records for the visits and diagnosis).

Where is the smart attorney or politician with big enough balls (either male or female) to take this on?

Why am I the only person to comment on this in four years?

#2 Meet Your New MD on 07.23.12 at 1:36 am

[...] response to a 2008 article titled, WHO is practicing medicine, “John” posted the following.  His remarks  demand a public response. My father practiced [...]

#3 deanewaldman on 07.23.12 at 1:46 am

John:

Your comment was greatly appreciated.
It was so important that I had to consider and then write a whole article in response.
You can find it here, and shortly also on AmericanThinker.com.
Again, thank you.

Deane Waldman, System MD

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