Letters to the Editors
I support FP Richard Waltman's determination to counsel patients on smokingand other unhealthy habits at each visit ["A family physician's promiseto himself," Memo From the Editor's Guest, Sept. 6].
It's challenging to counsel about tobacco, alcohol, and other addictivesubstances. But asking detailed questions about a patient's social historyoften unmasks these unseen intruders. A complete medical exam is three partshistory and one part physical.
-Craig M. Wax, DO, Gloucester County, NJ, firstname.lastname@example.org
I wish all physicians would take on the challenge Waltman has. AfterI read the editorial, though, I looked again at his photo, and I have someadvice for him.
He seems to be carrying several pounds more than he needs, and I wonderwhether his own physician is doing all the things Waltman does for his patients.If not, I hope he will find one who does. The Richard Waltmans of the worldare too valuable to lose.
-Dale E. Fuller, MD, Dallas
On Jan. 1, 1998, I made a New Year's resolution to inform all my youngpatients that I expect them never to smoke and always to wear seat belts.I usually use a light approach, since most people don't take kindly to bluntadmonitions.
One of my colleagues undertook the same program that Waltman outlines,but he lost many patients because they didn't like being lectured abouttheir weight, lack of exercise, smoking, and drinking. My colleague wasnever condescending or even threatening. His mere--but ongoing--commentswere enough to drive patients away. The moral: We need to be instructive,but not overbearing.
One nice result, however: Today this doctor's patient roster is fullof clean-living folks.
-Les E. Riess, MD, Cloquet, MN
Few doctors have had formal training in medical school to deal with drug,alcohol, and nicotine addiction, or with domestic violence. But dealingwith a relative who was addicted to alcohol and nicotine taught me morethan any lecturer could.
It's unfortunate that managed care thwarts me at every turn, by not payingfor anti-smoking medication or for inpatient drug and alcohol treatment.What can we do to change insurers' reimbursement policies for these seriousmedical problems?
-Mary Fabian, MD, Alburtis, PA, email@example.com
Bravo to Waltman for his commitment to smoking cessation and the eliminationof substance abuse in his patients! I make smoking cessation a top priorityin my family practice and routinely turn a five-minute visit for sore throator bronchitis into a 15-minute smoking-cessation encounter. I've helpedscores of patients quit through the years, and I never give up on anyoneunless he gives up on himself.
If physicians did nothing more than spend their time getting patientsto quit smoking--and ignored all other common medical problems--we wouldprobably do more long-term good for our patients.
-Carl S. Wehri, MD, Delphos, OH, firstname.lastname@example.org
Attorney Lee Johnson gave readers some bad advice in the Aug. 23 MalpracticeConsult. A physician asked whether her practice's phone triage nurse shoulddial 911 for patients who call with emergencies. Johnson said that the nurseshould make the call.
Our group has a center that triages calls for our eight offices. We usedto call 911 for our patients, but emergency services asked us not to doit, because calls to 911 are routed locally--not to a centralized switchboard.By calling 911, we were actually delaying the dispatch.
-Lyne Chamberlain, Physician Associates of Florida, Maitland,FL
I'd like to congratulate internist Ada Rahn for describing her servicesso fully and so well ["Dear Patient: I didn't commit Medicare fraud.Here's why . . . ," Aug. 23]. Her patient had complained about excessivecharges for hospital visits.
It's about time we educate patients about the services we provide. Ourrates have been deeply discounted, and our fees are difficult to collect.In an ideal world, Rahn's patient would realize what an incredibly low feeher doctor received, and demand that Medicare pay Rahn better for the timeand outstanding treatment she provided.
HCFA's strategy of deflecting attention from itself by turning patientsinto watchdogs to detect physician fraud represents the most destructiveaction against doctors in the history of American medicine. The real questionis: Who's committing fraud--we the providers or HCFA?
-Herve M. Byron, MD, Englewood Cliffs, NJ
With Medicare appealing directly to patients to report fraud and abuse,I'm glad I've developed the habit of doing all my coordinating and chartingin front of my patients.
It's tempting to review the chart and make phone calls at the nurses'station, but that can leave the patient thinking nothing was done for him.If the lab results aren't back, I excuse myself to go use the computer,and I return to the patient's room to check with the nurse or speak withthe patient's family.
-Gil L. Solomon, MD, Malibu, CA
Jeff Forster cites several examples of doctors who've been humbled bytheir patients ["On the notion that doctors are not God," Memofrom the Editor, Aug. 23]. I was especially disappointed in FP Max Burger,who recommended an abortion to a woman with a high-risk pregnancy. (Thewoman didn't take his advice, and eventually delivered a healthy baby.)Burger considers himself to be "merely a guide" in his patients'lives, but I believe he's a poor one. Any doctor who recommends an abortionshould be ashamed of himself.
-Thomas P. Short, MD, Madisonville, KY
The photo of a house that accompanied "Why was this doctor allowedto start a health plan?" [Oct. 25, page 186] is not the home of neurologistMagdy Elamir. We regret the error.
In "A cheaper and easier way to trade stocks" [Nov. 8], tradingfees for Discover Brokerage Direct (now called Morgan Stanley Dean WitterOnline, www.online.msdw.com) wereunderstated. New customers will pay $29.95 for all trades. Those who signedwith Discover before Oct. 21 will pay the prior rates through 2000.
Suzanne Duke. Letters to the Editors.