Errors require an explanation

September 10, 2012

Medical Economics readers discuss the need to apologize for errors, the fact that sometimes advice can't change reality, and why there may be a better word than reimbursement for payer payments to physicians.

In my experience, I found that patients appreciate an explanation of a mistake, and how to correct it, much more than an apology ("Massachusetts doctors try apologizing for errors," Update, July 10 issue).

Heskel M. Haddad, MD
New York, New York

Strangers don't want advice

Why stop at smoking? Armed with this encouraging bit of evidence-based medicine that stopping and haranguing complete strangers does indeed promote global health and wellness, I am resolved to take to the streets.

First targets in my cross-hairs: those of us who are overweight. After giving my reflection in the mirror a sound tongue-lashing for noshing on that fettuccine Alfredo last night, I will take my show on the road, stopping those poor corpulent souls in line at my local Starbucks and other fast food emporiums. At a couple of parks nearby, anyone who happens to be making use of the park benches will be sternly reprimanded for being idle and told to get off their butts and get moving. We all know that exercise is good for you, whether or not you need it.

Next up: a hot pink espresso kiosk near my office where, depending on the day, I can buy coffee from a pretty miss younger than my daughter dressed as a vampire vixen, Little Bo Peep, or a candy striper. It is downright demeaning to women and promotes objectification of them, leading to all sorts of problems. Surely Little Bo Peep would be happy for me to tell her to put on some clothes and get a respectable job, perhaps even in Dr. Waltman's office.

And how about all those sad sacks walking around with flat affects who clearly are depressed? Depression is such a debilitating illness. They need to snap out of it, sing a happy song, and get started on a selective serotonin reuptake inhibitor right away. Heck, I might just dole out a few samples to get them started.

I am upset that I cannot pinpoint people on the street who have hypertension, but I can venture a good guess that those folks throwing back their fourth pint at happy hour may well be on their way to metabolic syndrome. Better put an end to that sort of nonsense right away as well.

Excuse me a sec. Just had to stop long enough to see a patient, which would be defined as someone who comes to see me and enters the doctor-patient relationship, not a complete stranger I may bump into out there in my day-to-day life. He is a nice guy, this patient of mine. Only 38 years old and his wife is dying of metastatic colon cancer. Maybe someone should have stopped her in McDonald's and told her to eat less junk food and more veggies 10 years ago. Oh, and to get one of those full body scans at age 25. Any way you slice it, she is sick and dying. My patient is managing the best he can. He has taken a spare job to help with the expenses. He doesn't smoke or drink. But if he did, he probably would not be particularly receptive to a stranger at the airport launching into a personal no-smoking campaign.

STEVE DUDLEY, MD
Seattle, Washington