COMMENTARY

Why Doctors Need to Be Gutsy

Michael Langan, MD

Disclosures

January 11, 2017

In This Article

A Growing Challenge to Do the Right Thing

Most doctors strive to do the "right thing," but it is difficult. Gauntlets have been put in place that cannot be maneuvered by those who strive to do their best and do not cut corners. The current environment precludes creativity and often disdains independent thought.

My heroes in medicine, both historically and personally, have always been the mavericks: those doctors with superlative and almost preternatural clinical acumen who can make the right diagnosis when no one else could, or those who have made daring and unprecedented contributions to the field.

One example would be Dr William Morgan, who helped the Boston Red Sox win the World Series a dozen years ago. He performed a surgical procedure that he invented on Curt Schilling's ankle that allowed Schilling to pitch, when all of the other experts said it was impossible. It worked.

Of all the sad stories I have heard, one particularly hit a nerve. A patient who was having intractable abdominal cramping and pain remained undiagnosed after multiple colonoscopies and endoscopies. He went to an older doctor, who recognized an obscure condition (splenic flexure syndrome) that is easily treatable and diagnosed. He cured the patient of his pain with dispatch.

When I was in medical school, this would warrant three cheers and a toast. That is not what happened. Those individuals wielding the endoscopes and colonoscopes who could not piece the puzzle together were not happy that a general practitioner made a diagnosis that was nowhere on their radar. They reported him to hospital administration.[3] He was bullied and deemed a disruptive physician.

What do those in the physician health and regulatory corner of medicine think of maverick doctors? The quote below is from an article in the Federal Bulletin, the official journal of the Federation of State Medical Boards, titled "Proctoring of Disciplined Health Care Professionals: Implementation and Model Regulations":

Unusual or Alternative, "Maverick" Practitioners: Maverick and respectable minority practitioners incur complaints through their unusual methods or because of insufficiently informed patients, as well as through their own, often idiosyncratic, personalities. While they do not all present a danger, those who are reported have a right to the same due process as other practitioners.

Those in the physician health and regulatory corner of medicine imply that 'maverick' physicians pose danger (not all of them, mind you), but let's identify them and weed them out.

One of their selling points to the medical boards was the absence of due process, because they could remove a doctor from practice immediately and "without the constraints" of due process. All it takes is the mere accusation of a "potentially impairing illness." That is what they did with Dr Morgan. They have done it to some of the brightest minds I have known in medicine. It is also not on the radar of most.

While outspoken in denouncing what they regard as unethical and unprofessional behavior by other doctors, many of those who hold others to account are resistant to applying such standards to their own activities. The primary author of the model regulations surrendered his medical license in 2001 after allegations of an "inappropriate extended relationship" with one of his patients.

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