Letters: Readers comment on Medical Economics stories

Be your own hospitalist

I enjoyed reading Dr. Fennelly's thoughts on PCPs' participation in hospital care ["PCPs: Get paid for hospital visits," June 20, 2008]. I, along with many others, surely agree with his thesis that communication between hospitalists and PCPs is vital and benefits the patient. However, I propose, as an additional solution, what many primary care physicians already do: take care of their own patients in the hospital. That is how we all were trained, and we should resist the voluntary or forced erosion of that privilege.

Indeed, recent work demonstrates that family physicians are more cost-effective than hospitalists, with negligible differences in length of stay ("Outcomes of care by hospitalists, general internists, and family physicians," N Engl J Med. 2007;357:2589-2600).

OMAR A. KHAN, MD, MHS, FAAFP
Wilmington, Delaware, and Burlington, Vermont

WHAT'S A PHR?

Thank you for an informative article ["The push for PHRs," September 5, 2008]. However, I believe you would help more doctors by explaining up front exactly what a personal health record is.

As I read your article, I wondered if we were talking about a chip a patient would carry, an applet in an EHR, or a website dedicated to patient info. I might be mistaken, but if most of your readers are like the docs in my group, it will leave them with questions about the specifics and a very short attention span.

JOHN LOUIE, MD
Pleasanton, California

Editor's note: A personal health record, or PHR, is a patient history of medical conditions, allergies, medications, immunizations, doctors, appointments, and other information that is stored online and can be viewed and managed on a web browser by both patient and doctor. The PHR will typically link to the patients' electronic health record kept by their doctors, but patients can open, maintain, and share their own records without linking to the doctor's information. Patients are able to alter and delete the information they post on the online record, but cannot change the information maintained in the doctor's file.

PATTERNS OF ADDICTION

I read with interest the recent article by Mark Crane ["Treating pain without fear," July 4, 2008]. He points out the importance of regular immunoassay urine drug tests in the treatment of chronic pain. In my multispecialty neuroscience practice, I have found regular UDTs and breath-alcohol tests to be the best tools to detect noncompliance in patient use of prescription pain medications.

A universal-precautions approach to treating patients with chronic non-cancer pain is essential. Given that about half of the risk for addiction is genetically controlled, perhaps the identification of genetic markers for addiction risk may play a clinical role in pain treatment in the future.

The challenge facing today's pain practitioner is a societal culture in which recreational, experimental, and self-medicated use and abuse of drugs, alcohol, and other substances is pervasive. These societal realities complicate approaches to the treatment of patients suffering from chronic pain. The majority of addictive disorders begins in patients less than 30 years of age. Instituting UDTs and breath-alcohol testing programs in middle schools (where addiction problems begin) and raising the legal drinking age may be steps that could help curb this trend.

JOHN W. GILBERT, MD,
Lexington, Kentucky