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The Medical Practice Act, I Physicians Overreach Themselves Austin In discussing the proposed Medical Practice Act now pending in the special session, I express here only the individual opinions of one private citizen of Austin, Texas, who is also a family physician. In making these statements I represent no group or organization, only myself. Many parts of the bill may have been written or influenced by other physicians who are friends, acquaintances, or colleagues in Austin, and nothing here is meant as a personal attack on anyone. My reason for writing this article is that I feel very strongly that this bill should not pass as now written; and this seems to me to be an effective way to communicate to the Observer readers, and I hope in particular to a number of legislators, that there is at least one M.D. who does not agree with “the party line.” To “sketch in a little background,” the Medical Practice Act is meant to replace current law regulating the practice of medicine in Texas. In its present form it has the enthusiastic and powerful backing of the Texas Medical Association. Under the Texas Sunset Act, the present State Board of Medical Examiners on Sept. 1,1981, unless new legislation is passed before then. The current bill has the effect of re-establishing the board, but it does more than just that. Clearly a regulatory body to oversee the proper practice of medicine in Texas is appropriate. The question is, does this bill meet this need in the best possible way? My answer is a qualified “No.” The act is long, detailed, and comprehensive obviously the result of much work and thought. Two of its major The writer, a 40-year-old Texan, is a family physician in Austin. After undergraduate study at Rice he qualified as a doctor at Southwestern Medical in Dallas. During a tour in Vietnam in 19671969 he was an adviser in preventive medicine and public health attached to the Military Assistance Command. After four more years of medical study, he practiced emergency medicine in Northern California and Austin; he entered private practice in 1979. He is a member of the Travis County Medical Society, Texas Medical Assn., and the Texas chapter of the Academy of Family Physicians. By Al Lindsey, M.D. goals, as stated, are to bring together “the separate laws regulating the practice of medicine . . . under one act” and to “modernize and make the laws relating to the practice of medicine more accessible and understandable,” both worthwhile purposes. But some of the provisions of the act are far too broad and vague, probably unconstitutionally so, and the overall effect of the act is to give such sweeping powers to the board as to create at least a potential monster. This disturbs me greatly. Big Brother The most important reservation I have about the act concerns its definition of what it means “to be practicing medicine within this act.” Not only is a person practicing medicine “who shall publicly profess to be a physician or surgeon and shall diagnose, treat, or offer to treat, any disease or disorder, mental or physical . . . ,” but so is a person “who shall diagnose, treat, or offer to treat any disease or disorder, mental or physical .. . by any system or method [italics mine] and to effect cures thereof and charge therefor, directly or indirectly, money or other compensation.” This means to me that any person who does anything for or to another person or persons is practicing medicine and is subject to the regulations of the board. Later in the act there is the specific exclusion from coverage by the act of dentists, optometrists, chiropractors, psychologists, physical therapists, social psychotherapists, military or public health surgeons, out of state consulting physicans, medical students, and “any person furnishing medical assistance in case of an emergency or disaster” if no charge is made. There is also a subsection that says a person who is “providing nutritional advice or giving advice concerning proper nutrition” is not prohibited from so doing. However, the language here sounds as though it is referring to advice such as might be given by your grandmother or back-fence neighbor, makes no reference to nutritionists as such or to vitamins \(only “dietary supplies strongly that only “the giving of information” about “food and food ingredients” is allowed. The term “the giving of information” [italics mine] suggests to me that a person who charged for such information would automatically put himself back into a regulated category, or at least run a high risk of so doing. All this leads me to conclude that nutritionists most probably, but also most definitely all other “alternative”-type practitioners \(massage therapists, acupressurists and acupuncturists, color therapists, vitaflex counselors, rolfers, stress management consultants, talk therapy counselors who did not fit into any of the above categories, curanderos, practicing medicine if they received any sort of compensation for their services and would therefore be subject to regulation by the board. This seems to me to be totally and completely wrong. Not only is this board not qualified to judge the qualifications and competence of such practitioners, it is not staffed to do the policing required. Much more disturbing is the implicit assumption that the physician’s board should be the medical “big brother” for society, protecting the public from the potential quackery and deception of the alternative practitioners and from the public’s own stupidity and childlikeness. This is 19th Century stuff! It is as if the framers of the act longed for “the good old days” when the physician was revered, as one seminary student expressed it to me recently, as “a splinter of God.” Most people, at least in the general public, no longer see doctors as divine, but the framers of this act apparently would place the physician back on his pedestal, all-knowing and all-seeing, the protector of all. The basic issue here, it seems to me, is freedom of choice. Does a person have the right to choose the sort of practitioner to whom he wants to go for health care, or does he not? If the board has the power to regulate all practitioners, both medical and non-medical \(in the strict nutritionists and other alternative practitioners will feel themselves under much more official scrutiny, in danger of being prosecuted for “practicing medicine,” and much less free to give care? And this means that individuals in need of health care will have fewer choices and options THE TEXAS OBSERVER 3