Downcoding, pharma freebies, vaccine costs
That was a lovely essay for me before going off to work ("A matter of trust," January 9, 2009). After all the cynical letters to the editor in which we talk about being beaten-down family physicians, and after all the practice management tips to eke out a living, it's nice to see an uplifting article about the doctor-patient relationship and a nice ending to an ethical quandary. I was choked-up!
MAMATHA AGRAWAL, MD Apex, North Carolina
I read Dr. Jeff Pearson's article "The pen is mightier" (From the Board, December 19, 2008) with amusement and shame at my fellow physicians. I have seen such displays at medical conferences more often than I care to recall. Why professionals behave in such a degrading manner defies my understanding. Are we so poor that we must fight like famine victims for food? Indeed, it can be amusing, but it does nothing to enhance our already tarnished image.
RUSSELL LEE-WOOD, MD Barnesville, Ohio
I laughed when I read your piece on "freebies" and physicians. Years ago, as a dental rep, I worked the New York Dental Show many times. We were warned to be on the lookout for docs and their spouses when they hit the display area. It was worse than a one-hour sale at Macy's!
Dentists would literally run their arms across the counter, scooping and dragging whatever they could get into their waiting bags. Pens, pads-everything was fair game.
Worst of all was the last day of the convention, when they would literally steal the regular-size bottles of Scope from the counter. A 64-ounce bottle of mouthwash is quite large. It didn't matter; they-as well as anything else not nailed down-were history. Thanks for the remembrance. It was quite a display of human nature.
JEFFERY TOPPS Washingtonville, New York
Downcoded to death
I enjoyed the article "An upswing in downcoding?" (December 5, 2008). I had an episode in my office similar to the one shared by Dr. Rivera-Hidalgo. I dropped the insurance company before it was able to scrutinize and downcode 80 additional charts, resulting in considerable inconvenience for my patients.
Before doing so, I spoke to the medical director to justify my charting. I explained that patients come in for one complaint and then add "while I'm here..." or "can you take a look at this..." in addition to their original reason for the appointment. This I gladly do, since I am a family practitioner.
I may not have the time or the luxury to write extensive notes, but I do address the additional problems with a proper diagnosis and plan. According to the insurer and the medical director, this does not justify what I charge. It is difficult to believe that I can address three separate problems and cannot get paid $68 (extended visit).
The most blatant disregard for patients came when the insurer failed to notify them that I opted out. After 60 days, I had more than 300 patients looking for doctors.
The medical director said I could extend my discharge date so that I could continue care for patients until they were reassigned. The insurer ended up paying me nothing for it, except to apply the amount to what I owed. So much for trying to give them some PR and saving them from possible litigation.
GEORGE O. BRICK, MD Brandon, Florida