Thumbs down on a Medicare defender, CME: Where's the beef? When a coroner performs the biopsy
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"I was wrong. Medicare is great" [May 10] is a sad commentary on a doctor finally beaten into submission by "the system."
Instead of making a case for the benefits of being a Medicare provider, general surgeon L. W. Ghormley shows us how the years slowly eroded his resistance to government intrusion: Forced into Medicare as the young folks moved away, Ghormley learned to knuckle under. He stood by as the entitlement mentality encouraged his patients to take advantage of him, cashing their benefit checks instead of signing them over to him. He paid a fine he didn't owe and agreed to change his specialty classification from general surgeon to general practitioner to avoid insurance hassles. And most pathetic of all, he eventually discovered a new "right" to health care by government entitlement.
It's truly sad to see the fight go out of a person. At one time Ghormley was an articulate spokesman for an efficient, market-driven, patient-involved system. Now he's just a government employee.
I couldn't agree more with family physician William T. Sheahan's criticism of CME lectures ["The way I see it: CMEZZZZZZZzzz, Apr. 26]. When I take time from my busy family practice to attend a CME course, I expect to learn how to make the best choices for my patients. My diabetic patient doesn't care which drug molecule binds to which receptor. He just cares that he doesn't go blind or lose a limb. My hyperlipidemic patient doesn't care if I can explain the enzymatic process involved in lipid transport. What matters is the "clinical pearls" I bring home that could keep her from keeling over from a heart attack.
Certainly, I need to have a basic understanding of how a class of drugs works, but two slides can show me that. Lecturers should use their limited time to present real-life scenarios and compare treatment options. I can't tell you how many expensive but worthless CME programs I have attended over the years. Kudos to Dr. Sheahan for pointing out that it doesn't have to be that way.
As a forensic pathologist, I found it odd that the costs of baby Kayla's autopsy had to be borne by her grieving family ["Malpractice: Why I would have sided with the plaintiffs," May 10]. Her sudden, unexpected death was clearly a case for the medical examiner and, as such, there is no charge for an autopsy, even if it requires sophisticated metabolic testing.
In situations like Kayla's, physicians should assure parents that an autopsy is not a hunt for evidence of child abuse. Rarely, if ever, will they be subjected to abuse allegations. Rather, we are all interested in determining the cause of death, and a specific diagnosis can help allay the parents' guilt or anxiety.
Walter I. Hofman, MD
Merion Station, PA
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Letters to the Editors. Medical Economics 2002;14:7.