scanman’s posterous

a conversation on twitter (between saroj & i about this article in the ny times - see the screen grab) reminded me of something that happened years ago when i was in sixth standard, in my first year in boarding school.

one day a whole bunch of us were ordered to gather in the assembly hall after lunch. once there, we were told there was to be an audition to select new members for the school choir. the music teacher sang a short "aaaah" (is that called a chord or a tune?) and asked each of us to try and sing it in the same tune.

my turn came in due course. i distinctly remember the dear lady's face twisting in horror within a few seconds of my attempt. she yelled out a tortured, "enough… next!!"

that was the end of my budding musical career. 

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[this one is specifically for my psych tweeps - @DrShock, @purplesque, @Geek2Nurse & @MotherJonesRN]


hello, and welcome to the mental health hotline.
 
if you are obsessive-compulsive, press 1 repeatedly.

if you are codependent, please ask someone to press  2 for you now.

if you have multiple personalities, press 3,4,5 and 6.

if you are paranoid, we know who you are and what you want. stay on the line so we can trace your call.


if you are delusional, press 7 and your call will be transferred to the mother ship. 


if you are schizophrenic, listen carefully and a small voice will tell you which number to press.

if you are maniac-depressive, it doesn't matter which number you press - no one will answer anyway. 


if you are dyslexic, press 6969696969696969.

if you have a nervous disorder, please fidget with the star and pound keys until a representative comes on the line.


if you have amnesia press 8 and state your name, address, phone number, date of birth, social security  number and your mother's maiden name.


if you have a bipolar disorder, please leave a message after the beep or before the beep. or after the beep. please wait for the beep.


if you have short-term memory loss, press 9,

if you have short-term memory loss, press 9,

if you have short-term memory loss, press 9,

if you have short-term memory loss, press 9,


if you have low self esteem. please hang up. all our operators are too busy to talk to you.

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i hope Zippy doesn't see this!

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a long conversation on twitter a couple of days ago between two US emergency physicians - symtym & movinmeat, one of them with a US law degree (but not yet licensed to practice), an Indian radiologist (me), an Australian surgeon (DrCris - sorry, I forgot to add you initially) and a US internist (changu) with contributions from 2 US psychiatrists (intueri & purplesque) about the seemingly simple, Byzantine medical licensing system in the USA. it's a long conversation with 42 tweets in all. my apologies if i've left out any relevant tweets.

it all started after i read this post by Tim (aka symtym) and asked him a question on twitter.

i have some thoughts about this, which i hope to put together in another post. any comments from others medtweeps who missed the conversation are welcome.

following the twitter timeline as always, with the oldest tweet at the bottom & the newest on top...

1. changu @scanman @movinmeat @symtym what licensing fees pay 4 .» link to AMNews: May 12, 2008. Doctor disciplinary actions down for 3rd year ... American Medical News IMC do anythin comparable? about 14 hours ago from digsby
       
   
   
   
2. movinmeat @intueri "eavesdropping?" OMG I feel so violated! about 17 hours ago from Tweetie
       
   
   
   
3. purplesque @scanman Missed the entire licensure discussion, but it is insane. Not just the money, but the paperwork involved takes months. about 19 hours ago from web
       
   
   
   
4. intueri @symtym @scanman @movinmeat I enjoyed "eavesdropping" on that MD license/Constitution discussion y'all had. International forum. about 20 hours ago from web
       
   
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5. movinmeat @symtym very true. Just back from DC - great way to get the ol' patriotic/reverence for our system juices flowing again. 12:17 PM Apr 24th from Tweetie
       
   
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6. symtym @scanman so disagree, you need to read McCullough's John Adams, etc. -- they got it right despite all the lawyers, politicians, etc. 12:12 PM Apr 24th from TweetDeck
       
   
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7. scanman @symtym @movinmeat they got so much right in the 18th century coz - lesser number of politicians, laws & lawyers 12:06 PM Apr 24th from iTweet
       
   
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8. DrCris @scanman Ridiculous that we have to oppose something that we want. Like when we had republic referendum. Politics ruins everything. 12:04 PM Apr 24th from Tweetie
       
   
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9. symtym @movinmeat don't disagree, but then I'm tending to see it as amazing that the guys got so much right in the 18th century, that lasts so long 12:00 PM Apr 24th from TweetDeck
       
   
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10. scanman @DrCris there's bound to be politics / political interference in any kind of regulatory set up. 11:59 AM Apr 24th from iTweet
        
    
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11. movinmeat @symtym won't say it's good/bad, just an odd unintended consequence of particular way the gov't here formed. could have been better, though. 11:34 AM Apr 24th from Tweetie
        
    
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12. symtym @scanman most things US is one entity, but there are many aspects where we are truly 50 different states, all types of licenses r like this 11:03 AM Apr 24th from TweetDeck
        
    
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13. symtym @scanman that's what I figured, I've heard the question before, common misconception for those out of the US 11:02 AM Apr 24th from TweetDeck
        
    
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14. DrCris @scanman We are moving toward national registration in Australia (currently state-based) but the model makes medical appointments political. 11:02 AM Apr 24th from Tweetie
        
    
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15. changu @symtym @scanman is much stronger here, and India could use a lot more policing of physicians , life time licenses that s just ridiculous! 11:00 AM Apr 24th from web
        
    
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16. scanman @symtym that's what I was looking for Tim. Trying to make sense of something that is beyond me. 10:59 AM Apr 24th from iTweet
        
    
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17. symtym @scanman don't get nasty there, "lawyer" means license, don't got that, whole other set of fees...there are 50 of those as well 10:59 AM Apr 24th from TweetDeck
        
    
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18. changu @symtym I actuallly appreciated symtym's photons, didnt realise licensure , had to do with police..Also think the fed structure contd... 10:59 AM Apr 24th from web
        
    
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19. scanman RT @symtym $890/3 yrs, DEA license $551/ 3 yrs, board recert every 10 probably $1,500 < Obscene. 10:58 AM Apr 24th from iTweet
        
    
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20. symtym @movinmeat it seemed more like what @scanman was looking for, instead of "because" or "its that way" ;) 10:58 AM Apr 24th from TweetDeck
        
    
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21. scanman @movinmeat "granular level of detail" << you have to remember @symtym is a lawyer :) 10:57 AM Apr 24th from iTweet
        
    
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22. symtym @scanman mine is $890/3 yrs, DEA license $551/ 3 yrs, board recert every 10 probably $1,500 10:57 AM Apr 24th from TweetDeck
        
    
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23. scanman @symtym @movinmeat @changu regulation = control = $ << very true. And the Americans have perfected it. 10:56 AM Apr 24th from iTweet
        
    
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24. movinmeat @symtym never said it was wrong - just funny/granular level of detail 10:55 AM Apr 24th from Tweetie
        
    
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25. scanman @changu It's a lifetime licence. If u're registered in Karnataka Medical Council no one's going to stop you from practising in Kerala or TN 10:55 AM Apr 24th from iTweet
        
    
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26. scanman @symtym @movinmeat Moreover our licensing fees, which are usually for life, are a pittance. About $50 - both national & individual states 10:54 AM Apr 24th from iTweet
        
    
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27. changu @scanman there are 30 states now? I left when it was 22, am only licensed in Katnataka, prob expired now.. 10:53 AM Apr 24th from web
        
    
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28. symtym @scanman my wife has 17 RN licenses to just to do telephonic nursing; regulation = control = $ 10:53 AM Apr 24th from TweetDeck
        
    
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29. scanman @symtym @movinmeat Our states have individual Medical Councils too, but they don't usually care if u're licensed in another state. 10:52 AM Apr 24th from iTweet
        
    
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30. symtym @movinmeat @scanman at the risk of tossing more photons, for many aspect of US Gov u have 2 consider us as 50 distinct states, license = $ 10:51 AM Apr 24th from TweetDeck
        
    
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31. scanman @symtym @movinmeat And you guys complain of a doctor shortage!? *exits shaking head in wonder* 10:50 AM Apr 24th from iTweet
        
    
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32. symtym @movinmeat @scanman obviously India is more advance, or we have an older democracy (federal form of democracy) 10:50 AM Apr 24th from TweetDeck
        
    
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33. scanman @symtym @movinmeat Why should a US doctor be forced to pay 50x to practice in 50 states. Shouldn't there be a national licensing authority? 10:49 AM Apr 24th from iTweet
        
    
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34. scanman @symtym @movinmeat - If I'm licensed by the Indian Medical Council - after paying a fee once, I can practice in all 30 states in India. 10:48 AM Apr 24th from iTweet
        
    
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35. scanman @symtym @movinmeat - I understand a federal set up. We have one in India too. But don't you guys have an overall national licensing body. 10:46 AM Apr 24th from iTweet
        
    
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36. symtym @movinmeat what's your explanation for 50 licenses? 10:36 AM Apr 24th from TweetDeck
        
    
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37. symtym @movinmeat I sent him the specific Amendment, the 10th, that is responsible for all state police powers, which is the source for licensure 10:35 AM Apr 24th from TweetDeck
        
    
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38. symtym @movinmeat he asked why we have 50 licenses, it is because the Constitution guarantees that power -- specific question, specific answer 10:34 AM Apr 24th from TweetDeck
        
    
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39. movinmeat @symtym @scanman he asks about MD state licenses & you send him Constitution. That's like he if asks about rainbow & you explain the photon. 10:28 AM Apr 24th from Tweetie
        
    
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40. symtym @scanman our constitution: » link to Tenth Amendment to the United States Constitution - Wikipedia, the free encyclopedia 8:32 AM Apr 24th from TweetDeck
        
    
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41. symtym @scanman why, because we have a federalist system; the power of a general police power (nidus) is vested in the 50 states = 50 licenses 8:32 AM Apr 24th from TweetDeck
        
    
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