Too many doctors practice medicine they're not qualified for, the Florida Board of Medicine says.
The doctor doing your breast implants might not be properly trained in that procedure, and nothing in Florida law says he has to be.
Members of the Florida Board of Medicine say doctors increasingly are practicing specialties without enough training, sometimes with dangerous results. On Friday, they took the first step toward crafting new regulations to stop it.
The board also moved toward trying to regulate chelation, a controversial but popular therapy billed as a treatment for a variety of illnesses, from hardened arteries to macular degeneration.
Regarding doctor qualifications, the board ordered a committee to recommend policies requiring doctors to get appropriate training before entering a new specialty, such as cosmetic surgery. Board chairman Georges A. El-Bahari said he wanted a report by April.
"If you have a medical license, you can do anything in medicine," said Dr. John W. Glotfelty, a board member from Lakeland. "People have taken advantage of it. Medicine has changed, and we've got to change to keep up with it."
Board members cited several examples where doctors practicing outside their field injured patients. They included a woman who died while getting a breast implant from an ear, nose and throat doctor and a boy who had a fatal reaction to anesthesia while his family doctor tried to remove a birthmark.
Several years ago, the board disciplined an obstetrician who had switched to the diet business and was prescribing dangerous growth hormones to overweight patients. At least one became chronically ill.
More and more surgeries are taking place in doctors' offices rather than in hospitals. Doctors who practice outside their specialty typically can be disciplined only if they make a mistake or a patient is accidentally injured or killed.
Francesca Plendl, executive director of the Florida Medical Association, which represents doctors, said that the issue deserves a look, but that rules already prevent doctors from practicing outside their scope of education. Patients also need to take some responsibility for making sure their doctors are qualified.
"They need to ask those questions, they need to make those inquiries," Plendl said.
Board member Becky J. Cherney of Orlando, who recently was named to a National Institute of Medicine panel studying ways to reduce medical mistakes, said stricter rules are overdue. But she said some doctors would fight them.
"The consumer doesn't realize that a family practitioner can start doing breast implants tomorrow," she said. "The consumer thinks there's something . . . to prevent that, and there's not."
Meanwhile, the board directed its alternative-medicine committee to study chelation and determine what sorts of regulations the board could put on its practice or advertisement.
"When patients get sick, they will do anything to get better," said board member Zachariah P. Zachariah, a cardiologist from Fort Lauderdale and one of the most vocal opponents of chelation. "It just doesn't work. Any treatment, whether you drink Gatorade or eat cow dung, will have some placebo effect."
But some patients and doctors swear by chelation, which uses an intravenous drip of chemicals and vitamins. It is a standard method for removing lead and other toxic metals from the body, but the U.S. Food and Drug Administration and mainstream medicine have doubted its ability to treat other ailments.
Board members acknowledged it may be difficult, legally, to limit the procedure if it does not cause direct harm. The board tried to limit chelation more than two decades ago, but in 1980 the Florida Supreme Court ruled it did not have grounds to do so.
El-Bahari, however, said that chelation can be directly harmful if it prevents a patient from seeking other proven treatments.
"We have more science now," El-Bahari said. "If we can prove that chelation therapy is harmful, we should probably test this law again."