In "How patients' emotions can unlock a diagnosis" [March 19], GP Patricia Elliott's central message is in her last sentence: "Perhaps the best thing you can do for each patient is to understand how the stress factors in his particular life are affecting his health, and, after covering all the bases physically, to offer a healing dose of compassion."
As a psychiatrist, I wonder why it never occurred to Dr. Elliott, or any of the five doctors she described, to refer their patients to a psychiatrist. It's a big mistake to assume that psychiatric knowledge does not exist in the medical profession as a help to patients.
Edith M. Jurka, MDNew York City
Patricia Elliott is to be commended for advocating treatment of the "whole" person.
Unfortunately, there's little room for this type of involvement in many doctors' practices. Life is hard, and so is medicine. A few words of kindness and sympathy are always in order. But according to my dictionary, compassion encompasses not only sympathy, but a desire to alleviate another person's distress. If doctors were to really feel the tragedies that occur in daily practice, they couldn't make it through the day.
Evelyn W. Bradford, JDWaynesboro, PA
As a taxpayer and physician, I think doctors need effective unions and the right to bargain collectively. Physicians have not fought hard enough for this.
Lawyers and judges should not be permitted to advocate a mode of payment that they would not accept for themselves. Imagine if LMOslitigation maintenance organizationsdetermined when, where, and how much lawyers were paid. Certainly a lawyer's fee ought to vary with the type of defendant, rather than with how much time and effort he puts into the case. Who better to dictate that fee than the LMO?
Consider the morass physicians encounter when coding for physician assistants, nurse practitioners, and the like. Why should we pay an attorney a full fee when three-quarters of the work is done by a paralegal?
Physicians who argue against unionization should be willing to accept the alternativesunjust laws and enslavement by managed care. If there is a legitimate advocacy group that's committed to fighting for our right to bargain collectively, I'm ready to support it.
Robert A. Wymer, MDAustin, TXrwymer@mwr.is
While it's encouraging to learn that physicians have eliminated the oppressive all-payers policy of some managed care companies, the onerous referral system remains in place.
This system serves no real medical purpose. It is, however, quite effective in driving a wedge between physicians and their patients, as well as between primary care doctors and specialists. It also enables managed care companies to deny or delay payments.
Physicians need to unite and demand that the referral system be dismantled. The millions of dollars saved could be spent on patient care or quality assurance.
I plan to present such a resolution to the Medical Society of New Jersey. I call upon the AMA and other physician organizations to take similar action.
Roger Thompson, MD Middletown, NJ
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Gail Weiss. Letters to the Editors. Medical Economics 2001;11:8.