Letters To the Editors

Caught between duty and a colleague

In your ethics roundtable, you present a case in which an oldersurgeon confides in his friend, an FP, that he may be in the earlystages of ALS ["A colleague may be losing it—but asks younot to tell," Dec. 6].

If I were the FP in question, I'd offer to monitor the surgeonmyself, at least while trying to make a definitive diagnosis.And if the situation seemed dangerous, I'd have a duty to warnothers about his condition.

Robert Fisher, MD
Baltimore

I was particularly chilled by panelist Jordan Busch's statementsconcerning the surgeon's condition: "At what point do yousay, 'I'm not going to send him any more patients . . .' "and ". . . until we get this sorted out, I can't refer anymore patients to you." What about the patients the surgeonis already seeing?

I was also disturbed by panelist Bonnie Steinbock's responseabout the surgeon who may have ALS: ". . . that would justlead to a situation where everyone would be checking up on everyoneelse . . . you have an obligation to the patients you share."I'd like to know what Steinbock would do about the patients whowill not be protected because they are not "shared."

Suppose Busch and Steinbock observed an obviously impaireddriver weaving down the road, right after their own family turnedinto the home driveway. Would they not call the police becausetheir family was out of harm's way?

The responses cited above serve as strong arguments for healthcare benefit administrators to watch over doctors' shoulders,since it seems that not all of the doctors' colleagues are doingso.

Joan P. Ogden, Joan Ogden Actuaries
Salt Lake City
jpogden@xmission.com

First, show some humility

I recently visited an elderly cancer patient in a nursing home.She said, "Doctor, if you knew what your visits mean to me,you would visit more. My daughter lives in Dallas, and the onlyvisitors I receive are you and the nun who comes to help me walk.Being able to see you, hear your voice, and have you sit at mybedside, relieves me more than the pain pills."

At that moment, my arrogance and pride were erased. I'm humbledthat it has taken me such a long time to reach this simple insight:To be human, all it takes is love, empathy, and a hug. Many ofmy elderly patients continue to live because of the affectionthey get from their loved ones—not because I or my pills keepthem alive.

Arturo J. Blanco, MD
Tamarac, FL

This patient had good reason to shop around for drugs

I have a question for FP Anthony Miksanek, who laments thatone of his patients was taking an over-the-counter drug she purchasedin Mexico ["Are bargain-basement medications harming yourpatients?" Nov. 22]. He mentioned that he hadn't seen this62-year-old woman for more than a year. Yet one of the first questionsMiksanek asked her was, "Are you taking all your prescribedmedicines faithfully?" If he hadn't seen her for such a longtime, how could she have had enough medication to be taking itregularly?

The longest supply of medicine I will give a patient is sixmonths' worth. It's not appropriate to see a patient with chronicproblems like hypertension or arthritis just once a year and eithergive her a prescription with 12 refills or call in refills everymonth without ever examining her. When a patient calls my officefor a medication refill, but hasn't seen me for six months ormore, I'll call in a seven-day supply and schedule him for a checkup.

Steven Gitler, DO
Glassboro, NJ
sgitler@aol.com

Overlooked resources for finding jobs on the Net

Though recruiter Sue Cejka's article about the advantages ofdoing job searches on the Internet [Career Consult, Oct. 25] isinformative, it appears highly self-serving. Cejka lists her ownfirm's Web site as the first source of physician recruiters andneglects to list the National Association of Physician Recruiters'site, www.napr.org. The NAPR, whichhas the largest online listing of physician jobs, is a nonprofitnational trade association representing both physician recruitmentfirms and in-house recruiters at medical institutions.

Cejka's company is a charter member of NAPR. It's hard to understandwhy she would eliminate this great source of available jobs.

Charles C. Corbett
President
Davis Smith
Southfield, MI

Cejka failed to mention the NAPR's "World Job Bank,"the largest Internet recruiting site for physicians, and my firm'sWeb site, mdrsearch.com, whichlists more than 300 practice opportunities and allows physiciansto submit mini-CVs online.

Cejka, in listing only three companies' Web sites, includingher own, provided information that was misleading and self-serving,at best. Perhaps you can devote a page in a future issue to thedozens of Web sites with physician job listings.

Stephen G. Schoen
Executive Director
MDR Associates
Miami, FL

When the disabled travel, it's never first class

My family and I decided to transfer our dad from a communityhospital in Florida to a rehabilitation facility near my brother'shome in Rochester, NY. He had an amputation of the forefoot, whichwas not completely healed. I had the bright idea that a first-classticket would give him a better ride and more attention boardingand arriving. That wasn't the case. The airline provided the wheelchairI had requested, but it was too big to enter the plane. My fatherhad to hobble to his seat.

The ordeal had just begun. The bulkhead seat was cramped andit caused more swelling at the wound. Changing planes exacerbatedhis foot pain. Fortunately, the airline offered us a narrow wheelchairon the second leg of the flight. If it had been offered duringthe first flight, my father's pain and swelling would have beenreduced dramatically. Moving from one wheelchair to another wasdifficult. Using toilets, even those designed for the handicapped,was tough.

The whole experience gave me a better appreciation of the indignitiesthe disabled have to suffer while traveling.

Max Burger, MD
Medford, NJ

Edited by Suzanne Duke, Senior Associate Editor

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

Suzanne Duke. Letters to the Editors.

Medical Economics

2000;3:13.