Why is Rep. Cary Pigman being such a jerk to Florida doctors?
I’ll qualify the following with this: The man is a hero. He’s a veteran. He’s an emergency medicine physician, too. The means that he has saved far more than his fair share of lives — directly, in his daily avocation, and indirectly, in what it means to put your life on the line to protect the freedom and lives of millions.
But then there’s this. Evidence that to Dr. Pigman, a cool-headed bedside manner is reserved for patients — not policy debate.
As it turns out, though, in this case the policy debate is about patients.
Both in the context of telemedicine policy and scope of practice expansions for non-physicians, Pigman has staked out positions quite contrary to many of his health care colleagues.
Pigman’s reaction to the possibility that patients may need to be protected from out-of-state quacks who play doctor online seems way out of proportion to what a rational person would see as a problem. Of course, Florida law should require out-of-state physicians to prove their credentials before FaceTiming with patients.
I mean, we require a lot from Florida doctors that patients see in person… like, a gazillion years of schooling and residencies, rigorous testing, ongoing education, malpractice insurance, accountability before a Board of Medicine, you name it.
If Pigman had his way, though, doctors from Ala-to-zona could prey on vulnerable Floridians without any proof of credential or recourse if something goes wrong.
For a Legislature that is so concerned about assuring fair interstate playing fields for things like electronic commerce, and rightly concerned with ensuring the accountability of classroom teachers to standards, Pigman’s telemedicine heist would be a slap in the face to these values.
Let’s take a step back though, to the opening question: Why? Why would a decorated soldier and emergency physician stake out a position so contrary (or even irresponsible) to the interests of his colleagues and their patients?
I don’t know. But maybe it’s that he has beef with the Board of Medicine.
In 2007, a 37-year-old woman went to an ER in Sebring, complaining of a severe headache, blurred vision, vomiting, and nausea. The CT scan revealed some unusual ventricular dilation for her age and recommended a follow-up MRI. Dilated vessels are a big deal and can indicate meningitis or aneurism. The patient left with some meds. About a week later, she returned with the same symptoms. Dr. Pigman was on call that day. He gave her some analgesics and told her to follow up with a specialist, but did not order any more diagnostic tests. Later that night, she was brought back to the hospital, unresponsive and in respiratory arrest. She died.
Pigman was found by the Board of Medicine to have committed medical malpractice by failing to order more tests in the face of those persistent symptoms. He was forced to pay $5,000, perform 50 hours of community service (not that he hasn’t already performed tens of thousands of hours of service for our nation), and complete six hours of continuing medical education.
All for something that he probably felt was out of his control.
Emergency room physicians have a raw deal when it comes to avoiding claims of malpractice. They see very sick patients. They must act quickly. They have little to no knowledge of the patient’s medical history or lifestyle. They often have little time to assess a patient because ERs frequently are full of very sick people.
All of that must have been true for Dr. Pigman that day in 2007.
And maybe he feels that the board’s ruling was inappropriate or failed to consider other parts of the case that would have better explained Dr. Pigman’s decisions.
Maybe Dr. Pigman has been left with a lot of distaste for Florida’s “system.” But is that reason enough to deny other Floridians the same protections that his patient in 2007 had — a system that holds providers accountable when things go wrong?
Is that reason enough to say, as Pigman has, that nurses with two years of graduate coursework can make the same judgment calls, diagnoses, and treatment decisions as a physician with more than quadruple that amount of training?
Is that reason enough to speak harshly when members of the public advocate their desire to maintain the highest standards for care?
Not in my book.
It is only the first week of session, and Dr. Pigman has already made clear that he doesn’t believe Florida doctors are “up to” snuff.
But I highly doubt that the answer to quality problems is to blow the doors open and allow anyone to practice — anyone with an online nursing degree, or anyone from another state who has access to Skype.
Instead, maybe this is time for us to wonder if Dr. Pigman’s positions have been shaped more by his personal issues than a clear-headed assessment of Floridians’ medical needs.