New respect for academic medicine; Helping your med mal carrier see reason; Why punish everyone? Confronting HMOs on coding
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Your article "Career moves: Think twice about academia" [Sept. 5] reminded me of the time I decided to try my hand at academic medicine. I had always enjoyed having residents in my practice and with 17 years in rural medicine, I figured I could bring the "real world" into an academic training program.
It was only after I took the plunge that I realized thatno matter how well a doctor may otherwise fit into university-based practiceyou also have to have "It" to succeed. I'm still not sure what "It" is, but one would be selling academic medicine short to assume that being a good doctor necessarily translates into being a good teacher. Academics is not just a shift from practice; it's a different discipline altogether.
After three years, I moved back to country practice. The old adage that those who can, do and those who can't, teach could never be further from the truth.
"Don't try to 'settle' a case yourself" [Aug. 8] is good advice, but sometimes you can't rely wholly on your malpractice carrier either.
A number of years ago, I excised a large skin cancer from a patient's thigh. Then I went on vacation, leaving her postoperative care to a locum tenens. He failed to provide the proper care when the wound became infected. When it dehisced, my patient had to be hospitalized briefly.
My patient was not upset with me, but wanted my malpractice insurance carrier to pay her out-of-pocket expenses related to the hospitalization, as well as lost wages. In a letter to my carrier I supported her request. But when their review board denied it, my patient became angry and consulted a plaintiffs' attorney.
So I decided I'd better consult a lawyer, an experienced litigator, on my own. His letter to the director of my malpractice carrier stated that the insurer was not acting in good faith and had violated its contract with me. Shortly afterwards, my patient received a check for the low four-figure sum she desired.
I was spared a lawsuit and, incidentally, the patient continued to use me as her dermatologist.
Instead of making everybody suffer through recredentialing tests, Dr. Edward M. Hundert's IOM committee should work a little harder to figure out how to identify those doctors whose skills are deficient. ["The IOM targets doctors," Sept. 5]. Why punish everyone as if he were an outlier? Medicare has used a similar bureaucratic response for years, and as a result, doctors are starting to drop out.
Your article "Coding: How to fight bundling" [Sept. 5] was superb. A related topic that deserves a major article by you is the failure of our medical and professional societiesboth state and nationalto enter the ring with the HMOs, who steal millions of dollars through their manipulation of the coding process.
Ian Schorr, MD
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Letters to the Editors.
Nov. 21, 2003;80:9.