American Medical Association (AMA) Seeks to Test Older Physicians: The Aging Physician–Goodbye Dr. Welby!

imgres-3

The AMA is seeking to test older physicians.  This is no doubt due to the influence and lobbying of the “impaired physicians movement” and the “addiction medicine” specialists who brought us the “impaired” and “disruptive” physician constructs.    As do all groups of this ilk, they want to expand.  It is predictable and that is what we are seeing here.


Originally posted on Disrupted Physician:

The Aging Physician—Goodbye Dr. Welby!

IMG_8902

As a specialist in geriatric medicine I have experience in taking care of a number of  doctors who were referred to me for suspected memory problems. Still operating and teaching residents in his 70s, my first was a well-respected surgeon, a pioneer or Maverick who had made advances in his particular subspecialty.  Known for his detailed knowledge of the history of medicine and sharp clinical acumen, he had not seemed himself for a while.  His colleagues noted he appeared slower,  fatigued and forgetful at times (not remembering his keys, having trouble finding the right word).  An internist friend and co-worker who knew him for 50 years curb-sided me and asked if I would see him.  He did not have a primary care physician or even seen a doctor professionally for decades (a common phenomenon in this age cohort of doctors).

I met him the next week and he readily admitted to having difficulty concentrating and having trouble with his short term memory.  On taking his history he told me of his life and career which started as an intern in Boston in 1942 and he was on duty the night 492 people were killed in the  Cocoanut Grove fire with many of the victims transported to his hospital.  “I can see every detail as if it were yesterday–beautiful young women wearing fashionable dresses and gowns and young men in formal evening wear who looked as if they were sleeping but were dead.”

“Gastric reflux ” was the only medical problem he reported, adding it was well controlled for the better part of a decade with anti-reflux medications from the office sample closet.   I tested his memory with several cognitive scales which showed some mild deficits in short-term memory and sent him to a neuropsychologist for more comprehensive testing.  His physical examination, including a comprehensive neurological exam was normal.  I ordered the usual lab work up for dementia to look for possible metabolic causes and his B12 level returned markedly low–a result of his long-term use of proton pump inhibitors.  He was given an intramuscular injection and started on high doses of oral B12.  As one of the “reversible’ causes of dementia he was back to his usual sprightly self several months later.

Another, a 70 old psychiatrist still teaching medical students and residents had asked a third-year psychiatric resident out on a date on two separate occasions. She reported him to administration on the second request.  When I  asked him about the incident he replied he didn’t see what was wrong with what he did and it was being blown out of proportion.  “She’s in her 20’s” I said to which he replied “Well I’m only 36.” Still giving lectures to first year medical students without error or pause from knowledge he learned long ago, he could not identify a pencil or a watch when I pointed to them and asked what there were. He knew neither the month, season or year.  After an MRI and neuropsychological testing he was given a diagnosis of probable Alzheimers disease.   He had no spouse or children and his work was his life.  After that he became  profoundly depressed and six months later was dead.

Another  elderly doctor, an internist, had a fairly sudden sudden onset of memory problems and symptoms of delirium.  It turned out he was having trouble sleeping and his cardiologist prescribed him Dalmane, a benzodiazepine similar to  Valium (medications that have a whole host of adverse effects in older patients including memory problems and falls).  But valium has a half-life of hours whereas Dalmane has a half life of days.   The medication was stopped and he was back to normal after a few days.

Aging  is associated with an increased  decline  in many areas including  cognition, motor-skills, muscle strength, and vision that can individually or cumulatively create risk to the person or others in a variety of situations (driving, living situation, occupation).

With advancing age comes advancing risk and the recognition and vigilance of others is often necessary for intervention. If the risk is recognized the problem can be addressed by the appropriate healthcare providers and specialists.

Doctors are not immune from cognitive impairment or dementia and the perspicacity of others is necessary should this occur.

Recognition and awareness are important.  So too is an assessment by a qualified physician Board Certified in Neurology, Geriatrics or Geriatric Psychiatry who has education and experience in the diagnosis and treatment of memory disorders.

Slide15

Recognition, Insight and Education Essential

In 2009 Dr. Ralph Blasier, M.D, J.D., published an article in the Journal  Clinical Orthopaedics and Related Research entitled “The Problem of the Aging Surgeon: When Surgeon Age Becomes a Surgical Risk Factor” discussing the ability of older physicians to practice medicine safely and effectively.

His primary message is that a decline in physical and cognitive abilities is associated with the aging process and that these issues are especially pertinent to the field of medicine.

An area  little researched, Blasier gives anecdotal examples such as a surgeon in his late 80s who had to regularly depend on younger colleagues to finish his operations. He concludes that these anecdotal examples suggest many surgeons lack insight into the degradation of their own skills and suggests recognition, insight, and education can help facilitate retirement of the aging surgeon  before  a decline in competency and skill creates a problem.

The awareness, education and insight of others is necessary to identify age associated illness in doctors who can then be referred to the proper specialists for evaluation.  And although no evidence base exists, anecdotal reports such as these caused some groups to see an opportunity to increase the grand scale of the hunt.

IMG_8901

Aging Physicians Next Target of Physician Health Programs

As with the “impaired” and “disruptive” physician, the “physician health and wellness movement” organized as the Federation of State Physician Health Programs (FSPHP) is linking the “aging” physician with threats to patient safety and  hospital liability.  “Experts say doing nothing could result in lawsuits, higher liability insurance rates, ruined reputations for practices and all involved, and even possible losses of practices and the licenses of non-reporting physicians.”

And if you look at the articles and presentations aimed at  the administrative, regulatory, and legal arenas of medicine it appears a new moral panic is percolating in the “physician wellness” cauldron.

Labelling a group dangerous and creating fear in those responsible for that group is an effective means to sway policy and opinion.

With absolutely no evidence base these groups have acted as   “moral entrepreneurs ” and used this same methodology to successfully change policy and regulation in the medical profession and advance their goals.  The methodology is to

1. Label a group and link that group to danger

2. Offer to assist in identifying and eliminating that danger

3. Corner the market and control all aspects including assessment, testing and monitoring by swaying those in authority to make it public policy and regulation.  Screen Shot 2015-03-11 at 8.10.37 PM

The methodology is not new–witches are real, witches are dangerous and witches need to be identified and exterminated at all costs.  Convince the authorities to assist you in protecting the public from harm and advance  the greater good

In this manner the FSPHP has convinced state medical boards to adopt and enforce policies that have incrementally and systematically increased their autonomy, scope and power since they first cultivated a relationship with the Federation of State Medical Boards (FSMB).  This occurred in 1995 when they took an uninvited seat at the table of power by offering a non-disciplinary “safe harbor” as an alternative to discipline for doctors impaired by drugs or alcohol.

Since then they have increased their scope from  the “impaired” to the “disruptive” to everything else.  Arising from the “impaired physicians movement”  as “addiction specialists” these doctors whose specialty of addiction is not even recognized by the American Board of Medical Specialties have now become the “experts” in all matters related to physician health.  Jacks of all trades covering neurology, psychiatry, geriatrics, and occupational medicine.

A 2011 updated FSMB  Policy on Physician Impairment  states that Medical Boards should recognize the state Physician Heath Program (PHP) as their experts in all matters relating to licensed professionals with “potentially impairing illness,”   and these  include those potentially impairing maladies that increase as we age.

They are also using “everyone else does it why don’t we?” logical fallacy.  According to a Washington Post article “other professions are subject to age-related regulations. For example, airline pilots must undergo regular health screenings staring at age 40 and must retire at age 65. FBI agents must retire at age 57.”Screen Shot 2015-03-11 at 8.10.59 PM

Proposing drug testing in doctors a  JAMA article  uses this same logic stating when sentinel events occur in the airline, nuclear power and railway industry the get drug tested.  However all of these industries use FDA approved tests, certified labs, strict chain-of-custody and MRO review in their drug testing.  One of the authors of the JAMA paper, Dr. Greg Skipper, introduced the non-FDA approved and unvalidated Laboratory Developed Tests currently used in PHPs such as EtG.   He claims no conflicts-of-interest.   Comparing drug testing to industries that use the highest quality of testing and safeguards to protect the donor from false-positives to the junk science used in PHPs is comparing apples to oranges. Which one do you think they’s be using in the random drug testing of doctors?

Furthermore, airline pilots, railway engineers and nuclear power plant employees have a choice of assessment and treatment centers should they get a positive test.  Doctors do not.  They are mandated to “PHP-approved” facilities.  This is enforced by state medical boards as they adhere to an ASAM   Public Policy Statement  recommending only “PHP approved” treatment centers be used for assessment and treatment and a recent  audit  found the PHP in North Carolina could not provide any measurable indices  or qualitative indicators of how an assessment center is stamped “approved.” The best they could come up with is “reputation” and other ‘informal sources.  What the audit missed is all of the 19  out-of-state “PHP-approved” centers Medical Directors can be found on this list.

Screen Shot 2015-03-11 at 8.13.13 PM

And what will happen with the “aging physician” is the same.  Doctors will be forced into “assessments” at “PHP-approved” facilities where they will be misdiagnosed, over-diagnosed and forced into monitoring contracts under threat of loss of licensure. Goodbye Dr. Welby!

IMG_8900

Screen Shot 2015-06-18 at 2.17.48 AM

IMG_0933

IMG_0706

Gay Doctor coerced by Physician Health Program (PHP) into mandated 12-step treatment and monitoring for sex addiction: The slippery slope begins

gay-friendly-doctorA legitimate interest in the private behavior of a doctor should be limited to behaviors that have a legitimate impact on that doctor’s capacity to work. Though it is pretended that these programs are being maintained for the benefit of doctors and the public it is apparent that they only serve to injure both.

The Federation of State Physician Health Programs (FSPHP) is following the same pattern they have with the “impaired” and “disruptive” physician constructs to discriminate and control with ignorance, bigotry, intolerance and stupidity.

The targeting of gay, lesbian or transgender doctors for what they do in their private lives is predictable. One doctor told me that the state PHP told him that if he did not cooperate in addition to losing his medical license the state medical board would make his sexual history part of the public record.

The civil and human rights violations remain hidden. The crimes remain hidden. So too will this. More sheep for the slaughter.

It is an inevitable part of this well oiled slope of coercion, control, obedience and abuse.

The import of this can not be overestimated.

Disrupted Physician

gay-friendly-doctor

State Physician Health Programs -coercion, control and abuse.

This anecdote concerning  a gay doctor’s revelation he liked his non monogamous lifestyle leading  to a forced acceptance of a “sex addiction”  diagnosis, mandatory inpatient treatment and indoctrination into 12-step recovery was just posted on the physician social network SERMO.    If the pattern looks familiar it is.

Screen Shot 2015-04-10 at 11.56.04 PM

Physician Health Programs (PHPs) are non-profit NGOs that exist in every state ostensibly to help impaired doctors and protect the public from harm.  PHPs have no regulation or oversight and have essentially removed all accountability. Under the ruse of protecting a doctors anonymity and providing confidentiality they have built barriers of opacity.  Most doctors are unaware how they work unless they become involved with them and they are not on the radar of the public at large–they need to be.

Organized under the Federation of State Physician Health Programs, (FSPHP),  state medical boards have abdicated their…

View original post 1,104 more words

Gay Doctor coerced by Physician Health Program (PHP) into mandated 12-step treatment and monitoring for sex addiction: The slippery slope begins

The civil and human rights violations remain hidden.  The crimes remain hidden. So too will this. It appears the FSPHP is following the same pattern they have with the “impaired” and “disruptive” physicians–to discriminate.    The targeting of gay, lesbian or transgender doctors for what they do in their private lives is predictable.  I just heard from one of these doctors who was told by the PHP that  if he did not cooperate with them in addition to losing his medical license the state medical board would make his sexual history part of the public record and available on their website!

It is an inevitable part of this well oiled slope of coercion, control, obedience and abuse.The import of this can not be overestimated.

via Gay Doctor coerced by Physician Health Program (PHP) into mandated 12-step treatment and monitoring for sex addiction: The slippery slope begins.

Gay Doctor coerced by Physician Health Program (PHP) into mandated 12-step treatment and monitoring for sex addiction: The slippery slope begins

gay-friendly-doctor

State Physician Health Programs -coercion, control and abuse.

This anecdote concerning  a gay doctor’s revelation he liked his non monogamous lifestyle leading  to a forced acceptance of a “sex addiction”  diagnosis, mandatory inpatient treatment and indoctrination into 12-step recovery was just posted on the physician social network SERMO.    If the pattern looks familiar it is.

Screen Shot 2015-04-10 at 11.56.04 PM

Physician Health Programs (PHPs) are non-profit NGOs that exist in every state ostensibly to help impaired doctors and protect the public from harm.  PHPs have no regulation or oversight and have essentially removed all accountability. Under the ruse of protecting a doctors anonymity and providing confidentiality they have built barriers of opacity.  Most doctors are unaware how they work unless they become involved with them and they are not on the radar of the public at large–they need to be.

Organized under the Federation of State Physician Health Programs, (FSPHP),  state medical boards have abdicated their responsibility and consider them expert authority on all things related to physician health–a logical fallacy that has placed illegitimate and irrational authority in professional control of medicine once again proving that knowledge isn’t power and ignorance often reigns.

PHPs encourage confidential referrals for “warning signs” such as those on the list below from the Massachusetts PHP, PHS, Inc. and guarantee  the reporters anonymity.  All semblance of due process has been removed.  Medical boards have given state PHPS complete and absolute managerial control over  assessment,  treatment and monitoring.  PHPs are not healthcare providers but monitoring agencies.  If a PHP recommends an “assessment” of a reported doctor there is no choice in the matter.   No allowances for a second opinion,  outside support or appeal exist.Screen Shot 2015-03-06 at 7.33.17 AM

This doctor was apparently reported to his state PHP because a patient thought she smelled alcohol on his breath.  As it turned out, the accusation was bogus but by being honest and forthcoming about his sexual orientation in the interview the PHP mandated an “assessment.” for unrelated issues.  A not uncommon scenario as reports of behavioral issues often end up with hair tests for alcohol and other substances resulting in mandated assessments for “substance use disorder” followed by a five-year monitoring contract with the PHP and weekly urine tests.

The PHP provides  a list  of three or four facilities drawn from the same pool of “PHP-approved” assessment and treatment centers. However, an audit of the N.C. PHP found no written objective criteria or quantitative measurements existed on how these assessment and treatment centers are “approved” by the PHP.  The common denominator seems to be that these facilities are  (1) 12-step ASAM directed, and (2) willing to “tailor” an assessment to support a predetermined diagnosis. It is, in fact, a rigged game.  Unfortunately the medical boards have been duped into mandating assessments at these centers under threat of loss of medical license and specifically exclude non “PHP-approved” assessments.

This scaffold  is also the unspoken and hushed major contributor to physician suicide—It is the elephant in the room no one speaks of out of fear of being targeted.    Doctors who really need help for mental health, substance abuse or other issues are afraid to get it for fear of being reported to the PHP.  Those already monitored are subject to all sorts of psychological, financial and emotional abuse.

The Federation of State Physician Health Programs (FSPHP)  has a relationship with Pine Grove.  It is one of the “PHP-approved” facilities and two of their staff, Phillip Hemphill, PhD and James C. “Jes” Montgomery, MD are are listed as Program Faculty at the FSPHP annual educational conference and business meeting on April 24-27, 2015 in Fort Worth Texas.

26well-gaydoctor-tmagArticle

Political Abuse of Psychiatry

Political abuse of psychiatry is the “misuse of psychiatric diagnosis, detention and treatment for the purposes of obstructing the fundamental human rights of certain groups and individuals in a society.  The coercive use of psychiatry represents a violation of basic human rights in all Cultures.Screen shot 2013-05-13 at 1.29.38 PM

What has occurred in the medical profession is no different from China or the Soviet Union under totalitarian rule where dissent is disapproved, often punished, and those perceived as threats to the existing system can be effectively “neutralized with trumped up psychiatric illness” and by this stigmatization reputations were ruined, power was diminished, and voices were hushed.

Screen Shot 2015-03-12 at 11.17.53 PM

Political abuse of psychiatry involves the deliberate action of diagnosing someone with a mental condition they do not have as a means of repression or control and if you do not believe it is occurring right here today then take a look here and here to see how they are colluding with commercial drug testing companies to engage in forensic fraud and the assessment and the treatment centers to fabricate data to support non-existent diagnoses.

“Sex Addiction” used as a tool to Discriminate

There has been a lot of “chatter” in PHP circles concerning “sex addiction” and I knew they had been aligning themselves and setting up specialized programs at certain facilities.  It seemed unusual as many of the key players who erected and run this scaffold have themselves been involved in sexual misconduct.   Screen Shot 2015-01-09 at 5.22.34 PM

009935_3_thumb

One of the architects of the current system, Dr. Robert Walzer, M.D., J.D. who was instrumental in tinkering with administrative and medical practice laws to remove the due process and appeal rights of doctors surrendered his license in 2001 due to inappropriate sexual relationships with patients.  He was the co-author of the current physician health program paradigm.

  Dr. Margaret bean-Byog, M.D, Chairman of the credentialing 7109298-Mcommittee for the first certification exam and ASAM president surrendered her medical license after being accused  of sexually abusing one of her patients, a Harvard medical student who subsequently died by suicide.

Somehow, I don't think this is quite what they had in mind!And the FSPHP seems to treat doctors involved in sexually related misconduct in a favorable light.  Take for instance, Dr. James Peak, M.D., a child psychiatrist who was sent to prison on a federal child pornography conviction taken under the wing of the Montana PHP.  After “proving” he only ‘”looked” at pornography of young boys but never abused any using a polygraph “lie-detector” test his license was reinstated in no time at all.  His treatment includes going to one AA meeting and one 12-step sex addict meeting per week.  My guess is they need more staff at the PHP or one of the assessment centers.

Screen Shot 2015-04-11 at 2.25.11 AM

I had been wondering what the motivation was behind this focus on “sex addiction” and my suspicions seem to be correct.

  I have since heard of a second case of a gay doctor being forced into his state Physician Health Program (PHP) in Alabama.

Once under the control of the PHP most doctors are afraid to come forward because of the “swift and certain” consequences imposed on them.  All they have to do is say the doctor was “noncompliant” to the medical board and it is over.  They lose their license and there is not a thing they can do about. it.  I have heard from doctors in multiple states going to law enforcement,  the Attorney General,  the media and the ACLU only to have the door slammed in their faces. Myself included.    .

 The coercion, control, ethics, and civil and human rights violations remain hidden.  The crimes remain hidden. So too will this.

It appears the FSPHP is following the same pattern they have with the “impaired” and “disruptive” physicians–to discriminate.    The targeting of gay, lesbian or transgender doctors for what they do in their private lives is predictable.  It is an inevitable part of this well oiled slope of coercion, control, obedience and abuse.

The import of this can not be overestimated.


References:

Position Statement on Political Abuse of Psychiatry. Paper presented at: Global Initiative on Psychiatry2005.Birley JL.

Political abuse of psychiatry. Acta psychiatrica Scandinavica. Supplementum. 2000;399:13-15.

4-stage-plan1week-4-human-rights-8-638