"Where a war on doctors has already begun" [July 9] depicts an E-Class Mercedes with the license plate FED UP DOC. The article itself speaks clearly to our feelings, though none of us drives a Mercedes.
We are a group of surgeons who have been on the front line of the malpractice insurance crisis in West Virginia. As a result of soaring malpractice premiums, one of us has accepted a position in Texas, and the other two are looking for opportunities outside the state. As much as we'd like to remain in West Virginia, it's doubtful that we can.
Ronn Grandia, MD
Michael Hall, MD
Bruce Hoak, MDSouth Charleston, WVhoakhallgran@newwave.net
"Online prescribing: How one doctor got caught" [June 4] details the Arizona medical board's decision to discipline a doctor for approving online drug orders without seeing the buyers. In my opinion, it's the medical boardnot the doctorwho got "caught."
The real issue is not the appropriateness of authorizing prescriptions online. It's the medical board's attempt to control and regulate the Internet. The medical community must decide how to revamp the outdated regulations of traditional medicine and allow for global access to a variety of medical resources, including online prescribing.
Patients who use the Internet for prescriptions and other medical services should be the judges of whether they are receiving adequate care.
Jaroslaw J. Fedorowski, MDPlattsburgh, NYjjfedorowski@pol.net
Your advice on how to terminate difficult patients ["You'd better be able to answer these legal questions," June 18] reminded me of my own infrequently needed method. I arrange a no-charge visit during which I tell the patient that we haven't seen eye to eye and he deserves better than a physician with whom there is conflict. If the patient still isn't convinced, I add that I'd rather have his friendship than his money.
Those who've left the practice this way have done so without anger, and without my having to wince the next time I run into them in public.
Philip R. Alper, MDphilipa@itsa.ucsf.edu
Over the past few months, I have read several articles about how Aetna is becoming more physician-friendly. So I was surprised when, after our IPA folded, I received my individual contract.
Not only was the reimbursement rate 15 to 20 percent below community standards, but there was a clause stating that Aetna can change reimbursement at any time without physician consent. (Any guess which way it will go?)
The final insult was Aetna's insistence on dictating coding practices, per-hour volume of patient visits, and appointment schedules! When my contract negotiator contacted an Aetna representative, she was told that the company does not negotiate. Apparently, old habits die hard.
James A. Zimmer, DOColorado Springs, CO
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