Texas Medicine Inbox: December 2016

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Inbox — December 2016 

Having read the commentaries "U.S. Opioid Abuse: Teaching Is Fundamental" by Emilie Y. Prot, DO, and "Pharmacogenetics in Physician Practice" by Kevin Pauza, MD, in the September issue, I applaud Texas Medicine for providing both. I would add there are two things that can be done to reduce prescription opioid abuse. The first is to ensure any patient satisfaction survey tied to physician payment is constructed so a physician acting in good faith is not financially penalized for refusing to provide opioids. The second is to improve payment for primary care. 

My colleagues in the primary care specialties must adopt strategies to overcome poor payment, often by increasing volume. This makes it difficult, if not impossible, to explain the refusal to every patient inappropriately seeking opioids. No one can blame them if on occasion they triage their day by simply writing the scrip and intending to deal with it on the next visit. Time devoted to patient counseling must be compensated, not just presented as an unfunded directive.

Stephen L. Brotherton, MD
Fort Worth

I enjoyed reading "MOC Revolution" in the September 2016 issue. The article highlighted problems with the maintenance of certification (MOC) system. I hear physicians complain because MOC is another expensive, time-consuming thing we must do. But, when you can show data that it doesn't actually improve patient care, the argument against MOC makes sense. 

I am all for the initial boards because training varies among residency programs. We do need an accepted certification process for each specialty. Continuing medical education is essential to keeping your knowledge up to date, but I think that is sufficient.

I have been out of residency for about three-and-a-half years. After passing my oral boards, I worked to fulfill the first-year requirements for the American Board of Ophthalmology, and it was time-consuming, costly, and essentially worthless. The multiple-choice tests were full of ridiculous questions, and it was essentially open book. The practice improvement modules were time-consuming data entry that were also worthless. 

The biggest indictment of MOC is that it grandfathers in some older physicians. That should shed light on how important the board thinks these activities are. If MOC does truly improve patient care and the boards consider MOC essential, why not require some of your oldest boarded physicians to participate? Wouldn't you want these physicians who were trained years ago to be brought to current standards? 

Mark Trevino, MD
San Antonio 

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