May 2000
Volume 64 |
Number 5
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| Letters to the
Editor |
To BC/BE or Not to BC/BE, That's This Reader's Question
I enjoyed reading the report on the activities of Drs. Gary D.
Thal and Ronald L. Harter in the AMA-YPS (March
2000 ASA NEWSLETTER). Dr. Thal mentions the problem
with the term "board eligible." Sometime in the mid-1970s, I served
on a committee where the problem terms came up. Our recommendations
at the time were that the major journals should forbid the use
of "BC/BE" (board-certified/board-eligible) in their advertising.
Obviously no action was taken.
The suggestion is as good today as it was then. The editorial
boards can simply forbid the use of the offending four-letter
abbreviation "BC/BE" in any ad in their journal. They can also
ban the expression "board eligible." The ad writers will come
up with something more appropriate. There are creative writers
everywhere.
Many years ago, doctoral students might call themselves "Reg.
PhDs." That was as elusive as "BE." Now they have a term "ABD"
(all but dissertation), which tells where a candidate is in the
certification process. Maybe we could use "ASC" (actively seeking
certification). There could be "ASCI" for those waiting for the
written and "ASCII" for those in the chute for orals. Just a thought.
Gina M. Glick, M.D.
Carrollton, Texas
Devil's Advocates Stir Controversy
As members of the ASA Committee on Pain Management, we were
asked to co-author a controversial article on the business of
pain medicine. We deliberately raised uncomfortable, hotly debated
issues to spur discussion among ASA members. It appears as though
our efforts to strike upon controversy were successful.
Judson Somerville, M.D., described our article as "...a misrepresentation
and a display of ethical ignorance" ("Pathetic ethics regarding
pain practices," January 2000
ASA NEWSLETTER). Several of his comments deserve reply.
Concerning encoding and billing for pain services, we posed the
following question: "Are all patients who are referred to a pain
management clinic in need of a full consultation prior to a procedure?"
We never suggested that a procedure be done without a thorough
evaluation of the patient. We simply posed the question of whether
or not every patient referred for a procedure should be charged
for both the procedure and a consultation. This is analogous to
preoperative evaluation of a surgical patient. No anesthesiologist
or surgeon would ever treat a patient prior to a medical assessment.
Should patients be charged both for a consultation and for administration
of the anesthetic?
Dr. Somerville also questions our comments regarding routine
use of fluoroscopy for epidural steroid placement. One could argue
for or against the routine use of fluoroscopy since there are
no scientific data to guide our practices. But, there are ASA
members who practice and argue strongly on both sides of this
issue. Our goal was to raise the controversy and generate discussion.
Finally, we were chosen to write this article specifically because
we come from very different practice settings; one from a university
practice, the other from a full-time, private pain practice.
In a more recent issue of the NEWSLETTER, Eddy Fraifeld,
M.D., presented a thoughtful reply that covers many of the controversial
clinical issues facing pain management practitioners ("Controversies..."
ASA NEWSLETTER, February 2000). We were charged with
preparing a discussion of controversial topics in the business
practice of pain medicine.
ASA Committee on Pain Management members try to represent the
problems and concerns of members who practice pain medicine. We
welcome their questions and concerns and thank Drs. Somerville
and Fraifield for their comments.
James P. Rathmell, M.D. Rebecca J. Patchin, M.D.
Burlington, Vermont Riverside, California
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