Lawrence Stewart, MD

I know we don’t actually need more evidence that Mississippi’s medical board is the worst in the country but we’re going to get some. Lawrence “Larry” Stewart, MD was an otolaryngologist from McComb, MS. Stewart pleaded guilty to felony drug charges and admitted in federal court to having sex with a patient in exchange for drugs. His DEA registration was taken from him because he was a threat to public safety.

He was charged by the Mississippi board with the drug charges (after all he pleaded guilty- should have been a chip-shot). For some reason the worthless morons running the board didn’t charge him with the sex.But, everyone on the board knew about the sex- after all it was in the local paper.

But the Mississippi board, after careful consideration determined that Stewart’s “license to practice medicine in the State of Mississippi is hereby suspended.” Whoa- the Mississippi did something right. Well, not quite. The order goes on “[h]owever the suspension is hereby stayed provided Licensee complies with the following requirements…” Yes, you read that right. This low-life trades sex for drugs and even that won’t get his license revoked in Mississippi!

But it gets better still. The requirements consist of a course in ETHICS. Seriously- does anyone believe that a confessed felon will change because of some more education? But it get better still. The next requirement “[l]icensee shall maintain at all time full and complete advocacy with the Mississippi Professional Health Program (MPHP) and comply… for life.” Holy crap.

So in Mississippi you can be a confessed felon trading sex for drugs and as long as you go to rehab you can keep practicing medicine! Basically, you can be almost any kind of low-life, bottom dwelling scumbag and be a doctor in Mississippi.

This is exactly why laypersons should be afraid of their doctors. Never has Stewart been accused of being an alcoholic or drug addict. So why is he going to rehab? What is the board not telling the citizens of Mississippi? What the board is telling the citizens of Mississippi is that it values the protection of doctors more than it values public health and safety.

The Mississippi board makes it hard to find Stewart’s order. I made it easy. Click his name- stewart.

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Patrick Johnson, MD- genius or luddite?

Patrick Johnson, MD is a physician in Lagrange, TX, who’s bio indicates that he is the Chief Medical Officer for Tejas Health Care and holds a medical degree from the “highly prestigious” St. George’s University School of Medicine, Grenada, West Indies. This off-shore medical school  turns out over 800 graduates annually flooding the US with international grads who were generally rejected by US schools (it’s rarely the first choice of Americans).

Johnson recently penned a whiny screed decrying the woes of the modern physician saddled with electronic medical records. It starts with this gem:

believe that it is high time that medical doctors (not “providers”) rise up and regain our rightful and long-lost place at the top of the medical hierarchy. How in the world did this happen in the first place? How did we become second-class citizens, led around by the nose and pushed around by those with half of our education, intelligence, and dedication?

His rant goes on from there with more whining, half truths an bizarre statements. In fact the answer to some of his questions are inherent in the questions themselves. For instance, what kind of massive hubris could possibly make this graduate of a third-rate, off-shore medical schools believe that he has  a “rightful” place anywhere. The practice of medicine is a privilege (most certainly not a right) to participate in a governmentally sanctioned monopoly. He goes on to state that he’s twice as smart  as those leading him around by the nose (I wonder if he also has wonderful hands a great brain). I’m assuming he’s self-referential here since I suffer no such leadership. But then I work in an environment where my leaders have earned their positions and they’re indeed rather smart.

But he goes on with even more whiny nonsense:

Almost none of the “innovations” happening in medicine these days come from doctors, they all come from bureaucrats and non-physician managers. They all come from outsiders who now know best. Doctors have become whipped dogs waiting passively for the next group of bureaucrats to rain down the next mumbo-jumbo solution from on high.

This time he is, in fact, correct. Most doctors are not innovative. Most doctors are like Johnson and would prefer be “worshiped” for their superior intellect and supreme doctoring skills (although most are painfully average). Doctors would rather procratinate and complain about “work-life balance”- which is usually code for “pay me more for working less.” Rather than blaming the innovators for doing what they do why doesn;t Johnson get off his off-shore medical school butt and make some meaningful contributions. An online rant about his poor lot in life is not a contribution and definitely not innovative.

He gets better:

There now is a huge emphasis on measuring the “quality” of medical care and to improve “outcomes.” I believe it is impossible to judge the quality of medical care by looking only at discreet, retrievable data points generated by an EHR.

This is the epitome of a specious argument. The push for quality has existed since the Flexner report in 1910 (but I wouldn’t expect an off-shore medical school to devote mush time to American medical history). Outcomes have been a concern since the days of Hippocrates and Maimonides. These are nothing new. The use of an electronic record simply allows data to be captured. Prior to electronic records handwritten paper records were used similarly (perhaps there were no records at all in his off-shore medical school).

But his genuinely fallacious arguments start a bit later with:

Quality starts with a relaxed, unhurried atmosphere where the doctor asks the patient about their concerns, takes a thorough history and performs an adequate physical exam. He then uses his experience and vast knowledge of anatomy, biochemistry, physiology, and pathophysiology and interprets appropriate studies to arrive at the correct diagnosis. He then must decide on the best medications, treatments, and follow-up plans. If done correctly, this all takes a good deal of time, much of which has now been stolen from us by the data-entry, box-clicking, and typing demands of the EHR.

I’ll grant that this is unvarnished opinion on his part. Quality might start in a relaxed, unhurried atmosphere. But neither of those are limited by and electronic record. In fact, I’ll bet the “unhurried atmosphere” in Johnson’s office includes follow-up visits scheduled every 17 minutes (or less). I’m quite certain that’ his doing, not the electronic record’s. Again, nothing about using an electronic record should preclude a skilled physician from using “vast knowledge of anatomy, biochemistry, physiology, and pathophysiology and interprets appropriate studies to arrive at the correct diagnosis.” Blaming the record is simply dissembling. It’s the equivalent of a carpenter blaming the saw because he cut the board a foot too short.

Johnson, and is ilk, are precisely the reason that modern healthcare sorta sucks in the US. Physicians with huge egos, minimal skills, and weak knowledge still think that hand holding is a reasonable substitute for actual knowledge (if that were the case Joh son could have gone to chiropractor school and saved a ton of money). They are frankly afraid to subject their professional performance to rigorous scrutiny for fear of discovering their broad inadequacies.

Johnson bemoans the loss of the “dictated and transcribed note”

The once thoughtful and educational consult note is now pages of worthless computer-generated gibberish.

Electronic notes can be just as thoughtful and insightful. The though and insight come from the user, not the computer. This is an example of a PICNIC problem- Problem In Chair, Not In Computer. If Johnson’s notes are not “thoughtful and educational” then it’s a user input error not a computer limitation.

I’m not  fan of electronic records either. But it’s a user problem, not inherent in the technology. Doctors simply need to be doctors and stop whining about the computer. Maybe whining doctors simply weren’t very good at doctoring. Now we can actually measure that.

Johnson’s whiny rant is a perfect display of all the things a doctor shouldn’t be. It’s a graphic demonstration of how to show the world your worst side while railing against progress. Never once does Johnson propose an alternative other than “the way we used to do it.” He’s clearly not one of the innovators at whom he pokes fun.

You should read Johnson’s piece. If you’re one of his patients, you should definitely read it.

 

Scott Gottlieb’s smoking hot idea- stupid or brilliant

Scott Gottlieb, MD is the commissioner for the FDA. His FDA bio claims he’s a “medical policy expert, and public health advocate.” Gottlieb has announced that he plans to lower nicotine levels in cigarettes to minimally or non-addictive levels.

Let’s look at this:

  1. There’s no evidence that there’s such thing as “minimally, or non-addictive levels” of nicotine. Maybe if a cigarette was created with no nicotine it might be possible. But nicotine is still nicotine. And, it’s still addictive.
  2. The components of tobacco that cause disease aren’t nicotine. It’s the rest of the smoke.
  3. On fairly predictable side effect of lowering the addictive component is that smokers will consume more cigarettes. Thus they will be exposed to more carcinogens. (Does anyone believe that alcoholics drink less beer with lower alcohol content?)
  4. More cigarettes means more sales for tobacco companies.

Gottlieb’s well-intended, yet potentially misguided plan is standard Washington short-sighted “ready, fire, aim.” It’s telling that no tobacco company has protested.

There’s a better more effective way. STOP the all tobacco subsidies in all forms. The federal government supports the production of tobacco products. Raise taxes on all tobacco products. Those are two easy, proven ways to reduce consumption. Neither of them will result in an increase in consumption.

Our favorite board and Jean Barker

The Mississippi Medical Board remains an easy target. Recently the former executive director wrote an op-ed piece for the Clarion Ledger. The piece apparently provoked one of “Mississippi’s finest” to respond.

Dr. Jean Barker of Greenville, MS wrote a letter to the editor (https://www.clarionledger.com/story/opinion/readers/2018/03/18/what-youre-saying-nra-gun-age-and-jackson-cemetery/432395002/). Let’s set some context. Barker has no public record according to the board’s website. So no one would have know about her experience at the board except that this “medical genius” outed herself.

Her letter speaks for itself and speaks volumes about Barker in myriad ways. For instance Barker admits:

  1. “failed to call another GYN doctor when the doctor I consulted did not come in.” Barker omits the fact that she didn’t call the on call physician but called another physician.
  2. [the patient]” was not dying, just in pain. Barker omits that the patient said she felt like she was going to die and Barker’s response was “you don’t look like you’re dying.” Barker then told the patient she should go to Jackson if she thought she needed care.
  3. Barker says she was “called four times before that board including an examination for mental stability.” But Barker omits the fact that her behavior was frankly bizarre. Further, no one would have known the board was worried about her mental stability if she hadn’t behaved like she needed to be evaluated and hadn’t announced it in a local newspaper.

Should Barker have a license? Who knows. The worst medical board in the US seems to think so. Should she have patients? That’s an entirely different question. I wouldn’t let her treat me.

Larry Nassar

Larry Nassar is a predator. The massive number of accusers have pointed fingers Michigan State, coaches, and even parents.

The one group that no one has looked at is the Michigan Medical Board. In fact it took the board until January of 2017 to revoke Nassar’s license (see order here). Unfortunately, the Michigan board’s incompetence is fairly common. Doctors protect doctors (I know you’re shocked by that revelation).

In my last post I wrote about Meisam Moghbelli, a physician and cyberstalker. The Mississippi Medical Board charged Moghbelli- and slapped him on the wrist despite tearful testimony by the victim. The Ohio Medical Board has taken no action against Moghbelli. He remains happily “practicing.”

In the next issue we’ll look at other physicians protected by medical boards.

Meisam Moghbelli, MD

Mississippi has a long history of being the worst at everything that’s good and first at everything that’s really awful. But licensing a cyberstalker is a novel low point. But Mississippi is not alone.

“Dr.” Moghbelli practiced cardiology in Mississippi until he was summarily fired by The Hattiesburg Clinic for- you guessed it- cyberstalking. From there he fled to Ohio where he was given a license.

In fairness, the Mississippi Board did issue a summons and have a hearing- then it sent a bona fide cyberstalker back out into practice without so much as a restriction. But he claimed he was sorry! You can see the summons (moghbelli summons) and the wholly inadequate consent agreement (moghbelli order).

Moghbelli remains in Ohio where is seems to be practicing at University Hospitals in Cleveland and Lima Memorial. Those places are either desperate for physicians or they needed someone who’s computer savvy…

Whine

Aimee Lutkin writes: The Difficulty of Completing Medical Residencies While Starting Families Is Holding Women Back In Medicine. In her piece she cites a Bloomberg article: Why Having a Baby Pushes Women Out of Medicine.

Both articles acknowledge medical training is hard. Yet both suffer from a fundamental flaw- students and physicians make choices. I’ll use one of the Bloomberg examples:

Like many medical residents, O’Brien forwent maternity leave, against the advice of her doctor. She’d already been accepted to a fellowship with a strict start date; she couldn’t extend her training any further. Instead, she used up all her days off, sent her newborn to day care, and returned to work, often ducking into a shower stall mid-surgery to pump breast milk.

Readers should understand that FMLA (Family Medical Leave Act) applies to residents. So O’Brien was eligible for up to 12 weeks of leave. Let’s look-

forwent maternity leave- choice

accepted fellowship- choice

newborn to daycare- choice

Don’t get me wrong, I have enormous respect for anyone brave enough to have kids while in training. I think it’s admirable for someone to put they’re family’s actual needs ahead of other personal goals such as long-term revenue and professional advancement. But it’s at least disingenuous to expect that you can “have it all.” O’Brien made her choices. Everyone of them. Oh, one other choice not included in the Bloomberg article- why didn’t the father of the baby stay home and provide care?

Children change everything. I got married as a resident and my wife (also a resident- surgeon no less) made the specific choice to delay kids until we finished and got new jobs started. Are we “older” parents, yes. But our kids had the benefit of a stable home and income and we were able to have control over our lives that would have been impossible while in training.

O’Brien and her ilk want the world to bend to her needs. It won’t. The O’Briens in medicine need to learn to accept their consequences of actions and live with them. I admire the women and men who can manage families while in training. The behaviours of “O’Briens” make all of us look like whiners.