Class of '14: Emphasis on Ethics

Washington State Medical Commission 2014

This past week I attended what likely will be my last meeting with the Washington State Medical Commission, formerly known as the Medical Quality Assurance Commission...or MQAC. Appointed by Governor Christine Gregoire in July 2006 as a public member, for the past eight years I have met with my fellow Commissioners for two or three days every six weeks, mainly in Olympia or Seattle. Additionally I have served on a couple of dozen health court hearings, as part of the judiciary process of ensuring patient safety in the state of Washington. I've also attended a number of national conferences sponsored by both the Federation of State Medical Boards and the Citizen's Advocacy Council.

The Washington State Medical Commission overseas the practice of medical doctors and physician assistants. Its mission is clear: promoting patient safety and enhancing the integrity of the profession through licensing, discipline, rule-making and education.

My term ended in August, but at that time Governor Jay Imslee appointed me as a pro tem, so officially I am still a member. That will end when I terminate my residency in Washington. Seven of us left together in August, and were honored at our August meeting as "The Magnificent Seven." I like to think of us new grads as the Class of '14,

We accomplished a lot in the past few years. The highlights are listed here:

http://www.doh.wa.gov/Portals/1/Documents/3000/658005Sep2014.pdf

A member of the Policy Committee and the Newsletter Committee, I also participated regularly on the Case Management Team reviews on Wednesday morning, and volunteered for other assignments that fell within my nonclinical skill set.

The achievement I am proudest of is heading the committee that developed professionalism and electronic media guidelines. These guidelines can be found here:

http://www.doh.wa.gov/Portals/1/Documents/3000/MD2014-02January2014.pdf

They earned the national Administrators in Medicine Best of Boards Honorable Mention Award earlier this year, and this past Wednesday night at a gathering of new and old Commissioners, staff and speakers for the conference, the current Commission chair, Richard Brantner, MD, awarded me the certificate our work committee work had won.

I am so proud of my fellow Commissioners and our staff who worked on this document with me. These are the basic concepts we wished to convey:

• First, do no harm;
• Place your patients’ interests above your own;
• Always adhere to the same principles of professionalism online as offline;
• Maintain professional boundaries at all times;
• Do not misuse information gained through the physician-patient relationship or from patient records;
• Do not do anything which you would hesitate to note in a patient’s chart or to explain to patients, their family members, your colleagues, the news media, or your medical review board.

The personal lesson I learned over the past eight years working with the Commission is that there are no easy answers in the practice of medicine. We debated, agonized and soul-searched over every single decision we made. Noted surgeon and writer Atul Gawande summed this up eloquently in his book, Complications: A Surgeon's Notes on an Imperfect Science.


“The core predicament of medicine - the thing that makes being a patient so wrenching, being a doctor so difficult, and being a part of society that pays the bills they run up so vexing - is uncertainty. With all that we know nowadays about people and diseases and how to diagnose and treat them, it can be hard to see this, hard to grasp how deeply uncertainty runs. As a doctor, you come to find, however, that the struggle in caring for people is more often with what you do not know than what you do. Medicine's ground state is uncertainty. And wisdom - for both the patients and doctors - is defined by how one copes with it.”