One day William Martinez, an Atlanta police officer, decided to engage in sexual activity with two other people at an airport hotel. He suffered a myocardial infarction during the activity and died.

Martinez had been having symptoms and been evaluated by a cardiologist. His wife, who was not one of the sexual partners, sued claiming that her husband should have been warned about strenuous activity.

It turns out there were 12 idiots willing to agree with the ridiculous premise and award Mrs. Martinez $3M. They found the physician and his group 60% responsible.

Dr. Sreenivasulu Gangasani offered testing to Martinez for the day after he saw him. Martinez instead decided to schedue the stress testing for the day after he had his sex fiesta planned. Martinez also had a long standing history of not following physician instructions.

Patients do not listen to their doctors on a daily basis. This is especially true for young patients. I have almost come to expect most of my inflammatory bowel patients to become non-compliant with therapy at some point. It is hard to blame a young person who has other things on their mind.

A case like this one in Atlanta comes up every few months and makes physicians shake their heads. Are we supposed to follow our patients around and make sure they do not do anything bad for them?

Medicare seems to think that should be the case. They want programs to penalize doctors financially if their patients' diseases get out of control. Are we supposed to go to every diabetic's house and remove the twinkies? I know, we should set up checkpoints at hotels so cardiac patients do not engage in threesomes. Perhaps the American Medical Association (AMA) needs to start the lobbying now.

It would appear the AMA is too busy making sure doctors do not have to be held to standards. Recently, the AMA came out against board-certification being a standard for licensure.

It gave me flashbacks to a discussion I had with a doctor in town about continuing medical education(CME) where he was appalled. I told him CME was lacking in any legitimate standard of measurement. So he sniped at me, "What do want, board-certification to be needed?" I retorted a quick, "Yes."

Alaska requires 50 hours of CME a year but there is no way to know if any of the knowledge actually enters into the intellectual weaponary of the physician. There have been efforts to make CME providers more accountable for showing their CME is effective but nothing is out there that shows a physician is more effective. That is unless you look at the recertification process where someone has to retest and prove their knowledge.

Board-certification is used by hospitals and health care plans as a measurement. And much like board-certification itself grandfathering has protected many physicians from having to certify. There is variability in standards between desperate rural hospitals and urban hospitals. There is even variability among Anchorage hospitals.

There is no logic being applied when a physician 10 years out of training has to re-certify while one 30 years removed does not. It seems many doctors would just like to be like lawyers and pass the Bar Exam once and be good for life.

The AMA's argument is that if board-certification is used it will mean worsening physician shortages. There are presently about 850,000 physicians in the United States and 200,000 of them are not board-certified. This is in a situation where projections are there will be a shortage of 130,000 physicians in 2025.

The AMA also feels that the various credentialing processes whether it be licenses or credentialing done by private organizations are cumbersome. They do have a point as any physician who fills out the various applications will attest.

Legitimate arguments can be made that board-certification is not a guarantee of anything. It is merely a test much like any other standardized test. All it does is give a spot check of knowledge. There is no better way to test knowledge than standardized testing even with its imperfections.

I do not practice internal medicine (IM) but every gastroenterologist has to be board-certified in IM to take the gastroenterology exam. I recertified in IM in 2007. I had no problem with the test and it scares me that there are practicing internists out there who fail the exam. No IM physician who practices regularly should fear the exam.

It is ridiculous to think requiring 50 hours of CME every two years even comes close to the standard set by board-certification. It exposes a flaw in the way states evaluate how physicians maintain their knowledge.

The AMA should be out there promoting a process that tries to establish quality in physicians. The opposition to states using board-certification goes against that practice. It also makes it difficult for the profession to stand against the inappropriate behavior of our colleagues in the legal profession.

Is it any wonder the AMA only represents 17% of physicians?

Willie Nelson likes to sing about mothers not allowing their kids to grow up to be cowboys. They should be doctors and lawyers and such. Maybe it is time we start practicing processes that make the advice worthy.