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How Doctors 'Keep Up' Could Give Us a Headache

June 05, 1988|DANIEL S. GREENBERG | Daniel S. Greenberg is the editor and publisher of Science & Government Report, a Washington-based newsletter.

Along with the stethoscope and the white coat, an enduring characteristic of the medical profession is steadfast resistance to periodic testing to ensure that doctors are keeping up with new medical knowledge.

Tests are not needed, insists organized medicine, since a doctor would be a fool to ignore the rapid change of pace in modern medicine. Besides, there are plenty of opportunities for keeping abreast through the nationwide system of continuing medical education.

CME, as it's known, is offered in all fields of medicine, with many classes conducted by medical schools, at hospitals and in professional meetings. It's referred to as a voluntary program, but the American Medical Assn. has set a standard of taking 150 hours of classes over three years.

Many states require evidence of CME credits as a condition of periodic relicensing. However, CME courses are not accompanied by recorded attendance or examinations.

Can anxious patients thus feel assured that the doctor is up to date on today's ceaseless gusher of findings in prevention, diagnosis and treatment?

There's no desire here to shake anyone's confidence in the training standards of modern medicine. But, for the record, it must be noted that this non-doctor has honestly, officially and effortlessly been awarded eight one-hour CME credits--a good step toward the recommended annual average of 50 credits.

In March many medical writers attended the annual meeting in Atlanta of the American College of Cardiology. I signed up for one session, giving my name and address as requested, but I did not attend because it turned out that a session of greater interest was scheduled for the same four hours that afternoon.

The session I preferred was sponsored by a drug company--not uncommon at medical meetings--and featured a panel of six researchers presenting favorable reports on one of the company's new drugs. After giving my name and address at the door, I sat through the entire proceedings.

Several weeks later a certificate arrived, bearing the title "Albert Einstein College of Medicine/Montefiore Medical Center," and signed by the "director, Continuing Medical Education." It stated that I had completed a postgraduate course of instruction in "Milrinone: a current prescription in the treatment of heart failure." The prize was four CME points.

Fair enough. After all, I had endured the four-hour session. But several weeks later a second certificate arrived, this one from the CME program run by the University of Maryland School of Medicine, recording another four points. Those were for the session that I signed in for but didn't attend--didn't even enter the room.

An inquiry to the AMA about the ease of acquiring CME points brought a straightforward response: "We assume we're dealing with responsible people. If someone says they attended a session, we take their word for it."

The AMA's trust is inspiring, even if the experience runs counter to a basic principle that has come down to us from Lewis Carroll: Urged by the March Hare to "take some more tea," Alice replied, "I've had nothing yet, so I can't take more."

Obviously, it is possible to continue one's medical education without ever having started it.

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