Letters to the Editors
Hooray for FP Joseph Hurst! He stopped to aid victims of a car crashon his way home from a family outing. I thought I was alone in the medicalcommunity in believing we should act on what is right, rather than out offear for our own comfort or liability ["How could a doctor not stopfor this car crash?" Oct. 25].
Several years ago, I had a similar, though less traumatic experience.I was working at an urgent care center when a man came in hollering forsomeone to help his father. I ran outside and found an 80-year-old havingan asthma attack. His son was driving to the hospital, but stopped at ourclinic because he was afraid they wouldn't reach the ER in time.
I called for the crash cart, laid the man on the sidewalk, and startedCPR. The monitor indicated flat-line, but in between breaths we were ableto shock the man's heart back into sinus bradycardia. I couldn't intubatethe man before paramedics got there, in part due to the stiffness of hisneck and my own inexperience. He later died at the hospital, but at leastwe had gotten him that far.
The next day, I presented the case to my colleagues. They unanimouslyagreed that, for medicolegal reasons, they would have waited for the manto be brought inside. But none criticized my decision to treat him on thesidewalk. If I had to do it over, I'd do the same thing. I sleep well knowingI did everything in my power to try to preserve a person's life, regardlessof circumstances or outcome.
David H. Stern, MD
A physician roundtable discusses what to do when siblings quibble overa "do not resuscitate" order for their 87-year-old mother ["Whoreally has the last word on a DNR?" Oct. 11].
As physicians, it's our duty to make the best decisions we can for ourpatients. We choose which X-rays to order, prescribe drugs, and decide whetherto operate or not. Why, then, when it comes to end-of-life issues, do wesuddenly defer to families, courts, hospital administrators, and religiousgroups who do not have the knowledge and skill that we have?
Kim Elliott, MD
The bitter complaints against Aetna [Letters to the Editors, Oct. 11]all came from physicians who have voluntarily surrendered their autonomyto HMOs and are now unhappy with the results. No one held a gun to theirheads while they signed managed care contracts. Doctors are now learningthe consequences of ignoring the words, "Go to bed with dogs, and you'llwake up with fleas."
The only hope for our profession is to resign from managed care and stopallowing ourselves to be pawns in someone else's chess game.
John Lary Jr., MD
Your interview with Aetna's executives revealed the HMO's philosophyof administering health care and its relationship with network doctors.
The insurer's real problem, however, isn't addressed in the interview.You should have asked the Aetna executives: (1) How can you take an inadequateamount of money, spend a part on promotion, company operation, claims processing,and drugs, and still have enough left to buy medical and hospital care foryour insureds? (2) How can you allow the marketplace to drive down premiumsto the point where you can't deliver adequate service, just because yourcompany wants to stay in business at any price?
Warren J. Lieberman, MD
Ken Terry cautions that there's a steep learning curve for doctors whouse voice recognition software ["Instant patient recordsand all youhave to do is talk," Oct. 11]. But some programs just aren't readyfor professional use.
I bought the professional version of Lernout & Hauspie's voice recognitionprogram for $159. Since it wouldn't work on my Windows NT operating systemat home, I took it to the office. The recognition was so poor that it wouldhave been easier to type my notes rather than correct the program.
At the same time, dealing with the company was worse than wrestling withits software. It wouldn't answer my e-mail, wouldn't let me return the program,and wouldn't issue a refund. A tech even said I shouldn't expect the programto work on NT. I gave up and reported L&H to the Better Business Bureau.
Elizabeth Korte, MD
Paul McNulty, vice president of Lernout & Hauspie's PC ApplicationsGroup, responds:
While the lack of technical detail makes it impossibleto specifically address Dr. Korte's experience, her comments suggest thatshe may not have used the right tool for the job at hand. It's importantthat users purchase the application that's customized for the work theyexpect to perform. We offer another product lineVoice Xpress for Medicinein14 versions, each customized for a different medical specialty, and eachdesigned to handle the complex vocabulary that characterizes most medicaldictation. What's more, our products do run on Windows NT systems,and we do accept returned software.
Neurologist Randall Hawkins contends that "transcriptionists regularlymess up notes." As a transcriptionist, I disagree.
If Hawkins had to look up the name of a rarely used, hard-to-spell medicationbefore he dictated it, why couldn't he spell it for his transcriptionist?Then he wouldn't have to look it up again, because it wouldn't be misspelledon the report. Our office must be fortunate. If our pathologists dictatea bizarre word, they spell it for us. It beats being interrupted later forthe proper spelling.
Medical Secretary, Pathology Department
Morton PlantHospital,Clearwater, FL
Perhaps the greatest Medicare fraud is committed by the carriers themselves.Yet, there are almost no investigations of Medicare
For example, I have received checks from Medicare that should have goneto my patients or other physicians; I'm a dermatologist and don't even participatein the program. In addition, Medicare has reimbursed my patients for cosmeticprocedures, which it definitely doesn't cover.
If I've received my share of illegal payments, how much money does Medicaresend out illegally to other physicians and patients?
Richard B. Swint, MD
In "Your Financial Guide 2000" [Nov. 8], we incorrectly identifiedJacqueline C. Tuttle as an MD. She is a DO. We regret the error.
Address correspondence to Letters Editor, Medical Economics magazine,5 Paragon Drive, Montvale, NJ 07645-1742. Or e-mail your comments to email@example.com, or fax them to 201-722-2688.Include your address and daytime phone number. Letters may be edited forlength and style. Unless you specify otherwise, we'll assume your letteris for publication. Also, let us know if you don't want your e-mail addressprinted with your letter.
Suzanne Duke. Letters to the Editors.