From: hack@arabia.uucp (Edmund Hack)
Subject: Re: Repealing medical licensure laws
Organization: Lockheed ESC, Houston
Distribution: usa
Date: Mon, 23 Nov 1992 22:52:25 GMT

In article <By6sCH.Bvp@mentor.cc.purdue.edu> hrubin@pop.stat.purdue.edu (Herman Rubin) writes:
[munch]
>So what is the present situation?  At this time, I have no way of knowing
>if the doctor is a clod who can handle routine situations, or if he can
>think and do something sensible in a non-routine situation.  I suspect
>that at the present time most cannot.  

From what I have seen, most "clods" get weeded out in med school, or
shunted off into non-realtime, non-critical specialization.
>
>You are right that a patient cannot know how good the doctor is.  

There are a few pointers that can help.  First, are they board
certified?  (Your milage will vary, some boards are easy, some are very
hard.) Second, where did they go to school - a major school in a big
city (where they see lots of cases as a student and resident) or a small
school in a rural area of the US or in a place where modern medicine is
not practiced?  Third, get a pointer from a physician you trust.  Ask
them who they would send themselves or loved ones to if they had your
problem.  Believe me, most physicians will give you a reference if
asked.

>This is
>the situation WITH licensing.  In a free market situation, there might very
                                                                  ^^^^^
Loophole alert!
>well be an attempt to provide better information.  Fraud should be a far
>more serious crime than it is now, and interpreted so as to include much
>of the current hype.
>[munch]
>How do you know that the surgeon has not lost his skills?  

Ask if they do Continuing Medical Education, ask what kind and when.

>How do
>you know that your surgeon has kept up with the increased knowledge
>about the dangers of anesthetics?  

If the surgeon is smart, they don't need to know much, because they use
a good anesthesiologist (as is done in most hospitals and outpatient
surgical centers.)
>
[regarding deregulation of prescription drugs]
>As long as they do not directly pose a danger to others, yes.
One major problem with over the counter availability of drugs is the 
of development of resistant strains of bacteria.  This is already a
problem with the current regulated state of antibiotics in US/Europe,
etc. and is (from what I have been told by a pediatric epidemiologist) a
problem in the developing world, where non-narcotic drugs are o-t-c.

>But far more information should be provided.  Concealing known
>information about the dangers of a substance should be far more
>actively prosecuted.  

No matter how much information is provided, the current state of
humanity is not such that they will heed it. How many of us sit and read
every page of our auto owner's manual? How many RTFM on the software on
our computers? I admit that it is hard to prevent fools from harming
themselves, but most people want to have some set of standards that allow
the social impact of irresponsible behavior to be minimized.  In
addition, the current crop of lawyers make too much money from lawsuits
on drugs that are reasonably safe (e.g. Halcion) that the drug companies
would go bankrupt if anyone could walk up and buy their products.

I look at it this way: the FDA and medical licencing agencies are a lower
cost and effective way of pre-screening practices and substances.
Leaving things up to lawsuits to decide will only drive costs up and make
things take longer.  The system is not perfect, but leaving it up to
lawyers is asking for disaster.
-- 
Edmund Hack - Lockheed Engineering & Sciences Co. - Houston, TX
hack@aio.jsc.nasa.gov - I speak only for myself, unless blah, blah..
"You know, I think we're all Bozos on this bus."
"Detail Dress Circuits" "Belt: Above A, Below B" "Close B ClothesMode"
Newsgroups: talk.politics.medicine