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We were surprised by the comments attributed to Bruce W. McIntyre, general counsel of Rhode Island's Board of Medical Licensure and Discipline, in the article "Shaping your profile on the Web" [May 7]. He is cited as suggesting that the Rhode Island Medical Society used political muscle to compel the board to use ISO (Insurance Services Office) codes rather than American Board of Medical Specialties classifications as the framework for comparing physicians' professional liability histories. [The former puts physicians of different specialties into "risk categories"; the latter compares physicians only with other doctors in the same specialty.]
In fact, our role was to assist the board in designing a method to implement the Rhode Island profiling law. According to the law, the basis of comparison is not to be similar procedures or patients, but similar risk.
We believe that the only way to comply with this law is to use the well-established system of comparative risk categories established by ISO. This system, in addition to being fair to doctors, offers meaningful comparative information to the public on a physician's liability history. After all, insurers stake their livelihood on measuring risk and keeping abreast of changes. ISO may not be perfect, but nothing else comes close to it in accuracy.
Newell E. Warde
Executive Director, Rhode Island Medical Society
Your May 21 Practice Beat item "Wasn't e-medicine supposed to cut down on paper?" leads the reader to believe that patients must activate MDHub in order to contact medical practices listed in The Little Blue Book. This is not true. In fact, with MDHub, any patient can contact almost any (practicing) physician via the Internetat no cost to the doctor. A doctor's access to his own electronic "in-box," however, is available only upon activation with user name and password, for obvious security reasons.
MDhub is not simply a patient-to-doctor fax service. Virtually every practicing physician has a personalized Web site (or message center, as we prefer to call it) up and running. Nearly every practicing physician is included in The Little Blue Book database and, therefore, nearly every practicing physician has a personalized MDhub message center.
Jerry Spitz, MD
Chairman and founder, National Physicians DataSource
Your response to the March 19 Practice Management question about a physician's liability for a nurse anesthetist ["When a hospital lacks a specialist to give anesthesia"] was surprisingly wrongand potentially damaging to rural heath care throughout the United States.
It has been well established in US courts that a surgeon's liability for an anesthetic mishap depends on the facts of the case and the extent of his involvement in the anesthetic process, not on the credentials of the individual providing the anesthesia.
Doctors must develop working relationships with competent anesthesia providers, whether they're CRNAs or anesthesiologists. To transfer patients to another facilityas your consultants suggestis not in the best interest of the patient or health care facility. When a good rapport exists between surgeons and anesthesia providers, the latter can work in a wide variety of facilities without jeopardizing quality of care or patient safety.
N. Leon Books, MDSteven R. Wooden, CRNABroken Bow, NE
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Gail Weiss. Letters to the Editors.