Letter: Readers comment on Medical Economics stories

March 25, 2011

Letters discuss the relationship between primary care physicians and specialists, electronic health records, solo practice and patient perspective on physicians.

Patient trust matters most

Terry Nye, MD, FACP, addresses a lot of key issues regarding the relationships between specialists and primary care physicians ("Seeing all doctors as equals," January 25 issue). The bottom line: It's not about us and our egos; it is about what is best for the care of our patients.

That being said, I am a family medicine doctor who takes pride in caring for people from newborns to geriatrics, with every subspecialty thrown in the mix. I enjoy the management of irritable bowel syndrome from the gastroenterology field, hypertension and hyperlipidemia from the cardiology field, asthma and COPD from pulmonology, migraine headaches from neurology, BPH and OABS from urology, type 2 diabetes and hypothyroidism from endocrinology, osteoarthritis and joint injections from orthopedics, eczema and mole removals from dermatology, menopausal syndrome and women's health from gynecology, and a dizzying array of mood disorders from psychiatry. That was a brief list, believe it or not.

Point being: We primary care doctors don't have to bow to anyone. It seems to me that a lot primary care doctors have an inferiority complex that is self-perpetuating.

I see my colleagues "punt" cases to specialists at the drop of a hat and just throw their hands up. Do they want to just see head colds all day? Do they have no clinical acumen, or is it just laziness? No wonder a lot of specialists take the attitude as delineated by Dr. Nye. He is right in saying that we should leave no stone unturned and provide the workup and information that the specialist needs to act quickly and efficiently. Indeed, they should correspond back to us in a timely manner, as it is a two-way street.

Dr. Nye is clearly not enthused about midlevel providers. I agree wholeheartedly, and I am glad that the group I work with is now only composed of physicians. However, it seems to me that a lot of primary care groups employ midlevels to improve their bottom lines. Why shouldn't an orthopedist have a physician assistant to manage the mundane ankle sprain case sent by the internist, or the pulmonologist have a nurse practitioner assess the run-of-the-mill asthmatic patient sent by the family practitioner? Who are the guilty parties here?

Indeed, we should offer each other mutual respect as physicians. As Dr. Nye wrote, if you're not happy with the relationship with a certain specialist, let it be known. If things don't change, then turn off the flow of referrals.

Changing the attitude of the insurance and pharmaceutical industries is a larger issue, but do you really care that ads refer to "providers" instead of "doctors?" Are doctors' egos that fragile? Personally, I prescribe generics as much as possible and could care less what the ads say. My patients respect my professional opinion as their "doctor," and they know that I have their best interests at heart.

The bottom line is, we should all practice as if we only have our black bag, stethoscope, and our wits to rely on. Hold your head high and relish the tremendous responsibility and trust that is given to us by our patients.

MARTIN KLEIN, MD
Flemington, New Jersey