Letters to the Editors
My 7-year-old happened to be looking at the Jan. 24 cover featuring a blueprint for the story "Re-engineer your practicestarting today." He brought it to me and asked why the blueprint didn't have a bathroom. This younger generation continues to amaze me. I couldn't interpret plans until I built my house.
Kevin Wong, MD
I'd like to update your article about the independent practice association debacle in California ["The California nightmare: Is this where managed care is taking us?" Jan. 24].
On Feb. 3, the financially troubled Mission Valley IPA in Lompoc, CA, filed for bankruptcy, which will leave area specialists with about $1 million in unpaid work. I'm one of the few Lompoc doctors who never joined the IPA.
Local politicians are talking about patient protections within HMOs and making IPAs more financially stable. Instead, I think we should promote alternatives to HMOs, such as medical savings accounts combined with indemnity insurance.
Lawrence S. Riemer, MD
I'm responding to physician Michael McShan's comments [Letters to the Editors, Jan. 24] suggesting that midlevel providers will not surpass physicians. As a primary care physician assistant for more than 22 years, I'd like to think I'll continue to occupy a prominent role in the health care delivery system.
Midlevels canand dosee as many patients as physicians, and, as recent studies conclude, do an equally creditable job. Though our scope of practice may not be as broad, we can evaluate psychiatric and physical disorders, and in most states prescribe medication.
The physician is the leader of the health care team, but there's room for the well-trained midlevel provider to dispense what continues to be excellent care.
Ralph J. Marsala, PA-C
The most impressive adjustment former New York internist Daniel Buff made when he moved to Israel, well beyond having to study pediatrics, was understanding Hebrew ["From specialist to generalist: Nothing comes easy," Feb. 7].
Not only did he learn it, but he mastered it well enough to see patients without a translator. Compared to Hebrew, pediatrics is a piece of cake. Kudos to Buffor, rather, mazel tov.
John Barchilon, MD
Woodland Hills, CA
I found your collection of vignettes about doctors who have been practicing for decades both fascinating and heartwarming ["Still practicing after all these years," Jan. 10].
There are two essential qualities that these outstanding physicians share: They take their time in treating patients, and they realize that in many cases, the presenting symptoms aren't the real problem. By taking the time to ferret out what's truly bothering patients, they're able to be of help. That personal satisfaction has kept these doctors practicing for so many years.
Because of changing economics, today's doctors don't have the luxury of time to treat patients. This loss of control leads to depression, a condition that's epidemic among physicians. The real tragedy is that doctors are in denial and don't seek help, so their problems worsen.
Physicians should be required to undergo comprehensive annual examinations before their medical licenses are renewed. It's my guess that an incredible number of serious mental and physical ailments would be detected.
Herve Byron, MD
Englewood Cliffs, NJbyronmd@rcn.com
Physicians who wonder whether it's professional to join a union are in the wrong century ["Doctor unions: Time to join the parade?" Jan. 24].
At first, doctors didn't believe that the bloated greed of for-profit HMOs would delay or deny care to the extent that people would die. They thought that reason would prevail. They didn't understand the degree to which executives' profit and shareholders' wealth would subvert health care.
My union promises to improve doctors' working conditions and the circumstances under which care is allocated and provided. That's why we're riding the crest of a jihad, and why doctors are joining real unionsnot flocking to the ersatz one formed by the AMA.
The prevailing wind is the one blowing from the bloated cheeks of mismanaged care. Luckily, the same hot air also carries our music high in the sky to doctors everywhere and to their patients, too. That's why the answer to your title question is an emphatic Yes.
Robert L. Weinmann, MD
PresidentUnion of American Physicians and DentistsOakland, CAuapdhq@aol.com
While you continue to give ink to the short-lived efforts by a small faction of physicians to establish a union, you ignore the growth of doctor leadership that has taken place during the last several years, even before the AMA sent its legal team to support physician unionization.
Here at Rockford Health System, for example, there's a strong commitment to physician leadership at every level of governance. I have the honor of being the first physician chairman of the board of directors in the health system's 100-year history. Seven of 17 board members are physicians. In the last several months we've created policy boards, each of which has 50 percent or more physician membership. And there were more than 30 doctors involved in the recent redesign of our physician compensation program. Since Rockford involves physicians at every level of decision-making, most doctors here don't need union representation.
Joseph R. Whiteley, MD
Chairman, Board of DirectorsRockford Health SystemRockford, IL
The physicians Leslie Kane interviewed in her article on home gyms ["A home gym you'll actually use," Dec. 20] seem to subscribe to the high-tech fallacy that they'll lose weight faster and endure less sweat and work if they just buy the right stuff.
The first thing that a physician needs to achieve better health is the right mental attitude: Just as financial planners advise paying oneself first, we need to schedule 30 to 45 minutes three to seven days a week for fitnessas we so routinely advise our patientsand stick to it!
Once that commitment is made, there are many waysseveral of them much lower on the gadget indexto skin this cat. For women, I recommend Miriam Nelson's Strong Women Stay Slim, which advocates weight training for women to improve metabolic rate and bone mineral density. I use a set of free weights (about $30) and a series of tapes called The Firm, which mix weight training and light aerobics. I do this workout early in the morning and fulfill my commitment to myself.
Am I slim yet? No. But I feel better, look healthier, and have a commitment for life, not just until my delight in the newest toy dissipates.
Patricia L. Raymond, MD
Chesapeake, VA PatRaymond@aol.com
As an exercise proponent, I found your article useful and accurate. However, I would make one comment on the photo of internist Paul Reinbold on page 93. I hope he doesn't do the now outdated behind-the-neck lat pull; it has been shown to result in neck and shoulder strains. The front lat pull is now accepted as a safer alternative.
Robert L. D'Agostino, MD
It seems that in America we demand clear-cut explanations for everything. We dislike things that don't make sense and can't be fixed. We have to be able to understand why the April 1999 shootings in Columbine, CO, happened, for example. We also figure that this tragedy has to have been someone's fault, so we look for someone to blame. I understand the compulsion; it reminds me of times during my career as a pathologist when a clinician or a family member had a hard time accepting an inconclusive autopsy.
We pathologists revel in cases where an autopsy reveals a cause of death that was unknown to the deceased's physicians. We've satisfied their desperate need to know, and given them information that they can use to improve care for future patients.
There are other cases, however, in which competent pathologists perform thorough autopsies, but the cause of death remains a mystery. Pathologists, clinicians, and relatives often speculate on what killed a patient, but in some instances we'll probably never know for sure why a patient died.
Similarly, we can't always assign blame when tragedies strike. This is true whether one accuses an airline pilot, plane manufacturer, internist, pediatrician, the psychiatrist who saw Eric Harris [one of the Columbine gunmen], or a parent who "should have known" that pipe bombs were being manufactured in the garage.
We've got to realize that some bad things are beyond our comprehension. We can't nownor will we ever be able toreduce the unknown to zero.
Kent Bottles, MD
Your Washington Editor, Michael Pretzer, tells us that the biggest problem facing American health care is that 44 million people are uninsured [Washington Beat, Jan. 24]. Though it may be socially repugnant to challenge such a notion, I must. Otherwise, we succumb to Mao Tse-tung's technique of making truths out of opinions simply by repeating them often enough. Here are my opinions:
What I find most annoying is that organized medicine's solution involves more and bigger government. Instead of that, we ought to encourage charity among doctors by giving them tax breaks. The recipient might find charity demeaning and inefficient. But what's more demeaning and inefficient than watching federal and managed care bureaucrats expand their systems to deliver care to the uninsured?
Calvin Ennis, MD
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Suzanne Duke. Letters to the Editors.