Letters to the Editors

Scroggins isn't wrong

As vice president of my wife's medical practice, I must defend practice management consultant David Scroggins. His assessment of physician productivity in "Secret weapons for a successful practice" [Oct. 7, 2005] is correct. If we don't meet our financial goals and pay our fiscal obligations, we shut our doors.

The business of medicine requires planning, discipline, and performance. It means hitting the numbers: keeping expenses low, production high, and growing the business. Imagine your practice is a sealed room filling with water. The ceiling symbolizes your Medicare, Medicaid, and insurance reimbursement rates. The rising water represents your business expenses. Now imagine the ceiling being lowered. No matter how good a swimmer you are, at some point you run out of air.

What does that imply about quality? Nothing. It's not an either/or proposition. And my wife still derives satisfaction from her profession.

We've invested in technology, including an electronic medical record, and we've introduced alternative services to help reduce our reliance on insurance companies and to improve our cash flow. Along with hard work and some degree of luck, we will transform our company and break the bonds of dependency.

After all, it is a business.

Carl H. RupeCharlotte, NC

Patients should be held accountable

The Michigan Supreme Court's dissenting opinions in the malpractice case involving emergency physicians Dennis Adams and Mary Ellen Flaherty made my blood boil ["Malpractice: A new break for doctors," Nov. 18, 2005].

The evidence linking obesity, smoking, and sedentary life-styles-let alone untreated high blood pressure, cholesterol, and diabetes-to morbidity and mortality is incontrovertible. As a family physician, I routinely advise patients of the risks associated with their unhealthy behaviors. When I see a new patient who has health problems and who has been noncompliant, I strongly urge him to start getting healthy, and I document this advice along with the patient's noncompliant behaviors. Nevertheless, it is the patient's responsibility to comply with my recommendations-I cannot force him.

Patients' poor health habits are absolutely part of the cause of their health problems. To disallow a person's pretreatment negligence to be considered in med-mal cases seems to be just another part of a healthcare system that demonizes doctors and allows patients to blame someone else for every bad outcome.

Wendy Fuhr, MDCollegeville, PA

EHRs: More problems than benefits

My view of EHR implementation differs slightly from that of family physician Richard E. Waltman in "EHR? Count me in!" ["Last Word," Aug. 18, 2005].

In late 2000, my former office purchased a pretty good EHR system-a touch-screen monitor in every room, dedicated server, etc. For ease of use and ability to rapidly document the visit, it still works well. I nonetheless would now recommend against adopting an EHR. After the initial investment, annual license fees and updates get expensive, as does having an IT guy on retainer for the inevitable crashes. But more importantly, I counsel any primary care office to avoid any electronic interoperability outside the office. It opens one to HIPAA scrutiny, hospital bylaws, and other regulation and monitoring.

This is not an argument for primitivism, but for survivability. Today's primary care doctors had better learn to be less interconnected and more independent if they wish to render good and sustainable care.

Patrick Conrad, MDNiceville, FL