I read with interest internist Mary Ann Bauman's article tracking her day ["What would make your day perfect?" Jan. 22]. As a solo general internist, I found many of the suggestions regarding control of scheduling, telephones, paperwork, and so forth to be absorbing and helpful.
Calls from the hospital during office hoursespecially from myriad discharge planners, case managers for various health plans, and even medical directorscan be very disruptive. When you add the calls from nursing homes, pharmacies, and home health nurses, one could easily spend the better part of the day on the telephone.
Joseph W. Clift, MDOakland, CAjwc14030@aol.com
The Feb. 5 letter complaining about "lumping" preferred provider organizations with HMOs ["PPOs are not 'managed care' "] is off the mark. Splitting the hairline differences between HMOs and PPOs is tantamount to differentiating between the pit vipers Agkistrodon contrortrix (copperhead) and Agkistrodon piscivorus (cottonmouth): An interesting exercise, but for what aim, as both are venomous?
Joseph R. Dombroski
The Office of Robert T. Cook, MD
In a letter to the editors [Jan 22], Spencer Kulick complains that by using a sketch of an assault rifle to illustrate an article about guns, you "make people who know nothing about guns think of them only in terms of 'bad' guns."
Please tell meor, rather, have Dr. Kulick tell us all: How do you define a "good gun"?
Sidney Grau, MD St. Petersburg, FL
Andrew A. Johnstone's "Why Barbara carries a gun" and Timothy W. Wheeler's "I'm a doctorand a gun owner" [Memo from the Editor's Guests, Feb. 5] were welcome breaths of fresh air.
What most people don't understand about our Second Amendment is that it prevents deaths. American mass murderers take a few guns or bombs and kill people by the tens or hundreds. Foreign mass murderers disarm a population, then take over the government and kill by the thousands or millions.
A comparison of the Littleton school killings or the Oklahoma City bombing with Auschwitz, Tiananmen Square, the Gulag, or Pol Pot's "killing fields" reveals what a disastrous idea gun control is.
B.J. Bett, MD Woodbridge, VA
I completely support Johnstone's and Wheeler's viewsespecially Wheeler's assertion that the only universal deterrent to violent crime is the perceived capacity of the potential victim to retaliate.
Lin Church, MD Raleigh, NClchurch@mamsi.com
I was surprised that no other views about gun control accompanied those of the Editor's Guests. Their support for unfettered gun ownership is symptomatic of our society's fascination with violence and the tools of violence.
I belong to Physicians for Social Responsibility (www.psr.org), an organization that views gun violence as a public health issue. For example, in the United States guns account for more than 17,000 suicide deaths each year. In 1998, 2,510 people between the ages of 15 and 24 committed suicide by using a gun. Many incidents of children accidentally killing themselves or other children are attributable to privately owned guns. Firearms are also significant instruments of domestic violence.
Guns should be registered, and owners should be licensed. We do this with cars, and guns are far more lethal than automobiles.
Thomas C. Washburn, MD Bradenton, FLktwshbrn@gte.net
"Some are meant to lead. Maybe you" [Jan. 22] cites the advantages of doctors' earning an MBA degree. Unfortunately, most MBA programs are designed for full-time students or professionals with schedules far less demanding than a physician's.
Regis University provides a multimedia online MBA program developed exclusively for physicians. It is designed to enhance physicians' leadership skills, expand their knowledge of the latest business methods, and broaden their understanding of the economic forces shaping health care today. There are six sessions per year. No classroom attendance is required. With online audio and video lectures available around the clock, physicians can set their own study schedule and "attend class" anytime. An added benefit is that CME credits are earned with each course.
For more information, call 877-370-2091, or e-mail email@example.com.
Thank you for the strategies outlined in "Leaving practice, but not the profession" in your Career Guide [Feb. 5]. I also found that issue's Web exclusive, "Where to go for help: Your career resource guide", very useful. It's an important source of information for doctors, like myself, who are going through a career transition.
The entire process has reawakened my interest in using the clinical skills acquired during my 18 years of "seasoning" as a family practitioner.
Michael Kirwin, MD Hilliard, OHmkirwin@columbus.rr.com
In your article describing hospitalist Mark L. Wesselman's duties ["Go on roundsin a hospitalist's shoes," Feb. 19], I was struck by the section where the services of a PA were needed for a procedure.
As a trainer of family physicians, I have opposed the hospitalist concept from its inception, and encourage our residents to continue caring for their inpatients despite the economic pressures to do otherwise.
Recently, a patient from my HIV practice was admitted via the ER to another hospital in our community with a diagnosis of pneumonia. When I tried to reach the attending from the internal medicine group that was in charge of his care, I found myself speaking to a PA who was rounding that day.
I have worked withand highly regardPAs and NPs. But I wonder if their increased presence in hospitals is in the best interest of our sickest and most vulnerable patients. What about continuity of care, and the therapeutic value of a strong doctor-patient relationship?
Jeffrey T. Kirchner, DO
Family Practice Residency Program
Lancaster General Hospital
Address correspondence to Letters Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742. Or e-mail your comments to firstname.lastname@example.org, or fax them to 201-722-2688. Include your address and daytime phone number. Letters may be edited for length and style. Unless you specify otherwise, we'll assume your letter is for publication. Also, let us know if you don't want your e-mail address printed with your letter.
Gail Weiss. Letters to the Editors. Medical Economics 2001;7:11.