Letters To the Editors

A pep talk all doctors should hear

I'd like to thank FP Richard Waltman for sharing his thoughts about why he enjoys medicine ["Hang it up at 55? No way!" June 5]. The article was engaging, entertaining, and inspiring. One passage resonated with me in particular: "The answer came to me last Sunday, as my wife and I walked through a wildlife preserve and stopped to gaze at the awesome sight of two bald eagles soaring across the horizon and settling above us on a tree branch: I'm really good at what I do, and I really like doing it."

Nadir Ali, MDHoustonmali@bcm.tmc.edu

I feel the same way that Waltman describes in his article—and I'm 10 years older than he is. I couldn't have said it nearly as well.

John R. Dykers Jr., MD Siler City, NC

Compassion ought to be part of end-of-life care

Medical Economics' Professional Editor David Azevedo decries the indifference of his father's doctors during the days leading up to his dad's death ["Where were my dad's doctors?" Memo From the Editor's Guest, May 22]. As a former hospice medical director and an internist with long experience caring for the elderly, I couldn't agree with him more. It's awful that doctors are not there for their patients at the moment of death.

These days, however, many things conspire to frustrate the situation. End-of-life care is not a priority. We physicians are paid to intubate patients and monitor ventilators. We're not paid for palliative care in the ICU.

With the AMA's Educating Physicians in End of Life Care program, the medical profession is trying to make end-of-life care a higher priority. In the meantime, doctors can help by sending a sympathy card to let the patient's family know the struggle they and their loved one just experienced is not forgotten or unappreciated.

Mary Shepard, MD
LB Healthcare Advisors
Bellingham, WAmaryshepard@worldnet.att.net

While I sympathize with the lack of personal attention that Azevedo's father received while dying, I'm disturbed about the son's misunderstanding of the medical system, especially since he's the Professional Editor of your magazine!

The realities are simple: Our increased patient loads, along with staggering administrative demands—creations of the insurance companies—leave physicians with no time to play the emotional caregiver. Maybe Azevedo should spend a week shadowing his father's primary doctor. Walk a mile with him before criticizing him.

Brian J. Broker, MD Phoenixville, PA Bbrokermd@aol.com

Azevedo asks, "Where were my dad's doctors?" He ought to think where he himself might usually be at 8 pm on a Friday: attending his daughter's birthday party perhaps, or celebrating an anniversary, or watching a ballgame, or spending quiet time with his wife after a long and grueling week of work. They're the kinds of things most people are doing Fridays at 8. That's where the doctors were.

It's not possible to be in all the places we would like to be, so every minute of the day we have to choose where we will be.

What's more, we doctors deal with a full range of patient personalities and family dynamics. Some families prefer to be alone with their loved one in the final moments; some prefer the guidance of their doctor. But unless someone tells us, we don't know which. Did Azevedo and his family explain their wishes to the doctors?

As a family physician, I don't routinely treat patients in the hospital. I do, however, stop in to see them before my workday starts, and many of my colleagues do the same. Most of the time the family doesn't know this, and if the patient isn't talking, it's usually our secret. Does Azevedo know that his dad's physicians didn't? He may have been surprised.

Stanley J. Savinese, DO Aston, PA stanley.savinese@crozer.org

If these physicians are like most doctors I know, they were trained by those paying for medical care, who taught them to provide only the most cost-effective care adequate to the situation in the least expensive setting. And, having learned the lesson, the primary care doctors knew they wouldn't be paid for a hospital call because their services were not "needed."

The support at the time of Azevedo's father's passing was delegated to "midlevel" providers. The doctors didn't think it was better medicine; they were just following the rules.

Leslie E. Reese, MDAmarillo, TX
lreese@arn.net

The doctors who treated Azevedo's father were hiding from the pain of his dad's death. We physicians are trained to absorb medical information, but there are no classes on how it feels to be a doctor. John Azevedo Jr.'s death will be discussed, but none of the participants will be asked how they feel—only what might have been done differently to keep Mr. Azevedo alive a few more days or minutes.

Doctors have trouble using the word "death." So what do we do? We build a wall to hide behind. That's where the doctors were when David's father died.

Bernie Siegel, MDWoodbridge, CTBUGSYSIEGEL@compuserve.com

Bucking the stopwatch trend—and reaping the rewards

It was so refreshing to read internist Michael Monaco's article about his stand against stopwatch medicine at his family practice group ["Internists are losers," May 22].

Like Monaco, I hung out my own shingle. Though I was a hospital employee with guaranteed income, I chose to open my own office because I believed patients would seek out quality care. At the beginning, it was scary. But now that my practice is doing well, I enjoy going to work in the mornings. I'm glad I'm not the only person who has taken this jump.

Charles Sutherland, DOParis, MO

Don't blame the insurer for a bad contract

Karen Johnson's attorneys were able to shake down Humana for $13 million for denying payment for her hysterectomy to treat cervical dysplasia; a sympathetic plaintiff and just the right jury were enough ["Straightforward UR—or a 'machine of denial'?", May 8].

I'm certainly no apologist for the managed care industry, but Humana followed its contractual obligations to the letter. To state that a hysterectomy is "also" acceptable or appropriate in the given circumstances proves nothing. Johnson's contract didn't promise any and all appropriate treatments based on patient (or physician) choice, regardless of cost.

Mike Thibodeaux, MDOscar, LAMike627T@compuserve.com

Edited by Suzanne Duke,
Senior Associate Editor

Address correspondence to Letters Editor, Medical Economics magazine, 5 Paragon Drive, Montvale, NJ 07645-1742. Or e-mail your comments to meletters@medec.com, or fax them to 201-722-2688. Include your address and daytime phone number. Letters may be edited for length and style. Unless you specify otherwise, we'll assume your letter is for publication. Also, let us know if you don't want your e-mail address printed with your letter.

 

Suzanne Duke. Letters to the Editors. Medical Economics 2000;15:13.