Letters To The Editors

The perils and problems of pain management

I feel sorry for anesthesiologist Joan Lewis, who was prosecuted for "injudicious prescribing" of controlled substances by the New Mexico Board of Medical Examiners ["Pain control: Did Dr. Lewis cross the line?" March 7]. Anyone who treats pain fears such an ordeal.

To protect themselves and discourage drug abuse, doctors need to be able to identify patients who doctor shop to obtain drugs. I understand the DEA gives law enforcement agencies access to their prescription records, but all physicians need this information. I suppose, though, that with HIPAA, it probably will be even harder to obtain.

John T. Legowik, MD
St. Cloud, FL

Your article perpetuates the myth that those who seek drugs for reasons other than what we think they should be used for are basically "bad." In fact, you even use the term "bad apples" to describe these patients.

Unfortunately, it seems many physicians have rejected the ancient maxim, "Nothing human is foreign to me." Do you think anybody wants to be "a drug seeking person"? People in pain will seek relief. We shouldn't cop out by blaming the patient.

Brian Lynch, MD
Chicago

Free from oversight and review, state medical board investigators and physicians decide cases any way they wish. It's their kingdom and the physicians before them are their "subjects."

Here's an example from my state: A physician was summoned before the board for allegedly prescribing controlled substances to known drug abusers. Subsequent investigations confirmed this—and uncovered many instances of substandard care and poor or nonexistent documentation as well.

Did the board revoke his license? Demand the surrender of his DEA certificate? Place him on probation? Impose any sanctions at all? No! It sent him a letter recommending "careful" prescribing, proper documentation, and a narcotics prescribing course. None of these recommendations were followed; the physician remains in practice.

It's a safe bet that the medical board that prosecuted Dr. Lewis has given similar "free passes" to physicians guilty of far more egregious offenses than hers. The disposition of a case often depends on the accused physician's personality, likability, and deference to the board.

Victor Theriault, MD
Bogalusa, LA

Proving the value of stolen property

I disagree with your blanket recommendation to throw out credit card charge slips as soon as you check them against your monthly statements ["Personal Records: What to keep, what to toss," Feb. 7]. After a recent break-in and theft of personal property, my insurance company requested original receipts for every item stolen. If we couldn't prove when and where we purchased something and how much it had cost, the company set its own value. Those charge slips are your proof.

Christine Schwartz
Medford, OR

Did the war in Iraq affect your practice?

For months, the economy worsened, the stock market plunged, and physicians filled the doctors' lounge with complaints about never being able to retire. Then, America went to war against Saddam Hussein. The attention of all Americans turned full-time to the war—supporting the troops, protesting the war, watching the news for updates, or trying to put the whole thing out of their thoughts. The last thing on anyone's mind was plastic surgery, right? As a board-certified plastic surgeon, I braced myself for a huge slowdown.

I have to admit I was shocked at what's happened. In my practice the number of cosmetic procedures doubled during the month of March. No one seemed to be letting the war affect their lifestyle! Perhaps consumers are just trying to focus on positive things, but it saddens me that maybe our society has gotten used to the idea of war and people dying. (Sadly, we plastic surgeons become intimately involved in the aftermath of war, providing the reconstructive procedures war's victims require.)

I would love to hear comments from other doctors about the war's effect on their practices. You can e-mail me at prplastic@yahoo.com.

Sam Speron, MD
Chicago

Health plans live in clover while denying meds to patients

"Rx cost control: What's your role?" [Feb. 21] fails to mention a significant factor that compromises a patient's ability to get the medicine he needs: the money the insurance industry wastes. For example, the creation of wasteful literature: fancy, multicolored bar-graph performance reviews, calendars, and treatment protocols. I have a six-month accumulation of these mailings stacked up four feet high. Do patients know their premiums pay for all this?

Recently, a PharmD from an insurance carrier came to my office on a counter-detailing mission like the ones described in your article. After he reviewed my prescribing compared to other doctors', I asked, "Maybe my use of medications saves money in the long run by keeping people out of the hospital and minimizing catastrophic illness. Do you ever use any of your sophisticated equipment to monitor the quality of the care I deliver?" The answer was No. "So, the primary issue is cost, not quality of care?" No answer. "Then let's cut costs by sacrificing your superfluous lobbying job so your salary can go for buying more medications for my patients." End of interview.

I cut my medical teeth in the military and learned to work with pharmaceutical formularies before the civilian sector ever heard of them. I fine-tune medications all the time, looking for cheaper, reasonable alternatives. But until the insurance industry agrees to restrain its frivolous expenses, I will have no sympathy with their telling me my patient can't have the medicine he needs because it's too expensive.

Dewayne P. Darby, MD
Jefferson City, TN

Getting paid for completing forms

Even though your experts feel you shouldn't charge patients for completing forms, I feel it degrades the value of my service to work for free and undermines the integrity of the doctor-patient relationship. ["Practice Management Q&As: Charge patients for completing forms?" Feb. 21].

When my lawyer or my accountant completes necessary paperwork, I expect to pay for it. If I'm spending up to 30 minutes to complete a form of such complexity and detail that a staffer can't do it, I expect to be paid for it, too, whether it's "covered by insurance" or not.

Robert Watkins, MD
Cary, NC

No capital loss when these bonds are called

I'm perplexed by your advice on determining capital loss when you buy a tax-exempt bond at a premium and it's called at a lower price ["Answers to your tax questions . . . About investment income and losses," Feb. 21]. It's my understanding that these bonds are amortized to the call date and not to the maturity date. So, there is no capital loss.

Arnold L. Nedelman, MD
Los Angeles

Editor's note: You are correct. You must amortize the premium so that your cost basis equals the bond's call price by the call date. If the bond is called, you can't claim a loss. We apologize for the error.

Edited by Liz O'Brien,
Associate Editor

Address correspondence to Letters Editor, Medical Economics, 5 Paragon Drive, Montvale, NJ 07645-1742. Or e-mail your comments to meletters@medec.com, or fax them to 201-722-2688. Include your address and daytime phone number. Letters may be edited for length and style. Unless you specify otherwise, we'll assume your letter is for publication.

 

Letters to the Editors. Medical Economics May 9, 2003;80:11.