The threat of economic credentialing, Hospitalists pro and con, With defense like this, who needs plaintiffs' attorneys?
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Your magazine is one of a kind in its coverage of all aspects of medical economics. Over the years, your reporting has contributed greatly to my understanding of the professional and the business sides of medicine.
"Hospital hardball" [Aug. 9] was particularly pertinent. Economic credentialing is a burgeoning problem for practitioners nationwide. It touched me personally when a local hospital where I have practiced for 30 years told me that I simply did not bring in enough money and that they were diverting patients from my practice to another physicianwho sat on their board of directors and maintained a teaching program.
I believe that the economic credentialing problem will soon reach the proportion of today's malpractice/tort crisis. Thank you for sounding the alert.
Your cover story, "The changing face of hospital practice" [Aug. 23], was fascinating. You see, I was a "hospitalist" way back in 1967 before they invented the term.
For 25 years I practiced as a strictly hospital-based internal medicine specialist in a community osteopathic hospital. I was able to monitor patients closely and respond to their needs quickly, even taking call at night. Communication with the primary care physician and follow-up when the patient was discharged were mandatory.
It was, and remains, a viable system with excellent outcomes! All parties were satisfied: the primary care doctor got his patient back, the patients returned to their familiar doctor, and I was able to move on to the next acute patient.
Carl M. Pesta, DO
I was a little unsettled by your article on hospitalists. It left me feeling that those of us who provideand enjoythe full spectrum of care, including treating inpatients, are practicing almost substandard medicine.
Although I can see some positives to hospitalist care, I think there is still a role for the "old family doctor." Internist Robert Wachter believes it's hard to find a reason for not using hospitalists. Here's one: How can small hospitals afford them? In the discussion of hospitalists, the many hospitals in rural settings that offer care to real people with real needs have been forgotten.
Your example of the arrogant doctor who sat expressionless and alone throughout his malpractice trial was meant to show how an unfriendly demeanor in court can turn a jury against you ["Malpractice: How doctors sabotage their own defense," Sept. 9]. However, it also showed how a lawyer who is supposedly defending you, can help do you in.
When the doctor's lawyer explained to the opposing counsel why the defendant's spouse was not present in the courtroom"This guy doesn't want anybody to see his judgment questioned, particularly his wife"he betrayed valuable information that could be used against his own client. Not only was this giving aid and comfort to the enemy, it was a violation of legal ethical standards. It makes one wonder.
Michael R. Theerman, MD
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