Preserving Professionalism, One Testicle at a Time by Pat Conrad MD

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The agent told me to stand in front of the desk, and held my I.D. up next to my face to confirm the bearer. Stepping around the desk she said, “Please open your pockets so I can look inside.” Sigh…okay, fine, I thought. “I need you to open those small pockets on the side too.” Eyes roll…okay, here you go. These TSA checks are such a drag. “Okay, now please raise your arms”, she said, as the metal detector wand ran over my arms, chest, and legs, before asking me to turn around to repeat the procedure. Then the agent instructed me to raise my pant legs in order to inspect my ankles. Then I was handed my driver’s license and went through the door…back to my cubicle to continue my American Board of Family Medicine board renewal exam.

This procedure did not happen once, nor twice, but on my lunch break, and every single time I left the testing room to go to the restroom during an eight hour test day. I timed it once, and found that I had been away from my exam cubicle less than 4 minutes, not quite enough time to find a piece of esoterica hidden in my microfilm board review book hidden in the bathroom, or to tag in my better studied doppelgänger lurking in the parking lot. I checked with a buddy who took his exam two days later in a different state, and he suffered the identical indignities.

I’ll have more to write later on about these board exams beyond the insultingly asinine security surrounding them. I left exhausted, depressed, and angry at everything to do with the experience, and with a clearer view of what has gone wrong. For decades U.S. physicians thought we were adopting the lofty tenets of our profession, when we have actually been perverting them into a mindset, and an industry that embraces self-harm. Too often we have heard that it is noble to “sacrifice”, which has come to mean that most physicians will be told exactly what and how to sacrifice by an oligarchy of bureaucrats, academicians, corrupt corporatists, and lapdog establishment doctors. This profession has adopted the phrase “all for the patient”, which now means the doctor is expected to be subservient to the patient, or any other agent claiming to be looking out for him.

The poor drone attendant looked genuinely sorry for me as I shook my head in disbelief after a bathroom break, and said, “Yeah, you ABFM types seem to take it the worst. I can understand it, I mean you are doctors.” It wasn’t her fault; she was just doing what she was told by her testing center, which was fulfilling a contract with the ABFM. But at age 55, after passing multiple board exams including two for family medicine, and a month shy of 20 years as a practicing physician, I was being treated like a damn criminal. Claiming this to be necessary to preserve the “quality” and “professionalism” as defined by the ABFM, ABMS, and IOM does not justify this criminalizing treatment. This is the direct result of medicine’s philosophical failure, it is an abdication of its practitioners’ duty to themselves, and there is nothing authentic about it.

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  14 comments for “Preserving Professionalism, One Testicle at a Time by Pat Conrad MD

  1. K Murray Leisure, MD
    April 26, 2016 at 1:29 pm

    EXCELLENT post. Such insults to the medical and surgical professions from these irrelevant, frequently inaccurate MOC exams apply not only to Family Practice but also to all the ABMS – MOC (trademark) testing programs. All subspecialties and MOC programs from ABMS and its subsidiary umbrella boards. They represent bullying, un-validated racketeering from a monopoly testing industry. Board certifications should be ONCE and done for everyone, as before 1990. And perhaps Canadian or UK Boards (Royal Society..) or another group beyond the ABMS consortium needs to be accepted for ALTERNATIVE Board certifications after residency in order to stop ABMS from interfering with relevant, reliable patient care and medical research.

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  2. K Murray Leisure, MD
    April 26, 2016 at 1:29 pm

    EXCELLENT post. Such insults to the medical and surgical professions from these irrelevant, frequently inaccurate MOC exams apply not only to Family Practice but also to all the ABMS – MOC (trademark) testing programs. All subspecialties and MOC programs from ABMS and its subsidiary umbrella boards. They represent bullying, unvalidated racketeering from a monopoly testing industry. Board certifications should be ONCE and done for everyone, as before 1990. And perhaps Canadian or UK Boards (Royal Society..) or another group beyond the ABMS consortium needs to be accepted for ALTERNATIVE Board certifications after residency in order to stop ABMS from interfering with relevant, reliable patient care and medical research.

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  3. Mamadoc
    April 21, 2016 at 9:08 pm

    Took it last week (5th recert, after certifying in 1981) and ditto to all the above. The AAFP and the ABFM are just money sucking useless outfits. Wonder what that guy actually does for that $7400,000/year anyway? Retirement is looking better all the time.

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  4. William Douglas Given MD
    April 20, 2016 at 9:41 pm

    It is a tragedy. My last exam was 10 yrs ago and I have to revert next yr. Maybe I will get lucky and have a cavity check! That is ridiculous and degrading.

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  5. Dr Dave
    April 20, 2016 at 7:30 pm

    Thank goodness some of us older folks are grandfathered because this is THE most nonsensical nonsense I have ever heard of in my career. Not only does it NOT make us any better providers it surely doesn’t demonstrate any professional attitude so if we don’t how do we expect the patients to. In terms of it making care safer that is THE joke because the stats never change the same 10% still do the 90% of the mal-practice cases. The only value to this is that the ABIM can generate salaries for those idiots who can’t seem to make a living in patient care and to supply salaries to the staff at the office and feed the inimitable Trust that was created. The Trust is the financial joke of medicine and we are still too stupid to say “enough is enough I no longer need to participate in this boy’s club” ALL this is is a boy’s club with BAD rules. If enough members say NO then no it is until we grow a set expect more from ABIM and more like ACA that is just driven down our throats because we are too afraid of making waves. Hey what are they going to do to me toss me out of my OR? Not a chance I make far too much money for the hospital for them to shut me down. Besides if we can’t work who will do it for us? Dr D

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  6. Vincent Zeccola
    April 20, 2016 at 6:51 pm

    I agree that this is a very aggressive and demeaning security procedure. But the perpetrator is YOUR professional society. Change it! You are the only ones who can.

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  7. Kurt
    April 20, 2016 at 6:35 pm

    Dr. Doug pointed out the head of the ABFM makes $740,000 a year. Think about that when you send them your money.
    Is this retesting crap really necessary? I have one more to take and I am going to retire hopefully 5 years after.

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  8. farmdoc
    April 20, 2016 at 4:57 pm

    When are we physicians gonna go on strike and stop the madness. Let a few of the fat cats have their MIs and whatever else they have go wrong and nobody to treat them. There is a lot of squawking but no action. Would you like a big mac to go with your oxycontin rx?

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  9. Carolyn Eaton, MD
    April 20, 2016 at 12:05 pm

    I took mine last Friday, and I couldn’t believe the indignity of it all.

    The test itself rarely presents anything as we see it, deliberately obfuscating the answer, often asking about new treatments to rare conditions. (My favorite question I had was one about a 72 year with diabetes and hypertension, gave lab results, never mentioned smoking, then the question asked about lung cancer screening (not screening since he was not a smoker was not an available answer))

    But back to the indignity of it. If they were worried about people bringing in some kind of tech – do the test on paper with bubble sheets and jam electronic signals in the room. So what if someone managed to slip some crib notes in his/her sock – with the breadth of knowledge – they might help with 10 questions. I try to keep positive about Family medicine and Medicine in general, but if they can’t trust me to take a test honestly, I honestly don’t think I can trust them.

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  10. Glenn Mizrach
    April 20, 2016 at 11:44 am

    I took my ABFM exam 2 years ago, for the fifth time, and suffered the same indignities.

    But the big question is: why do we need to take a closed book 8 hour test in the era of the internet?

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  11. April 20, 2016 at 11:00 am

    I have seen a decline in the prestige of physicians in the eyes of society at large and at the hands of our regulatory bodies. Simultaneously, the expectation of the practice of good and ethical medicine by these entities persists. Litigation has done its own damage by instilling fear. Meaningless regulations to cause confusion and more fear in the minds of physicians to maintain control over the profession are also factors. Armed with all this knowledge, surely there is some thing the physicians can do, and, I sincerely believe, are doing. Some physicians have declared independence by taking out the regulating bodies and reimbursement intermediaries from the mix. That saves a lot of hassle, money and physician time which can be dedicated to the direct patient interaction and increased satisfaction of both the physician and the patient. Tough as it is, it is our path to Nirvana. Let us continue to work on it. I have a dream and have a lot of hope.

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  12. Perry
    April 19, 2016 at 9:49 pm

    I just took mine today, lovely experience. I just hope and pray I pass so it will be the last.
    I told the guy it was like going to the airport, but the plane crashes instead of reaching Aruba.

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  13. Steve O'
    April 19, 2016 at 9:20 am

    Doctors are indeed among the most stubborn of the counterrevolutionaries, that’s for sure. “I can understand it, I mean you are doctors.” That phrase today has as much meaning as “You are HLA B27 positive.” Doctors are in the obsolete category of “professionals,” along with lawyers and ministers – those who are available to the very poorest and most powerless to advocate for their well-being. Such Robin-Hoodism is silent terrorism, as seen in ISIL / ISIS.

    Professionals were people answering only to their own experience and training, numbering among the local bourgeois, who could be hired by the poor to improve their existence. To effectively control people, it is best done from afar, in another time-zone outside of flyover land. They need to be handled in groups of millions, manipulated and driven by subliminal advertisement, and given a limited set of choices. Do you want the beef, or the chicken?

    Professionals? Nothing but trouble. They need to be subjugated to a mechanical, factory-style method of management, to be frightened off their habit of intellectual opinions, to be pushed down into the ocean familiar to the proletariat where they live. They must fit into the fast-food culture, the big-box store culture, the minute-clinic culture.

    Professionals can often be identified as those who love their jobs, which is dangerous. All jobs should be hated, all should be degrading. All jobs should have a despicable boss. Within ten years, all memories of “professional doctors” will we wiped away with the self esteem of “professional teachers” and “professional lawyers,” down to a degrading and corrupt culture of just getting by.

    Self-aware doctors are a sabotage waiting to happen.

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  14. DR P.
    April 19, 2016 at 8:02 am

    This Physian ( who I highly respect ) tells the TRUTH about only ONE the layers ( meaningless every 7 year recertification tests ) of ” Medical Society & Regulatory ” puppet strings which are driving most quality physicians into part-time work with emphasis on investing or other ENDEVORS OUTSIDE of medicine…even after 20+ years. …. hurts care of patients in the end as most Doctors are now “Diversifying” … even the young Physicians! 😔

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