Primum Non Nocere
Walter], Pones, MD
Karoshi
The first case of karoshi , or “death from
overwork,” was reported in 1969 with the
death from a stroke of a 29-year-old, mar¬
ried, male worker in the shipping depart¬
ment of Japan’s largest newspaper company.
Karoshi is a socio-medical term used partic¬
ularly in applications for workers' compensa¬
tion in Japan, especially in cases of cardio¬
vascular disease brought on by excessive
workloads and occupational stress.
According to the Japanese Ministry of
Labor, the major medical causes of karoshi -
deaths are heart attacks and strokes.
Anxiety About Karoshi
In Japan, the word is well known. A
recent survey of 500 male, white-collar
workers in top-ranking corporations in
Tokyo revealed that 46 percent of respon¬
dents were anxious about their own risk of
karoshi. A quarter of them experienced
complaints from their families related to
anxiety about the illness, and from 5 to 20
percent of the workers themselves were
afraid. This fear increased with age. The
report also indicated that family members
are much more afraid than the workers
themselves.
Although karoshi has now been reported
by many industrialized nations, there are no
sound epidemiological estimates. The
Japanese Ministry of Labor awards compen¬
sation for 20 to 60 deaths each year from
overwork. Critics, however, claim that the
compensation is far less than the actual
occurrence. They claim that one third of the
35,000 deaths related to cerebrovascular or
cardiovascular disease in the 20 to 59 age
group are work-related — more than
10,000 each year. In 1994, the Japanese
government’s Economic Planning Agency in
the Institute of Economics agreed that the
level of compensation was low, estimating
the number of karoshi deaths at around
1 ,000, or 5 percent of all deaths from cere¬
brovascular and cardiovascular disease in the
25 to 59 age group.
continued on page 2
In This Issue of the FORUM
Item Page
President’s Message: Karoshi . 1
From the Executive Director:
Update . 1
Three Attorneys Join
NCMB Legal Staff . 4
USMLE, FLEX, and SPEX
Transcript Fees . 4
Fondly, Carolyn:
Letters to a Hung Physician — Part II . 5
Physician Needed as Member of
Board’s PA Advisory Council . 6
No One Is Immune:
Loss, Grief, and Bereavement . 7
To E-mail or Not to E-mail Patients — That
Will No Longer Be die Question . 10
Awards and Appointments . 1 1
iris: the UNC journal of medicine,
literature, and visual art . 12
Adversarial Relationship Is Really
a Choice . 15
Item Page
Don’t Assume Your Office
Is Ready for HIPAA . 16
Attention All Prescribers: Valid DEA
Numbers Required on
Pharmacy Prescriptions . 16
A Brief Introduction to die
Sexual Abuse/ Assault and Physical
Abuse Guidelines for the Evaluation
of Children: Emergency
Department Setting . 17
Sexual Abuse/Assault Guidelines
for the Evaluation of Children:
Emergency Department Setting . 18
Physical Abuse Guidelines for the
Evaluation of Children:
Emergency Department Setting . 19
Board Actions:
2/2002-4/2002
. . 20
Board Calendar . 23
Change of Address Form . 24
Notice: NCMB Mailing Address . 24
From the
Executive
Director
Andrew W. Watty
Update
Many of the quotations I use in this spaec
come from such obscure sources they cannot
be found in Bartlett’s. So I must attribute
this quote to several elected officials who use
it when describing the attitude of their con¬
stituencies: “It’s not, ‘What have you done
for me?’ It’s, ‘What have you done for me
lately?”’ We go to great lengths to chronicle
output of this Board. Our Web page fea¬
tures an annual report, as well as licensing
action information that is accessible in sever¬
al different formats. However, I appreciate
the context of the quotation above as it
relates to elected officials. I know they are
present and voting on a panoply of issues. I
can find out about these diverse issues
through a wide variety of sources, but it usu¬
ally requires a significant investment of my
own time. I would like to have a brief, con¬
solidated summary of what has been done
for me lately. In that spirit then, I would like
to offer an answer to that question for those
we serve: the people of North Carolina,
including our licensees. Here is what we
have done for you lately.
Fee Increase
The biggest recent issue is the Board's fee
increase. As a result of a statutory change
signed by Governor Easley in December
2001, the Board increased its annual regis¬
tration fee, effective for February and future
registrations, from $100 to $125 per year. If
you do any comparison with other regulato¬
ry boards, the dollar value of this fee is a bar¬
gain. The Massachusetts Board, for exam¬
ple, has been functioning on the fee level
that we just reached for the past ten years.
Their fee was recently raised $75 to $200 a
year. By comparison, we raised our fee —
continued on page 3
