Your Voice: MOC logic doesn't add up


In our latest Your Voice, readers share their thoughts on the MOC and certification, using APRNs and dealing with difficult patients.

MOC logic doesn't add up

Excellent article, Dr. Ellis. I agree with everything you said. (“ABIM: Time to heal thyself,” November 10, 2015). Initial certification is enough, then the board should leave us alone to do our job taking care of patients. As long as a diplomate keeps a clean record, the board has no business regulating or interfering with that diplomate’s practice.

ABIM extends practice assessment decision

Currently, the board assumes its diplomates are all mentally deficient, dangerous providers with questionable ethics who must be constantly reevaluated and monitored to protect the public. They base this assumption on the flawed and disingenuous 1999 Institute Of Medicine “To Err is Human” study and a bunch of pseudoscientific mumbo-jumbo about physicians being poor at self-evaluation. Their logic is laughable!

I forfeited my American Board of Urology certificate over MOC and I am now proudly board-certified by NBPAS. Let’s break the ABMS monopoly and get them off our backs!


Next: Tests not the answer


Tests not the answer

I agree with Dr. Ellis’s article. I have three different board certifications- internal medicine, cardiology, and interventional cardiology. I am “grandfathered” in internal medicine, and have recertified in cardiology. I refuse to continue participating in this process.

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I have done over 13,000 cardiac procedures and the board is going to make me take more tests that will not answer if I am able to do procedures. I believe we should have affordable CME and open book testing if we need to complete a test. After all, the purpose is for us to know the material.

Christine Zirafi, MD CLEVELAND, OHIO

One way physicians should emulate APRNs

Ryan Gamlin made some poignant judgments in his letter, “Using APRNs won’t solve physician shortage” (Trenches, July 25). His use of “throughput” to differentiate between the effectiveness of advanced practice registered nurses (APRNs) and MDs warrants discussion.

Next: Help with difficult patients


For many doctors, “throughput” has a pejorative connotation. Now that insurers’ control doctors’ fees, primary care doctors especially are compelled to see more patients than usual in order to survive financially.

This has serious consequences. It means seeing large numbers of patients in the time usually spent on seeing fewer in order to generate more revenue. This means less time spent talking to patients, less time getting a good history and less time doing a good physical.

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Already, patients complain that their doctors don’t spend enough time talking to them. Whatever disapproval the author has about APRNs, he is mistaken to use “throughput” performance as an indicator of their effectiveness. I would argue that the lesser throughput which he faults the APRNs for, may be just the thing that more MDs should emulate.

Edward Volpintesta, MD BETHEL, CONNECTICUT

Help with difficult patients

I wanted to thank you for publishing the article “Dealing with Mr. Smith” (July 10, 2015). It is not easy to deal with conflict. There have been several times when I terminated the physician-patient relationship because I felt I was being manipulated. This article gave me a different approach.

Next: Building trust


It helped immensely when I was dealing with a difficult patient. This patient happens to be a physician who requested my personal cell number, although I generally never give it out to patients. I reluctantly had given it to him and on two occasions he caught me when I was on vacation.

I was miserable that this physician-patient was taking advantage of our relationship in multiple ways including insisting on prescriptions for multiple controlled substances that I thought were inappropriate.

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Unfortunately he finally suffered overdose and was admitted. This article gave me the tools to deal with the visit after that hospitalization. I set boundaries and urged him to detox. He did not like what I had to say. To my shock, he has remained my patient and taken himself completely off narcotics.

Thank you for addressing the need to help by setting boundaries. I could have easily terminated him, but he simply would’ve found a different physician that allowed him to dictate his own care. I am certain that I was able to build trust and better meet his true needs because of confidence that I gained in reading the article by Dr. Beckham.


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