The Call of Something Different Primum Non Nocere SantiagoNo. 2,Atitlan: 2005 INA ME L DI O Non N C um oc A R m e ri re L A P C B Page 12 O H A T R R D O N A pril 15, 1859 forumN C M E D I C A L B O A R D From the Executive Director Some Questions & Answers “From the Executive Director” reestablishes the regular series of commentaries by the NCMB’s executive director that appeared in the Forum for some years. It will appear in numbers two and four of each annual volume, alternating with the “President’s Message,” which will appear in numbers one and three. As Executive Director of the North pital privileges issue, the same reasoning applies. That is, if the Carolina Medical Board, I frequent- doctor is not able to take care of a patient in the hospital, the ly receive telephone calls and let- doctor should (1) clearly make this known to the patient, and (2) ters from physicians, attorneys, and provide written instructions for securing hospital care. hospital administrators asking vari- Ideally, the physician will have made arrangements in advance ous questions. In this first article, with another physician or practice to admit these patients, and I’d like to share three questions I’ve all relevant parties (patients, ER personnel, etc.) will have been received lately and my answers to notified of this arrangement. Regardless, the physician should R. David Henderson, JD those questions.* make sure that all relevant patients have the physician’s contact NCMB Executive Director information so he can provide the patient’s medical history and QUESTION: Do physicians who other important information. do not have hospital privileges have a responsibility to direct their patients to a hospital with a designated physician or group QUESTION: Can a physician who wishes to terminate her re- of physicians who will care for their patients? lationship with a patient do so by simply transferring care to a ANSWER: Some physicians choose not to have hospital privi- nursing home? leges. A problem arises, however, when the patient of such a ANSWER: No. Although termination might be implicit in physician requires admission to the hospital. In this case, what is this case, the better course of action would be for the physician the physician’s responsibility? to notify the patient in writing. The Board’s Position Statement The Board’s Position Statement entitled “Availability of Physi- entitled “The Physician-Patient Relationship” states that “ter- cians to Their Patients” states that “once a physician patient rela- mination must be accompanied by appropriate written notice tionship is created, it is the duty of the physician to provide care given by the physician to the patient or the patient’s representa- whenever it is needed or to assure that proper physician backup tive sufficiently far in advance (at least 30 days) to allow other is available to take care of the patient during or outside normal medical care to be secured. It is advisable that the notice of office hours. If the physician is not generally available outside termination also include instructions for transfer of or access to normal office hours and does not have an arrangement whereby the patient’s medical records.” another physician is available at such times, this fact must be As with many things, good communication is important, es- clearly communicated to the patient, verbally and in writing, pecially when terminating a physician-patient relationship. along with written instructions for securing care at such times.” QUESTION: A patient is seen by a physician specialty group Although this language does not explicitly apply to the hos- and, due to difficulties with the patient, the practice terminates In This Issue of the FORUM Item Page Item Page Some Questions & Answers ............................................................1 Weathering the Storm ......................................................................9 *R. David Henderson, JD *James A. Wilson, JD Letters to a Young Physician Featured on Web Site .............................2 Charles L. Garrett, Jr, MD, President of NCMB, Honored Screening and Brief Intervention for Substance Abuse by MUSC Medical Alumni Group ............................................10 and Dependence in the Primary Care Setting ................................3 Robin N. Hunter-Buskey, PA-C, NCMB Member, Elected *Sara B. McEwen, MD, MPH, and Jacob A. Lohr, MD to Board of Federation of State Medical Boards ........................11 Changing Ourselves Is the Key .........................................................6 Santiago Atitlan: The Call of Something Different .........................12 *Paul Edward Hill, MD *Drs Bernadette and Jack Page Sheps Center Releases Two New Publications on Medical License Registration: An Annual Event .............................15 Allied Health Professions ..............................................................7 *Dena M. Konkel and David B. Shere *Erin P. Fraher Tiendas and Contraband Pharmaceuticals ........................................16 Setting a Good Example ...................................................................8 *David R. Work *Roselee Papandrea Board Actions: February-April 2005 ..............................................17 The Most Powerful Teaching Tool ....................................................9 Board Calendar ..............................................................................24 *Kelly Carter Nelson, MD Change of Address Form ...............................................................24 2 NCMB Forum its relationship with the patient in accordance with the Primum Non Nocere Board’s Position Statement. Several months later, the INA ME L DI O Non N C um oc A patient presents to the emergency department with R m e ri re L A P C B O H a similar problem. A physician in the same specialty A T R R D O N group is on-call at the local hospital for unassigned pa- Ap 9 ril 15, 185 forumN C M E D I C A L B O A R D tients. What are the physician’s responsibilities? Raleigh, NC Vol. X, No. 2, 2005 ANSWER: If the patient consents, good medical prac- tice (and likely the hospital’s bylaws) requires that the The Forum of the North Carolina Medical Board is published four physician treat the patient, including admitting the pa- times a year. Articles appearing in the Forum, including letters and reviews, represent the opinions of the authors and do not necessarily tient to the hospital if indicated. The physician should reflect the views of the North Carolina Medical Board, its members or continue to treat the patient until it is appropriate to staff, or the institutions or organizations with which the authors are af- filiated. Official statements, policies, positions, or reports of the Board re-commence the termination process. are clearly identified. We welcome letters to the editor addressing topics covered in the I hope these questions and answers are helpful. If Forum. They will be published in edited form depending on available you would like to discuss these or any other questions, space. A letter should include the writer’s full name, address, and tele- phone number. please do not hesitate to contact me. * Except when quoting a Position Statement, the above opinions are North Carolina Medical Board mine and not necessarily those of the Medical Board. Charles L. Garrett, Jr, MD Edwin R. Swann, MD President Raleigh Fondly, Carolyn: Letters to a Jacksonville Term expires Term expires October 31, 2005 October 31, 2005 Young Physician Featured on Dicky S. Walia Robert C. Moffatt, MD Cary NCMB Web Site President Elect Term expires On its Web site, the North Carolina Medical Board Asheville October 31, 2007 Term expires proudly offers Fondly, Carolyn: Letters to a Young Physi- October 31, 2007 Aloysius P. Walsh cian, by Carolyn E. Hart, MD, of Charlotte, NC, as a Greensboro service to all medical students, residents, faculty, men- H. Arthur McCulloch, MD Term expires tors, and other physicians and health care professionals Secretary October 31, 2006 Charlotte concerned about the humanity essential to professional- Term expires ism and the practice of medicine. R. David Henderson, JD October 31, 2005 Executive Director As director of medical education at Charlotte Memorial Janelle A. Rhyne, MD Hospital and Medical Center (now Carolinas Medical Cen- Treasurer Publisher ter) from 1962 to 1984, I would have made Dr Hart’s series of Wilmington NC Medical Board letters to a young physician mandatory reading for all interns Term expires and residents on a yearly basis. This requirement would have October 31, 2006 Editor served to enhance and guide their efforts in becoming complete Dale G Breaden (or, as Izaak Walton said, Compleat) practicing physicians. E.K. Fretwell, Jr, PhD Thank you, Dr Hart! Charlotte Assistant Editor And, I have mailed copies of the Fondly, Carolyn series to Term expires Dena M. Konkel October 31, 2005 my eldest grandson, who is currently in an orthopedic surgery Street Address residency. Robin N. Hunter-Buskey, PA-C 1203 Front Street Bryant L. Galusha, MD Raleigh Raleigh, NC 27609 Former President, FSMB Term expires Former Executive Vice President, FSMB October 31, 2006 Mailing Address Former Member, National Board of Medical Examiners PO Box 20007 Former President, North Carolina Medical Board Michael E. Norins, MD Raleigh, NC 27619 Greensboro To access Fondly, Carolyn, simply go to the Board’s Term expires Telephone Web site: www.ncmedboard.org. The text can be down- October 31, 2007 (919) 326-1100 loaded and printed out in the free