I have met 2x with my lawyer in order for him to prepare me for the medical board investigation interview and we will be meeting a few more times. In this post I’ll share with you how this session went and what I learned.
Dress The Part
The point of your attire is to come across as professional but not excessive. It’s not going to be a fashion show.
At the same time, demonstrating a lack of professionalism here would be a bad idea.
The colors matter less. You can wear whatever colors you like based on my own research and after discussing this with my lawyer.
Posture & Room Setup
My lawyer had a pretty good idea what the room setup would be like. He’s done enough of these that he was able to prepare me.
Why prepare? Because the scene is meant to intimidate me. Talk to your lawyer about what to expect and it will help a lot once that day comes.
We did some role-playing and he approved of me having my fingers crossed in front of me. Sitting up and just a slight slouch but not leaning back.
I am to face each person that I speak to by turning my shoulders and head towards them, make eye contact, but don’t gaze.
Instigation of the licensee is common and even accusing me of shit I’ve never done is normal. The medical board and investigators will try to mess with my head to throw me off.
They will start with some yes and no questions and then throw in something phrased in a leading fashion so that I have to agree to it. Then they will ask their real question which I might deny and they’ll fall back on what I previously said and point out then point out that I’m not consistent.
When playing this out it’s a whole different feeling. I froze up quite a few times and got flustered. When you only get one chance at answering something that phrased in totally the wrong way then you feel the pressure.
They will try to trip me up in a lie which is why my lawyer kept insisting on being 100% honest but making sure to phrase the truth in a way that won’t make me look like a criminal.
The board apparently will also pretend as though they have some data that I’m not privy to which indicates something negative about me. The interviewer might say that they spoke to some particular individuals who said that I did xyz or that they have proof of xyz – then they’ll ask me about a particular situation and I’ll be left defending it.
Though the medical board shared some points of contention with me in a discovery letter, they also will keep some things up their sleeve and try to trip me up.
When answering a question it’s important to take a moment to think about it and only answer what they are asking and don’t expand at all – wait for them to ask further questions.
What I learned is that when I try to explain my viewpoint or offer further insight then that’s viewed as me trying to cover my ass or distract the interviewer.
I shouldn’t talk for more than 10-20 seconds.
I should admit to what I have done wrong but don’t say that I am guilty. The point is to come across as someone who understands their mistake and genuinely wants to make a change but not someone who is guilty – weird, I know, but that’s the game plan.
I have to demonstrate to the board that I take the patient-doctor relationship very seriously. Whatever it takes to make them realize that I’m not a criminal and not a threat to patients will benefit me and hopefully keep them from attacking me more.
Casual Attitude Towards Medicine
After an hour of doing mock interview questions together my lawyer got a little disheartened and said something along the lines of “dude, I’m really worried that you have a very casual attitude towards medicine and the board will hang you for that”.
We took a break and he asked me about a few things at work and my interactions with patients and staff and he was shaking his head. What flies as normal interactions between employees at a place of work cannot be extrapolated to physicians interacting with staff.
I look back on my career in medicine and yes, my lawyer is right. When friends and family have asked me for medical advice then I’ve given it. If more than just advice was needed then I’ve stepped in to take action which I cannot do unless I am the official physician of that person and have carried out my interaction in the proper clinical setting.
Regardless of what I’m like, as it relates to this post what matters is that as a physician practicing in the US it’s important that you can demonstrate at all times that you behave in a very systematic and consistent way.
Obviously we don’t need to be dicks but I am starting to appreciate a little of that aura of superiority that some physicians have. Maybe they have that as a way to be a little less approachable but still kind enough that their patients feel their empathy.
Our behaviors as physicians aren’t only in the setting of a clinic. If you are a physician then you are responsible every second of every day to behave in a manner which is consistent with how your medical board wants you to behave. What you write on your FB, what you email others, what you say to others, how you dress, and how you interact with staff – all this can be dug up and will be dug up and used by the investigators of the medical board to help shape their negative impression of you.
There was one other thing that really hit me hard. My lawyer said that me doing telemedicine further solidified the perception of a casual attitude towards medicine. It’s not that he wants me to not do telemedicine but that it wasn’t helping my cause.
I see his point and that makes me doubt myself even more.
It was a surreal experience to be sitting in that conference room with my lawyer practicing scenarios back and forth. We’d be fully in character one second and then he’d let up and pull us out of character to address something in more detail.
My lawyer was great at helping me understand the frame of mind off the medical board investigators.
It’s tough for a lawyer because he can’t tell me what to say which might come across as deceitful. So it’s this game you play where I answer something and he’ll just pause which is a sign that my answer was terrible and then I get to rephrase it 401 different ways until he agrees and we can move on.
You have to tell your lawyer everything and unfortunately you don’t know what matters and what doesn’t. Some things that are perfectly logical and normal in my head come out of my mouth and my lawyer immediately points out how wrong that is, at least from the perspective of the medical board.
I have always felt that I could be 100% honest with my lawyer but at the same time he can’t tell me to say something that’s not truthful. I’m not trying to lie to the medical board but from everything that I’ve learned, I’d be hanging myself if I am 100% honest.
I feel a little defeated and I don’t know if that’s because I am realizing that I was in the wrong and that the way I do things needs revamping or because I’m emotionally beat up.
I don’t know. I feel that everything I say and do with patients has a hole somewhere and anyone with a macro lens could dissect my interaction enough to find a flaw.
- Did I move the breast over to feel for any signs of displacement of the cardiac border?
- Did I see the fundus on the neurologic exam?
- Did I get enough of the cerumen out of the ear to fully visualize the TM of the infant?
- Did I do a full HEADSS assessment on every patient in the urgent care?
- Did I know that what the nurse forwarded to me to sign was 100% necessary for the patient?
- Am I withholding antibiotics so much that I’m placing patients or myself at risk?
- Am I giving out way too many antibiotics?
The Professional Boundaries program was eye-opening. Can I practice medicine in that fashion where I am this robot during each and every interaction? I don’t think so. But I need to find a good balance.
The other day I had a telemedicine visit and right before connecting with the patient I realized that it was a vajajay problem with a pediatric patient and the reason the mother made the appointment by video was for me to look her vajajay. I cancelled the visit and had to come up with some bullshit excuse why so as to not piss off the telemedicine group. I never would have cared before but seriously, I don’t need any problems with such cases.
I want to explore this boundary thing more. The comment about me being casual when it comes to the practice of medicine obviously hit a nerve for a reason. I need to tighten my shit up but not go too far to become bitter or ineffective as a physician.
On another level, I don’t really think I want to have my name associated with a professional licensing group which can investigate me at will and doesn’t have to follow traditional law. It’s not necessary for me to be in this situation any longer. I got my experience in medicine, it was awesome while it was great. I have made my fair share of income from medicine and am living comfortably.
Or am I just being a little sissy and should just accept that this is the nature of my profession and this is what it comes with and just grow thicker skin?