The integration of Modern Physician and Modern Healthcare allows physician and nonphysician executives to share the same database. The first combined issue (February 2004) was a great start, with both magazines covering information technology advances. As Joe Conn noted in his editorial ("Calling a truce," p. 44), there are areas of significant conflict between physicians and health systems and hospitals, but advances in information technology provide common ground for collaboration. IT advances that improve the quality, safety and efficiency of health services are of interest to all, including and especially the patients all are dedicated to serving.
Additionally, the MP Stat e-newsletter continues as a valuable source of important breaking news for physician executives, and the Physician Affairs page in Modern Healthcare provides timely weekly updates.
Now if we can all use this information to focus on our patients and communities ...
Frank Byrne, M.D. Incoming president St. Mary's Hospital Medical Center Madison, Wis.
Plugged in or out?I found the recent issue of Modern Physician (February 2004) to be a paean to promoting info tech to medical practices. I also noted the source of the major portion of your advertisements to be IT companies. Hmm. Any connection?
After pricing several electronic medical records packages, I find the cost to be unacceptable in the continuing medical era of "do more with less reimbursement." If George Bush and Hillary Clinton want me to go electronic, they are going to have to free up some budget. The hospitals have been treated well by the feds. The docs have been cut and cut.
Remember that we are not allowed to pass along increases in overhead by increasing our fees; Medicare rates and dictated managed-care fees mean we are along for the ride.
Would I like to be able to go electronic? Sure. But I would also like to be able to take home some income, too.
Gary Cowan, M.D. Fort Worth, Texas
Keeping minds openRegarding the cartoon in the February 2004 (p. 4) issue of Modern Physician: What were you thinking? Is this supposed to encourage the physicians to have an open mind to new technology? My first response (and I am quite tech-savvy) was to ask you to cancel my "subscription," but I realized that that was counterproductive.
Think of your target audience.
Richard Perlman, M.D. San Diego
Doc says we got it wrongIn the February 2004 issue of Modern Physician, an article was written by Leigh Page titled "On the defensive" (p. 18). That article contains a number of erroneous and incomplete allegations, the most important of which is an inaccurate quote that is attributed to me that I "almost had a nervous breakdown" when I was sued for malpractice several years ago. That quote is wrong, as I never made such a statement.
The quotes attributed to me were purportedly from a telephone interview that was conducted more than a year ago. A very small portion of that telephone interview involved the lawsuit I was involved in, and yet the article appears to focus exclusively on that aspect of the discussion. However, the facts that are presented about that lawsuit are so abbreviated that they appear to be misleading. Indeed, I cannot determine where the reporter obtained information that "the sample was cancerous" or that the "results were delayed for months and the patient later died." I did not recite those facts, and they do not accurately reflect the underlying lawsuit.
In addition, most of the interview involved my observations of another physician I had previously worked with, Dr. Yoon, who had since moved out of the country. I advised the reporter that Dr. Yoon "almost had a nervous breakdown" from a string of malpractice actions that were filed against him. Most of the discussion I had with the reporter involved Dr. Yoon's emotional distress from the filing of the lawsuits, which I believed had been exacerbated by the lack of emotional support from either the hospital administration or from his colleagues.
Now, in the article, the reporter has taken my statement that Dr. Yoon "almost had a nervous breakdown" and completely changed the context to inaccurately portray that I "almost had a nervous breakdown." The quote attributed to me is wrong, and it inaccurately portrays me in a false manner.
Philip D'Arrigo, M.D. Bridgeton, N.J.
Money talks?Clark Bell's commentary on the government's moratorium on physician referrals to specialty hospitals in which they have an interest ("Legal interference," February 2004, p. 9) glosses over several key points.
First, healthcare is not a "free market." The presence of imperfect consumer information about cost and quality is enough to make it so, but add in government as the largest payer, employer-based insurance and barriers to entry in the provider market, and it is clear that the market is anything but free. The phrase seems to be applied to only selected circumstances such as physician-owned facilities.
Bell acknowledges that specialty hospitals will increase the burden of complex and uncompensated care on traditional community facilities and then puts forth the hope that such hospitals will receive higher compensation for their vital services. Let's wait for the latter before we allow the former.
Finally, he notes how much more efficient are hospitals owned and operated by physicians. This may be true, but it is a sad commentary when they only adopt protocols, standardize supplies and improve safety when they have a financial stake in the outcome.
Matthew Lambert III, M.D. Senior vice president of clinical operations Elmhurst (Ill.) Memorial Healthcare
Another perspective on OhioHealthThe issues surrounding the revocation of physician privileges at OhioHealth ("No instant relief for Ohio docs in privileges fight," MP Stat, March 5) does smack of economic credentialing but may be backed up by those physicians not performing the necessary minimum number of cases to maintain full privileges. Most physicians get around this requirement by reverting to a consulting staff position. It is still necessary that those physicians have a fully credentialed backup facility for admitting patients when necessary. These issues will come out undoubtedly during the process.
Gary M. Levin, M.D. Attending surgeon Loma Linda (Calif.) VA Healthcare System
Humor appreciatedRegarding "MGMA to put Physcape up for auction" (MP Stat, April 1), that lead, "For sale: Colorado mining operation," was great. Funny and very appropriate. It's nice to see some humor in what can be a very complex and arcane business.
James Harris President Westside Public Relations Culver City, Calif.
Dealing with intimidationRegarding "Hot-head docs create a climate for errors" (MP Stat, March 31, 2004), the brief summary provided of this study provokes several thoughts. The first, of course, is that national recognition and correction of problem behavior by physicians is long overdue. One hopes the initiative for proactively identifying and routing out unprofessional, inappropriate behavior by physicians would come from medical staffs and societies rather than hospitals, lay organizations, government or the courts.
This summary also may be construed as suggesting that the failure of personnel to address concerns regarding patient safety is mitigated if they feel "intimidated" by the physician involved in the care of the patient. Specifically, the summary stated, "Physicians who intimidate or berate caregivers are contributing to medication errors" because nurses and pharmacists are less likely to discuss concerns with them--even if the experienced intimidation was remote and despite the fact that such personnel are not supervised or employed by the physician.
I suggest that the idea that one's professional responsibilities can be mitigated by the remote interpersonal behavior of a second individual--especially when the second individual has no supervisory or fiduciary authority over the first--simply redefines "professional responsibility."
If we are going to offer staff understanding and support, it should be support to speak out against inappropriate behavior rather than support and understanding for failing to speak out if they feel "intimidated."
This study also highlights the need for studies to determine the extent to which "intimidation" is used to prevent not only paramedical personnel from addressing safety issues, but to prevent physicians from addressing safety issues such as inadequate practices by hospital personnel and administrators, insurance companies and other physicians.
The extent to which physicians not only subjectively feel "intimidation" but are actually threatened with termination or terminated and lose not only their jobs but their reputations and homes as a result of reporting inadequate care--as one hopes pharmacists, nurses and others will do, despite an ill-humored physician on the other end of the phone--has been reported by Steve Twedt in an investigative series in the Pittsburgh Post-Gazette titled "The Cost of Courage."
There is little doubt that the medical profession--and the patients who depend on it--would benefit from more professional, courageous behavior by its members. There is also little doubt that there would be more of both if whistleblowers were respected and protected, rather than persecuted without consequence or support, in many cases, not only by the law but also by hospital staff or medical societies. If we want to see a change in the behavior of others, it may well have to start with a change in our own behavior.
W. Harry Horner, M.D. Waynesboro, Va.
Unimpressed with Rhode IslandRegarding the Rhode Island story about the high cost of premiums and member satisfaction ("High health premiums equal high satisfaction in R.I.," MP Stat, March 8): Until I see a survey of "treated" patients and their "ratings of service" along with "outcomes" of the intervention and "quality of life" indicators, I remain unimpressed.
Ronald Pion, M.D. Special adviser Galen Consulting Group San Diego
Messenger, beware"I think if I had done this five or six years ago, I'd have been taken out and lynched." So says Robert Wachter, M.D., in MP Stat (Feb. 2, 2004), referring to his new book, Internal Bleeding: The Truth Behind America's Terrifying Epidemic of Medical Mistakes.
Wachter may think he is joking, but history confirms his notion. When Lowell Levin, Ed Weiner and I wrote our best-selling book, Medicine on Trial, it was met with an onslaught of hatred and threats from many in the medical establishment. The American Medical Association issued an "adverse commentary alert" to its member units suggesting state and local affiliates do all they could to discredit the book.
One affiliate even asked Yale University, where Levin was a faculty member, to review his tenure and status. Fortunately, we had thick skin and evidence to support our claims. The book sold more than 150,000 copies, and more than 80% of the studies we cited were referenced in the Institute of Medicine's To Err Is Human report.
The real tragedy is not the vitriol the established medical world has for heretics, but that they ignore the evidence and the findings. Little was done after our book was published 16 years ago to improve medical quality and frankly, little has been done since the IOM report five years ago.
Maybe Wachter's book will spark a little more action, but if I were him, I'd be watching my back.
Charles Inlander President People's Medical Society Allentown, Pa.