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Evaluation without retribution; The community hospital and its responsibility; Electronic health records; End of life comfort; Public information; A tax postcript
Evaluation without retribution Your excellent cover story, "Is peer review worth saving?" [Feb. 18 http://www.memag.com/memag/article/articleDetail.jsp?id=147405], presents several important ideas.
Good faith peer review means doctors can discuss events without reprisal. Mortality and morbidity conferences, with attorneys politely excused from attendance, is peer review. If something amiss is uncovered, education is the only long-term answer.
One model to consider is independent peer review by impartial physicians who are acceptable to all concerned. Under this approach, some states will assign doctors chosen at random, while others will elect panels by specialty. Doctors coming out of residency will face a period of proctoring when they start to work. Similar supervision could be adopted by county medical societies or states to protect both patients and doctors whose work is under review.
Henry E. Butler, MDPresident, Semmelweis Medical Education FoundationPortsmouth, VA
The community hospital and its responsibility Family physician Keith Dinklage's article, "I don't believe in the tooth fairy, either" [Jan. 21 http://www.memag.com/memag/article/articleDetail.jsp?id=143135], shows the trouble that many young doctors face when deciding where to locate. Some physicians find themselves in even worse financial shape than Dr. Dinklage. Nonprofit hospitals are meant to aid the community they serve, but often the people that sit on 501(c)(3) boards are there to help themselves or associates. Hopefully, the IRS will look more closely at these institutions, and investigate whether they are in fact community-concerned organizations. If more medical professionals spoke out about their experiences with community hospitals, perhaps positive change would occur. Unfortunately, many are afraid of retaliation.
Jacqueline BloinkMedical office managerCortez, CO
I worked with Dr. Dinklage at an urgent care center, before we each started our own solo practices in adjacent communities-each with one hospital. That situation may be fine for purchasing equipment, as each hospital will need only one MRI or other expensive device, but it's not fine when it comes to caring properly for physicians. He's written the story I've composed in my head many times.
Debbie Heck, MDMuncie, IN
Electronic health records Although I found the article "Doctors and EHRs" [Jan. 21 http://www.memag.com/memag/article/articleDetail.jsp?id=143144] interesting, I couldn't help but be concerned about our fascination with technology. We are physicians, first and foremost, and while technology helps us to become better healthcare providers, it may cause us to wander further from being "healers." I wonder what the patient is thinking while watching the doctor's face peering down at the computer screen.
As we develop these electronic interfaces, it would be wise to remember why we practice medicine, and to develop devices that are more transparent and do not get between us and our patient.
Vondell Clark, MDMooresville, NC
As I write this letter, my office computers are down. If they go down over a long weekend, they're of no use for three days, or even more. Computers do not perform miracles. They work on the garbage-in, garbage-out principle. What's more, they are easily hacked into for various offenses, such as sending fake prescriptions. My banker tells me my handwriting is so unique that it can't be forged. For that reason, pharmacists have caught people trying to falsify my prescriptions. I create records, check patient eligibility, and perform accounting tasks on the computer. But we store data, including patient records, on paper. Discs are fine only when your computers are running.