Thursday, March 5, 2015

Patient Certified vs. Board Certified Psychiatrist

I have finally been able to talk about an incident that occurred over 12 years ago.  It was, in my opinion, a harassment case.  I was verbally and emotionally abused by 2 young Psychiatrists who were serving as board examiners.  They were part of a 4 part process that would determine whether or not I had the ability to hang a banner in my office, declaring, essentially, that I knew how to practice Psychiatry.

Let me start from the beginning.  I had to travel to Columbus first to take a lengthy written exam covering all of the expected knowledge I possessed in both Psychiatry and Neurology.  It was in the fall of 2002.

The best part of the day was stopping in Cinncinnati to meet up with my son Andy, attending the University there, and Peter and Molly who drove down from Oxford, Ohio.  What a joy to be with my children and to of course treat them to this great barbecue restaurant that looked over the Ohio River.  I could see Kentucky.

I shared my day with them.  I felt good about the exam.  I studied and of course I was hoping that I was serving as a good role model to them as well.  Mom had gone to medical school when they were all in elementary school.  Now here we were, all grown up and discussing our accomplishments with rib sauce covering our smiling faces.

I was not surprised to receive my results.  I did well in both areas.  I was actually surprised on how well I did in Neurology and attributed this to my residency days in radiology.  I loved reading MRI's - especially those related to the brain and give a diagnostic assessment.

Close to 10 months later came the oral part of the boards.  I was more confident of this part.  After all, I actually served as a mentor to residents during mock oral boards, helping them with the essential part examiners would be judging them on.  The biopsychosocial formulation was the key.  I was such an expert on this that I eventually wrote a book containing these important factors that influence our mental health.

I travelled to Indianapolis this time.  I was, of course, nervous.  There were horror stories of board examiners.  They could be real pricks and have an agenda.  I thought I was prepared for anything.  After all, I was a mature, older woman, not a typical candidate, and prepared for pretty much anything.  I could diffuse what was thrown my way.   All I had to do was impress them with my knowledge, organizational skills, and of course my ability to do a biopsychosocial formulation.

I was first escorted into a room with two older examiners and a young man, a patient in a nearby hospital, volunteering to be examined.   I asked my questions without taking notes, and after 30 minutes was asked to present the case.

I loved these 2 gentleman.  They conducted themselves in a professional manner and even gave me a smile.  They are never to comment on your performance but one individual even praised a question that was asked of the patient. It seemed to make him comfortable, at ease, and spew forth a plethora of information that they themselves did not even know.   I'm thinking, "I nailed it".  And of course when results were mailed to me, I did.  I was passed on all four areas.

Now for the last part of that eventful day.

We were all to watch a video.  It was a scenario of a man who had an exacerbation of extreme paranoia when he was in a situation involving a Vietnamese woman.  He developed homicidal feeling towards that individual and was hospitalized.

I had this one.  I could recite the Tarasoff Law (look it up) forwards and backwards and felt that working with Vietnam vets during my residency had really prepared me to discuss PTSD - Post Traumatic Stress Disorder.  I had actually worked at the VA right after my Psych residency and was performing Comp and Pens - a process requiring an in-depth interview and investigation.  I would then recommend if their symptoms were indeed related to their war experience.  They most always were.

I walked into the room after viewing the video.  There sat 2 young men.  I could have been their mothers.  I sat and began to present as I did in the live interview previously.  You know, the one I passed with flying colors.  They started to interrupt me.  I thought I was in the middle of a criminal investigation but instead of good cop, bad cop, it was bad cop, worse cop.

They essentially were, in my opinion, sabotaging my ability to present.  How could they possibly know what I know if they are harassing me.  I attempted to not show fear and remained composed.  These were 2 men trying to fulfill the urban legend of the evil examiners.  Where was the roamer?  The roamer is a designated man who is assigned to sit in each room for a brief period to assure non-bias.  Are you kidding me?  This current setup was so subjective that you could cut it with a dull knife.

He finally came in the room, unassuming, and sat quietly.  I knew him.  He was the roamer during my first interview.  He actually gave me a nod and a smile.  I breathed deeply and relaxed in my hard, wooden chair that previously was hooked up to electric wires.

Well wouldn't you know it.  The 2 pricks began to conduct themselves in an appropriate manner and began to ask me to proceed.  From what point guys?  You never asked me for the history of present illness, so do I start at the beginning?  What would the roamer think?  I am half way through the torture and the roamer would assume that I would be further in my presentation that, to this point, was not allowed by these impostors.  I calmly asked them what they would like to know now.  The roamer got up and again nodded and turned toward the door.  Please don't leave me, I wanted to scream.  But he did, not witnessing anything that might be construed as bias.

They turned toward me and asked me repeatedly to list the risk factors that one should assess before discharging a patient that was admitted with homicidal intent.  Good question.  I had this.  I began my list of risk - oops - interrupted again.  What the hell.  How could they possibly pass judgement on me?  Oh, they did all right.  Right beneath my outstanding pass of the live interview came their 4 failing marks.  How could an individual who taught mock boards and passed a live interview not at least pass one criteria of the pricks?

I therefore failed.  It took me only 1 week to recover from the humiliation.  I was aware of the process that challenged their finding.  My husband and a lawyer and significant fee paid to the American Psych and Neuro Board opened an investigation.  My claim was that the 2 young pricks were too subjective.  I dare not claim harassment.  Why?  This is a He Said She Said case.  I was never asked to come in for an interview.  I was told they would investigate and get back with me.  I was surprised at the lack of investigation.  NONE.  They upheld their decision.

Despite the bias aspect of the oral boards I signed up to take it again.  After all, Board Certification defines you.

However, 2 months after receiving the news that I failed, my son Andy died.  I withdrew from the oral boards as I was not prepared emotionally and again lost a large portion of my fee to take them.

As time passed, I never thought about taking those boards again.  Even though the ABPN did eventually agree that oral boards are too subjective and are no longer part of the Certification Process.

I contacted my friend who heads the Psych residency at University Hospitals.  She offered me the opportunity to complete "clinical skills" which would then qualify me to take the written exam.  She made my day stating that I would pass with flying colors.   The cost?  You don' want to know.

I have decided to forego this process.  I don't need a plaque on my wall to define me.  If it comes to a point where insurance companies will no longer reimburse my agency as I am not certified then that will be a sign from God to retire.

As of now, I have a full load of patients who will wait at a bus stop in subzero temps to make an 8AM appointment.  I have patients who show up if they are sick.  I rarely have cancellations and if I do, they are readily filled.

I love my patients - each and every one.  And I am an excellent Psychiatrist.  I don't need 2 pricks to define me.  My patient show rate and my ability to keep them off the street, out of the hospital, and not self medicate with alcohol and drugs is praise enough for me.

I am a Patient Certified Psychiatrist and proud of it.