Letter: Readers comment on Medical Economics stories

Show your 'human side' when seeing patients

I agree with the importance of communication between physicians and patients ("Good rapport with patients helps lessen lawsuit risk," by Lee J. Johnson [Malpractice Consult], January 10 issue). When I was in practice I tried to learn one thing about each patient that had nothing to do with the reason the patient came to see me. And I tried to tell the patient one thing about me or my family that had nothing to do with my medical practice. It was usually something simple and quick. However, it helped show my "human side" to my patients and helped me to better understand them.

RICH SAGALL, MD

Doctor-patient relationship takes years

Thank you for a wonderful article describing some of the intricacies of family practice, as it involves so much more than just primary care ("It's time to optimize primary care for a healthier population," by Joseph E. Scherger, MD, [From the Board], December 3 issue). I have read many of Dr. Scherger's articles over the years, and I have always admired his grasp of the situation. Now, on my bully pulpit of 40 years of family practice (30 of which included obstetrics) in the same community, I feel as if I have to comment.

Yes, easy access, adequate visit length, and pertinent technology are necessary parts of the doctor-patient relationship, but it is in the relationship itself that the art reaches its intended goal. That is where the healing takes place, and healing is our priority. The doctor needs to provide years of service to the patient before being endowed with the trust and confidence necessary for a valid relationship. Younger physicians must realize that patient trust takes years and jumping around from practice to practice makes them as much of medical technicians as our surgical colleagues.

The proposals Dr. Scherger makes are magnificent, but their value is the same as a brilliant bill passed by a legislator without voting for the funding to make it work. There is only one way to fund such a program as he proposes, and that is by reducing surgical fees. (Yes, I am old enough now to say it.) For an ophthalmologist to perform eight cataract operations each on a Thursday morning and be paid $6,500, while it takes me a 5-day week of seeing patients to charge the same amount (and then pay overhead) is obscene and must change at some point.

A 38-year-old woman recently drove from Washington, D.C., to Boston to consult with me about her gynecologic health and fertility. I hadn't seen her for over 5 years and chided her for wasting all that traveling effort when there were many physicians she could have seen closer to home. Her response was:

"Doctor C, I am surprised to hear you say that. You delivered me, you saw me through all the health crises of childhood, always being there for me and my family. You saw me through adolescence, and your conversations about respect and decency and values have guided all of my adult relationships. You advised me through the terminal illnesses of both my parents and gave them all the time and expertise they needed. You delivered my two children. You have always said and done the right thing for me and my family regardless of the time and effort it cost you. How could I ever go to or trust another doctor to advise me about such important issues?"

GERALD P. CORCORAN, MD

Needham, Massachusetts