Letters discuss 'death committees,' the growth of urgent care and decline of primary care, and increasing revenue streams without compromising one's ethics.
Dying is the issue
Great thoughts and a well-written article by Matthew H. Huddleston, MD ("The many sides of patient care," December 10 issue).
How about the son who says, "Let's just let our 90-year-old, demented grandmother go." Will the family say the son murdered mom? In Australia, committees take this decision away from the family members so that there is no guilt placed back on them. Like Huddleston said, there is no easy solution. In the United States, someone would call these death committees.
FLEMING MATTOX, MD
Greenville, South Carolina
Phenomenon of urgent care impedes learning
To make good treatment decisions, doctors must learn from mistakes ("Study: To make good treatment decisions, doctors must learn from mistakes," by Annette M. Boyle, MBA, [Medical Economics eConsult], December 7 issue). With the rise of urgent care clinics, a phenomenon bred by the declining numbers of primary care physicians, we hardly ever have follow-up on patients seen in this setting. We never know the final diagnosis or outcome of these patients. This is a major impediment to our learning and future decision-making processes as physicians.
I have been in private practice for 20 years and was a military physician for 16 years. Now I work in an urgent care clinic. Ninety percent of my knowledge base (diagnostic skills, what to prescribe, what works, what doesn't work) comes from follow-up and observation of outcomes related to individual patient care encounters over the years. I miss this aspect of private practice. Our clinics perform callbacks on all patients, but the process is uninformative because most patients give little or no feedback information, or worse, cannot be found for comment.
ROBERT A. WYMER, MD
San Antonio, Texas
Doctors need to be paid fairly for their work
How sad it is that doctors are reaching out for revenue streams ("Allergy treatment nothing to sneeze at," by Annette M. Boyle, MBA, August 25 issue; [Talk Back], November 10 issue). What happened to treating our patients, developing rapport and a valued doctor-patient relationship?
I can remember when doctors complained about chiropractors selling pills and potions "on the side." Now, chiropractors have newfangled tests and machines that find various problems that need treat ment, and they sell the treatments right in their offices!
How is allergy testing any different from what the chiropractors do? Specialists also are branching out into areas that require only a course or two for training.
I am a family physician, and I specialize in primary care. I refuse to take the bait (and the bait is dangled in front of me more and more, especially as my reimbursement shrinks and the efforts I make to be paid for my work increase). My wallet may be thinner, but my ethics remain intact.
The answer to all this is not for us to seek new and lucrative revenue streams, but for doctors of whatever specialty to be paid fairly for our work. This is particularly acute in primary care, where we have the lowest remuneration and the highest overhead.
WAYNE S. STROUSE, MD
Penn Yan, New York