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"Does mandated diabetes coverage boost compliance?" [Nov. 19]. My answer is a resounding Yes! I found that once the regs were in place here in New York, my patients were much more likely to get their blood glucose monitors and use them regularly. As they learned to relate their blood sugar levels to such symptoms as blurred vision, foot pain, GI disturbances, and changes in urination frequency and sleep quality, they gained a personal awareness of the effects of diabetes on their own bodies. They became more engaged in their treatment and willing to exercise and modify their diet to manage the disease.
Here is my solution to the common problem of how to handle " 'Sick' notes for patients," [Malpractice Consult, Dec. 3]: Every patient who wants a note must come in for a visit. If the patient has recovered by the time of the appointment but still needs a note to return to work or school, I write something like, "Mr. Smith states he was ill with a cold for the past three days. He now states he has made a good recovery." Although brief, such a note is accurate and complete. I've never had an employer or school official complain about what I'd written.
I always ask the patient to read the note to make sure it meets with his approval. In his presence, I dictate an entry for the chart documenting that he has seen the note and found it satisfactory. A copy of the note goes in the chart; the original goes with the patient. To avoid breach of confidentiality problems, I never fax or mail notes.
Richard J. Sagall, MD
When a patient I haven't seen during her illness requests a "sick" note, I simply write, "Ms. Jones states that she was ill last week and is now able to return to work." That seems to satisfy even the most anal of managers at the patient's workplace. I suspect they really don't care what I've written, but the note satisfies their requirement for a "paper trail."
In many medical offices, the death of a patient means stamping "deceased" on the chart, moving the records to the inactive file, and proceeding with the final billing paperwork. It is a rare physician who takes a few moments to dictate a letter of sympathy to the grieving family.
Of all the cards, donations, and memorials we received when my own mother died, the one that stood out was the letter from the physician who treated her. I'd like to present it here as an example of the kindness we have the opportunity to show when a patient dies:
Please accept my condolences for the loss of your mother who passed away at the Morrison Heart Institute. I empathize with you and your family on the loss of this very special lady. I felt privileged to take care of her during my two "tours" with her, and feel that God was merciful and took her without pain. I think that the prognosis, as I told you, was somewhat poor and that she would not lead the life she had known before her last stroke. Again, condolences from myself and our office for the loss of your mother.
Harry Koenig, MD
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Liz O'Brien. Letters to the Editors.