Letters to the Editors
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The "Re-engineering your practice" series extols the benefits of information technology in the office. As an "older physician," it occurs to me that the time left to amortize expensive technologic improvements may be insufficient to justify large layouts of money. It also seems unbusinesslike to recommend across-the-board investments without analyzing revenue and expense projections.
In highly managed care areas like mine in California, practice value has dropped to zilch, so there isn't much chance of finding a buyer to bail out the doctor who decides he or she has had enough and who still owes money for new information systems.
Older doctors like me also have older office staffers who have not proved proficient with the newest technology. I can't afford more staff, and I don't want to replace employees who have given years of loyal service and who know my patients well.
Technology doesn't exist in a vacuum. Let's hear more about my concerns.
Philip R. Alper, MDBurlingame, CAphilipa@itsa.ucsf.edu
In the 30 years I've been a doctor, I've witnessed enormous advances in test accuracy, treatments, and outcomes. At the same time, the changes in health care deliveryfrom the doctor-patient focus to managed care's insidious financial emphasishave rattled all health professionals. Combine that frustration with the increasing numbers of under- or uninsured patients, the growth of managed care organizations, reduced Medicare payments, and the aging population.
Despite declining reimbursements, we're expected to deliver service as usual in terms of safety and financial efficiency. Yet administrators have been attempting to control costs by cutting nursing staffs and support personnel. Physicians may be central to health care, but nurses provide compassionate delivery of our directives. Who will care for patients when nurses retireor quit for less demanding, more lucrative work?
On a recent flight, I was settling into my seat when a middle-aged man sat down, answered his cell phone, and stated, "I have six patients in the hospital."
Everyone in the immediate vicinity was treated to five minutes of confidential patient information: first and last names, including the spelling; the hospital they were in; and their symptoms, diagnoses, and medical histories. The culprit made no effort to modulate his voice.
I always try to give others the benefit of the doubt, but I couldn't rationalize this physician's behavior.
I see articles in medical publications bemoaning the erosion of the doctor-patient relationship due to the fear of malpractice actions, managed care, treatment protocols, allied health professionals, alternative medicine, and the Internet. I don't mean to imply that many doctors would behave with this fellow's indifference. But the five-minute incident I witnessed that day probably did more to diminish respect for doctors in the minds of the people who heard that conversation than any of those other factors ever could.
The doctor depicted at the wheel of a convertible in our Feb. 19, 2001, issue is John A. Turner, MD, not John C. Hagan, MD.
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Gail Weiss. Letters to the Editors. Medical Economics 2001;6:14.