President’s
Message
Wa\nc W. VonScggcn, PA-C
Communication
Is the Key
Among the wide variety of problems that
come before the North Carolina Medical
Board, by for the most common involves
some sort of communication problem
between the physician and patient, the
physician and patient’s family, or the physi¬
cian and other medical support staff The
problem usually is based on the expectation
of the patient or the family that the physician
(or other health care provider, such as a
physician assistant or a nurse practitioner) is
responsible for communicating more effec¬
tively. In reality’, of all the fields of prepara¬
tion in which medical personnel are usually
trained, formal courses and practical training
in effective communication are often
neglected. While language, grammar, and
medical vocabulary courses may be pre¬
requisites, it is uncommon to see on¬
going communication training and inter¬
viewing/observing techniques being taught
in medical school. It is often assumed that
on-the-job training will suffice to bring the
student into the range of an “effective com¬
municator.”
Physicians in an active medical practice
must communicate with an astonishing
assortment of individual patients across die
full spectrum of ages. The choice of words
and messages must take into account multi¬
ple levels of education, the ever-present life-
critical emotions, and the possibility of vary¬
ing mental illness or cognitive states. Often
the communication must take place in the
midst of a variety of complex and unpre¬
dictable disease processes. Atop it all, die
crucial information the physician must send
and perceive may be affected by gender,
racial, or cultural sensitivities. The physician
must constantly be prepared to sort actual
truth from self-serving confabulation, hear¬
ing not only words and expressed thoughts,
but linking die verbal message widt die
objective evaluation of medical signs. It is
no wonder that effective communication by
physicians is such a Herculean task. The task
begins each time a physician-patient rcla-
continued on page 2
In This Issue of the FORUM
Item Page
President’s Message
Communication Is the Key . 1
From the Executive Director
Myopia in Licensure . 1
On-Line Registration: It’s on the Way . 4
House Calls . 5
Audio Tape Available . 6
NCMB Adopted Position Statement on
Advertising and Publicity in November . 6
Governor Hunt Appoints Dr Barrett
to NCMB, Reappoints Dr Kanof . 7
General Reminders for Physician Assistants
from the NCMB Licensing Department ....7
Reflections of the First Public Member . 8
Mutual Recognition in Nursing:
Licensure for the New Millennium . 9
Item Page
George C. Barrett, MD, Becomes President
of Federation of State Medical Boards . 10
Letters to the Editor:
I Count My Blessings Every Day;
Lying to the Board . 10
Electronic Distribution Used for Some
Forums , Bimonthly Action Reports . 1 1
Medicine in Moldova:
A Time of Transition . 12
Review: An Ethics Casebook fir Hospitals . 13
Board Actions:
11/1999-1/2000
. 15
Board Calendar . 19
Change of Address Form . 20
License Registration:
Important Information . 20
From the
Fjxecutive
Director
Myopia in Licensure
The licensing of physicians in this country
is still a state function handled by state
licensing boards. Let’s hope it stays that
way. Medical licensing boards, in many
states, evolved from horse-and-buggy days.
There was no prescribing over the Internet,
no telemedicine, and no uniform examina¬
tion for licensure. Each state asked its own
examination questions, some asking for
answers in a blue book. There were no
HMDs, PPOs, no locum tenens placement
services. There was no practice of medicine
across state borders except in border com¬
munities. All of that has changed.
Growing Federal Interest
There are now many forces at play that are
pushing for a shift in this regulator)' author¬
ity. Some suggest the need for federal inter¬
vention (see below). Those of us who have
been connected with medical boards for a
long time are very resistant to any discussion
about such a shift. We tend to feel that states
are doing an effective job of protecting the
public despite criticisms to the contrary. We
can, however, have a tendency to be myopic
in the face of these forces. One example is
the application process for licensure. We
require documentation of core credentials
because we’ve been burned in the past when
we trusted others to do it. Yet in the year
2000 we still require physicians to document
their core credentials over and over again at
licensing boards, hospitals, managed care
organizations, and other places. All too often,
we are not focusing on the more distant
object and the bigger picture. That which is
clearly before us is in clear focus, that which
is distant more difficult to discern.
continued on page .?
