Doctors don’t get investigated for being quacks

A doctor in our area was recently indicted for allegedly running a “pill mill”. According to local news reports, patients were recruited to come in and ask for narcotics and the doctor received massive cash payments to write the prescriptions. After the guy was nabbed, his patients (the real ones and the others) spread out in the community looking for new doctors to take care of them (or to write them more narcotic prescriptions).

Another doctor in our area specializes in so-called “holistic” medicine. He runs expensive tests that aren’t covered by insurance. Many of these tests are either of questionable significance and utility, or are run in labs widely known for their “variable” quality. He puts his patients on unconventional mixes of medications and supplements, many of which he apparently sells. He and many doctors like him send their patients to “real” doctors to take care of the rest of the patient’s healthcare.

In the first case, the cops caught up with the guy. The fallout for patients will last for a while as the scramble to find new primary care physicians (there’s a shortage, you know), or have to suddenly deal with a narcotic problem after their source dries up.

In the second case, the doctor will continue to collect cash from patient to whom is is very kind, and who get the answers they want from a kind man.

The second doctor isn’t doing anything illegal. He’s practicing bad medicine, outside of the standard of care, but as far as I can tell, he’s not breaking any laws. And his patients love him. He listens, spends time, and tells them what they want to hear. I looked into ways to get this guy investigated, to have some sort of third party look over his practices, but I couldn’t find one. Complaints against healthcare professionals have to be lodged by patients or their agent. As far as I can tell, in this state there is no way for anyone other than a patient to complain about bad doctors.

This makes some sense. If someone opens a practice across the street from me and my patients start fleeing there, who says I wouldn’t call in a complaint just to hurt my competition? (I wouldn’t obviously, and there’s no incentive even if I were a bad guy. There are plenty of patients for all of us.)

But while doctors clearly breaking the law can get caught and prosecuted, doctors practicing obviously bad medicine are pretty safe. Their patients often love them and wouldn’t think of lodging a complaint. Even if every other doctor in the community knows another doctor is bad news, there’s nothing they can really do.

I may not be completely right. Maybe there’s a way to complain to the medical board in this state. Maybe not. I couldn’t find one, and I’ve never heard of it happening.

Doctors get disciplined if patients complain, maybe get busted for breaking the law, maybe get sued if a patient is unsatisfied, but they don’t get investigated for being quacks.

I don’t have a solution to propose that wouldn’t create layers of bureaucracy and put good doctors at risk of false allegations. But there must be some way to deal with quacks. Their work harms patients and makes my job difficult as I try to tease apart what they’ve done to my patients.

“PalMD” is an internal medicine physician who blogs at White Coat Underground.

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  • Anon

    Stop hating and mind your own business. The guy isn’t hurting anyone any more than a dermatogist or plastic surgeon who sells patients Botox all day.
    I modified your paragraph, in brackets, to show how silly you are:
    “Another [PRIMARY CARE] doctor in our area specializes in so-called [EVIDENCE-BASED] medicine. He runs expensive tests [DONE AT LABS OWNED BY HIS AFFILIATED HOSPITAL]. Many of these [PHYSICALS, MAMMOGRAMS, MRI, CT SCANS, SCREENINGS etc.] are either of questionable significance and utility, or are run in labs widely known for their “variable” quality. He puts his patients on unconventional mixes of medications and supplements, many of which [ARE BRANDED DRUGS SOLD BY PHARMACEUTICS WITH WHOM HE HAS RELATIONSHIPS WITH]. He and many [PRIMARY CARE] doctors like him send their patients to [SPECIALISTS OR THE ER] to take care of the rest of the patient’s healthcare.”

    • PoliticallyIncorrectMD

      Bravo!

  • http://www.facebook.com/people/Tim-Hotze/2904469 Tim Hotze

    It is a shame that physicians don’t have some kind of a reporting functionality – many patients don’t know how if they’re receiving non-standard treatment, or if they’re being put through tests which can be expensive, time consuming and at times, even risky – because by definition, most of them aren’t doctors. Another MD who gets referrals or someone is in a MUCH better position to evaluate the doc’s behavior – whereas patients have to rely on heuristics (like whether s/he’s “nice” and “listens,” which are important, but so is medical knowledge and appropriate treatment).

    • f. lusu

      a specialist told me to switch my family doc because of the bad care i was getting. my new doc had the same opinion, and actually used the word incompetent. i’m very appreciative that they are looking out for my well being, and i also loved the fact that i saw a little righteous anger directed toward someone in their own field.

  • NormRx

    I had one primary care doctor in my territory that started doing liposuction, he killed one woman and severely injured another, he eventually lost his license. I had another one that came to a small town and started doing hysterectomies on most of his female patients, he then started prescribing various psychotropics (nobody is more loyal to his doctor than a junkie) His practice ended when he was covering the ER and a woman was transported after a car accident, she had a ruptured spleen that he did not pick up, she died and he lost his license. Another doctor had Parkinson’s with dementia (he would get lost in his office) this went on for years until finally the other doctors in the area pushed him into retirement. I had several dispensing physicians that would buy amphetamines in jars of 5,000 and dispense them to anyone and everyone,( this was prior to them being placed on schedule 2)

    Another one was a psychiatrist that started doing chelation therapy for diabetes, MS, arthritis and a host of other diseases. To the best of my knowledge he never did use it on heavy metal poisoning.
    Most physicians are caring and hard working, but there is definitely some bad apples that should be weeded out.

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    If a physician is board certified or board eligible working toward their certification , and if they have trained at a reputable residency program and if they are members in good standing of a local hospital medical staff and if they have few listings of medical malpractice on the National Practitioner Data Bank ( med mal cases settled for or awarded $10,000 or more are listed) then they probably have the training and expertise to practice competently. The county medical society would know about complaints as would the state medical board which investigates every complaint.The profession and the definition of professionalism have changed dramatically since the days we were not permitted to advertise or sell and dispense pharmaceutical medications from our offices. The Anti Aging hormone replacement , vitamin , mineral , herbal antioxidant selling practices may be snake oil or if the research is ever actually done in a scientific reproducible manner, may be cutting edge in their approach.? The physician who takes cash or favors for controlled substances is a criminal. The problem is that in an effort to curb the pill mills the climate of enforcement has made legitimate practitioners wary of prescribing substances to reduce pain and suffering in chronic pain patients. The laws are confusing and there have been numerous cases of entrapment of psychiatric physicians for prescribing chronic pain medicines for a legitimate fee for a visit because they did not perform a physical exam and document it ( most psychiatrists do not perform a physical exam on their patients.).
    Checking out your potential doctors credentials, getting references from friends and neighbors who use the doctor and asking health care professionals in your community who they use or who would they send their wife and children to , is a great way to find the good ones and avoid the controversial ones

  • doc99

    I’ll bet this guy gets rave reviews on Healthgrades, too.

  • drg

    what I always find interesting is there is some conception that it is easy to sue or easy to get reported to the board even for issues that may be more minor. This is where doctors i think in training become frightened. it is a good way to police oneself so to speak to be constantly worried and vigilant. And medical school instills that fear into its students.

    But there are pitfalls to this as well. It can prevent us from acting in ways that would be helpful, rebelling so to speak on issues that are not good for us and our patients in the long run. We are taught to be compliant in many ways that are not good for us or our patients.

    In the above case, it is aggravating to see the way this doctor practices, but in reality even if a patient complained little is done about these sorts of things. Their definition of no harm and yours are very different.

    Doctors may fear the boards just like we all cringe hearing about the IRS calling. But in reallty the boards like any regulatory agency in the US do not necessarily get the best and brightest consultants. Nor have the funding to pursue every case that comes in to the fullest extent. Let’s just say I have seen worse and nothing is done. It has to be pretty egregious for them to act.
    It is a misconception taught in medical school.

  • drg

    the state i practice in, California, the board will not allow doctors to report other doctors that have allegedly sexually abused their patients–unless the patient wants them to report it. In other states it is mandated that as a doctor you notify the board.
    As far as I can see the board is not an effective agency as they often make doctors believe.

  • http://www.facebook.com/vikas.desai.92560 Vikas Desai

    i have plenty of patients come to my office with 10 pages worth of mind numbing blood tests, including b6 levels, vitamin c levels, mercury, and the greatest of all……arsenic. Thinking they have heavy metal poisoning or some sort of selenium/manganese or other trace metal deficiency. I can’t even begin to comprehend any doc checking for arsenic except for a forensic pathologist. I believe that alternative treatments, can help but all this seems to be is taking advantage of desperate/anxious/dumb patients. Think of steve jobs who used alternative treatments for his cancer only to get a liver transplant a short time later. Nothing but absurdity.

  • http://twitter.com/DinoDocLucy Lucy Hornstein

    Amen!

    The saddest thing of all is when well-trained, science-based family docs turn to this nonsense because patients are willing to pay for it. Much harder to make a living taking the time to explain why you don’t need antibiotics for your cold, especially on what insurances pay.

  • querywoman

    A bit of trivia: once I went to a controversial, well-known allergist who did that kind of bizarre test. I refused to pay $400 for volatile and solvent testing. He did me some good on my allergies, treated the pollen-based ones, and help me identify my food sensitivities, but he was much too in to allergies as the cause of everything.
    I fired him when I realized he was of no more use to me.
    Then I quit a job and moved 35 miles away back into my mother’s home and began to use my old family practitioner.
    My family practitioner had been hanging around the allergy doc’s clinic and, at every turn, he wanted to do more of that stuff on me. He didn’t seem to understand it that I had already fired his teacher.
    Eventually, I fired that family doc too! Got sick of hearing it!

  • justanotherepatient

    Filing a complaint against a doctor is not as easy in some states as it should be due to the way the code of ethics is written. I left my primary care doctor after he committed flagrant abuse of his authority and crossed ethical boundaries that seemed pretty clear to me.

    When choosing a new PCP, I interviewed several other doctors and learned they all knew about this doctor’s issues. I was not the first patient with whom he had behaved inappropriately; however, given the way he did what he did and the types of patients he chose as his victims, reporting him would have been pointless. It’s one thing if one doctor tells you reporting would likely be nothing more than a lot of pain for nothing; it’s something else altogether when three other PCPs, none of whom knew I was interviewing the others, and two specialists I was already seeing told me the same thing even as they all acknowledged his behavior was wrong and they’d heard similar complaints.

  • DPMT

    In my city, the “quack” doctors, and most of us in the field know who they are, lose their hospital privileges. Smart patients would be wise to check the hospital to see if their provider has privileges. If they do not, that should be a red flag that something is amiss.

    • Suzi Q 38

      This is so true. I went to visit my 85 year old mother, who needed to see the doctor. No doctor was present at the office, only the NP. I liked the NP, but every time we went, we never saw the doctor.

      One day, my mother went temporarily blind. After seeing her ophthalmologist, he admitted her to the local hospital.
      Her internal medicine doctor never showed up (the one with the NP.) She was there for a month, diagnosed with a rare condition called “Giant Cell Arteritis.”
      She had to be seen by an internist that I did not know, but luckily he was better than her present doctor, who never showed up.
      I told my sister that that is really strange….maybe he doesn’t have privileges.

      Sure enough, after making a phone call to the hospital, it was true.

      We had to switch doctors, which was difficult, because seniors are very loyal.

  • Kat

    As a patient, I am GLAD we have choices in our health care system and can decide for ourselves, what works for our bodies. I LIKE THAT FREEDOM! My body never read any medical textbook and apparently does not behave the way it should. My body does not like taking medication with endless side-effects. All you do, PalMD, is follow an algorithm. You don’t listen to me, nor my body and you don’t understand. The “non-traditional (ie – one that doesn’t just treat symptoms)” at the very least ,LISTENS! That right there is healing for so many people! And the non-traditionalist are not trying to “harm” me they are trying to help. And why is it that the fact that I FEEL better – and so many others too…why, is that not considered EVIDENCE enough for you? I dislike anyone who tries to take away my freedom to do what I want with my own life/body. It’s someone else, who thinks they know what is best for me, all over again. I’m female, I’m highly-educated, and I am angry. Mind your own business!