Letters to the Editors
I found the story about the court battle being waged against ob/gyn Marshall Klavan's physicians to be tragic. The doctors are being sued for keeping him in a vegetative state after his failed suicide attempt and subsequent stroke ["Should these doctors have let their colleague die?" Feb. 7].
Klavan is a physician. If he truly wanted to commit suicide, he would have known how to do it. Instead, he took his overdose where he was likely to be found. That suggests that this was a suicide gesture, not a true suicide attempt. Based on the newspaper reports, he was depressed and therefore not competent to make medical decisions. Prior to his stroke, Klavan was not irreversibly incapacitated.
The tragic part is that a physician couldn't acknowledge his own depression and seek treatment. Klavan's case speaks volumes about our failure both to recognize mood disorders and to work harder to remove the stigma of mental illness.
Susan Sorensen, MD
Palo Alto, CAsksorensen@email.msn.com
I don't know how many patients try to negotiate discounts with their doctors ["Okay, Doc, let's talk price," Feb. 7], but it's not legal for the doctors to grant them.
If you participate in Medicare or Medicaid, you can't charge those plans more than you charge other patients, even if the programs pay substantially less. For example, if you charge Medicare $3,000 for a surgery and receive only $2,000, you can't then charge a private-pay patient $2,000 for the same surgery; Medicare will take the position that your real fee is $2,000 and you overcharged the plan.
Sure, a doctor may write off a portion of the entire bill for patients experiencing "hardships," but this doesn't allow you to discount fees for all self-pay patients, even if you only discount down to the fee paid by insurers.
My advice: Don't negotiate individual fees unless you look good in vertical stripes.
David J. Schiller, JD
Thank you for printing the Hippocratic oath in your Memo from the Editor [Jan. 10]. It's extremely valuable for the medical profession at this time.
Hippocrates was the complete physician, whose care of patients incorporated the body, soul, and spirit. His philosophy and therapeutics could well be studied by physicians of today.
Basil B. Williams, DO
The oath makes me feel more like a physician than a gatekeeper.
I will treasure those years when I was able to examine a patient and arrive at a diagnosis without having to do extensive lab work and MRIs. I was taught that the history and physical were paramount, and the other stuff was supposed to support the diagnosis.
David O. Boyer, DO
The oath of Hippocrates means a great deal to me. When I left private practice, I began clinic work. One day I was asked to sign the clinic's mission statement. I declined, saying I had taken the only oath I needed when I graduated from medical school in 1954.
But there's another reason: Years ago, a pharmacist sent me a young Irish patient. We got along well and became friends. This woman returned to Ireland frequently, and on one occasion brought back the oath of Hippocrates that now hangs in our home. You see, she later became my wife.
John A. Best, MD
Grass Valley, CA
I like what I read in attorney David Townend's article, "Hospital peer review is a kangaroo court" [Feb. 7]. In my experience, peer review favors those groups that stick together, form the majority, and want to eliminate competitors.
Elias H. Khoury, MD
David Rullo, chief medical officer at McKesson-HBOC, is clearly biased about his company's products, computerized code audit tools, which help insurers downcode physicians' services ["Why we need code auditing," Feb. 7]. My experience with McKesson-HBOC's program, ClaimCheck, is similar to that of gynecologist David Rogers ["They call it claims processing. I call it fraud against doctors," Dec. 20].
ClaimCheck bundles codes that have been determined by the AMA to be separate billable procedures. I recently disenrolled from PacifiCare after it began using ClaimCheck, which bundles multiple sinus procedures. Unless physicians drop insurers who persist in changing the coding rules, we'll all be bundled to death.
Victoria King, MD
Cañon City, COkingtor@earthlink.net
I'd like to know how physicians and their patients react when they see major TV campaigns by managed care companies. An orthopedic surgeon looks into the camera and says how wonderful managed care is, and what a difference it has made in his ability to practice medicine. Such campaigns fly directly in the face of many articles I read in your magazine.
Wanda A. Fischer
Director, Public Relations
New York Association of Homes and Services for the Aging
Your article on medical marriages ["Doctor-doctor marriages: What makes them work?" Dec. 20] brought to mind anesthesiologist-author Richard Gordon's law, which states that doctors marry other doctors, nurses, or cocktail waitresses because these are the only women they meet.
Joseph McEvoy, MD
San Clemente, CA
With the conflicts inherent in managed care, it's time that physicians examine third-party reimbursement. The only way we can be sure that we're working for the patient is to accept payment from the patient only. Then there will be no confusion about where our loyalties lie.
I've always been amused by physicians who self-righteously decry third-party interference in their exalted judgment, while at the same time accepting third-party payments. The doctors who cry the loudest often run the biggest mills. If patients didn't have coverage, would these doctors be ordering tests? In fact, would uninsured patients even be in their offices in the first place?
Roderick T. Beaman, DO
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.
Suzanne Duke. Letters to the Editors. Medical Economics 2000;8:15.