Telling it like it really is; The benefits of paying off your mortgage; Support our troops; Why I turn away Medicare patients
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What was wrong with our practice? Whenever my partners and I read the "Diary from a Week in Practice" column in the AAFP's journal, we couldn't understand why we weren't having the same touchy-feely experiences. Then we read your "What an FP's week is really like," [Jan. 10]. We're grateful to family physician William Sheahan for assuring us that other doctors are not always having "Marcus Welby" encounters either.
Don't be tempted to reduce expenses by paying off a mortgage warns your expert in "Investments: Sound tips for your situation," [Jan. 24]. But it's not a bad idea when your excess cash funds are yielding only 1 percent interest, and you're paying off a mortgage at 6 percent. Moreover, as to the tax write-off benefit of mortgage interest, remember that when your adjusted gross income exceeds a threshold amount, you must reduce the amount of your itemized deductions, including home mortgage interest, by 3 percent of the excess. So, you're not getting a dollar for dollar tax benefit for your home mortgage interest.
I was a flight surgeon and a division surgeon during the Vietnam War, and afterwards I witnessed the disturbing treatment and lack of respect toward our young men and women who served in that conflict. I had a private neurosurgery practice for 32 years, but after 9/11 I accepted an appointment as chief of neurosurgery at Landstuhl Regional Medical Center in Germany, We are the largest American hospital outside the US for our embassy personnel in Europe and for troops stationed in Bosnia, Kosovo, and Afghanistan, and soon, I fear, we'll have casualties from the Middle East. It is so sad to see not only the loss of life, but the serious, often disabling, injuries our troops suffer. And most are very young. Our soldiers do not want war. But they take their obligations seriously, with great professionalism.
Regardless of your position on a war with Iraq, please, do not forget them or treat them with contempt as in the Vietnam era. They should not be identified with the political situation. Believe me, they deserve your help and respect.
I am a solo family practitioner, trying to continue in the profession I have loved for 38 years. Like several of the doctors in "Medicare cuts: Will patients pay the price?" [Jan. 10], I have confronted problems that compelled me to close my door to new Medicare patients.
One, for example, is Medicare patients with supplemental insurance who abuse the system. Because they don't have to pay a dime to see a physician, they visit us for minor complaints or come to the office every week just to get out of the house. They waste valuable time when I need to see more patients than ever.
Another exasperating problem is that what Medicare permits you to charge does not allow for the difficulties you may encounter treating older patients. For instance, a woman brought in her elderly mother who had symptoms of cystitis. Now I can test a young person for cystitis, and send her on her way with a prescription in 15 minutes. However, it took 30 minutes just to help my older patient down the hall to the rest room to take the specimen. Then she unfortunately had loose stools before she could sit on the commode. By the time that was cleaned up and the visit completed, 50 minutes had elapsed. I later learned that Medicare stopped paying for urine testing. Now I send my older patients to the freestanding labs for urinalysis. Any reform of the system must consider these realities.
Thankam B. Pillai, MD
Hampton Roads, VA
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Letters to the Editors. Medical Economics 2003;7:13.