If FSMB wants better care, it should raise doctor morale and lower hassles

Regarding "Stricter requirements sought for relicensure as medical boards draft proposal," (Article, Dec. 24/31, 2007):

The Federation of State Medical Boards' goals of enhancing patient safety and ensuring physician competency might be better served by attending to those issues that increasingly drain morale and present obstacles to the quality practice of medicine, rather than making themselves one more group that adds to the burden physicians face daily. Their efforts would be greatly appreciated if they would focus on things they might do for the profession, rather than making themselves one more group that does things to it.

They could be working with their state legislatures to tackle the managed care rules of engagement that make patient visits shorter, thereby increasing the risk of the physician missing something. Or they could work on model legislation that protects physicians from frivolous litigation that includes testimony from those who are rarely in the trenches themselves but who have protected niche practices.

Instead, they seem seduced by the tendency of groups to want to expand their locus of control in the name of protecting others.

Physicians are famous for their willingness to put themselves and their colleagues through the wringer to prove that they are devoted to meeting and indeed surpassing whatever the current challenge -- real or manufactured -- happens to be. This happens while their counterparts in other professions, who would be unemployed except for the doctor-patient interaction, sit back, go home on time and invent one more thing for the doctor to do that they can monitor, regulate, evaluate and find wanting.

We need for the physicians involved in the FSMB process to think about their colleagues in their third or fourth decade of practice who nonetheless are in the hospital late into the night seven days each week and who do not have limits on their working hours.

The text box accompanying this article has four bullets, all of which begin "Doctors should ..." Those kinds of resolutions are easy to write. The ones that address the total systemic grinding reality that the practice of medicine has become are much more difficult.

M. Richard Fragala, MD, Malverne, N.Y.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2008/02/04/edlt0204.htm.