Congratulations to Michael Romano on his excellent cover story, "Perception is everything" (March 7, p. 6), about problems in healthcare ethics. This was a complex subject made easier to understand by this coverage. As is said by another news agency of its coverage, yours was "fair and balanced."
Chief executive officer
Wheeling (W.Va.) Hospital
A different perception ...
Your cover story on ethics in healthcare mentioned a 2004 Gallup Poll, which found that physicians had fallen to No. 5 on a list of the ethical standing of all professions ("Perception is everything," March 7, p. 6). I believe it was a grievous oversight not to have noted that the same survey ranked nurses No. 1.
As the largest professional group in healthcare, nurses have surmounted overregulation, lean financial-management directives and political influence in healthcare to earn the public's highest trust.
I am sure there were many reasons physicians ranked No. 5, but they work in the same environment as Nos. 1 and 3 (pharmacists), which is the hospital. Perhaps we are, as Quint Studer aptly points out, filtering out the positives in healthcare (Letters, Feb. 7, p. 23). Could we not instead embrace the fact that of the top five professions identified in the Gallup survey, healthcare professions accounted for three?
Vice president of patient-care services
St. Michael's Hospital
Stevens Point, Wis.
... docs crying poor ...
The declining public opinion of physicians comes as no surprise as I've watched the evolution of the physician practice veer from its original mission of healing and caring to profit and more profit.
I have a difficult time listening and observing physicians crying about government reimbursement and insurance premiums when they drive away in a new BMW or Hummer to their million-dollar vacation "cabin" by the lake. (I believe that rural community doctors who are seriously struggling to keep the doors open are an exception.)
Chief financial officer
St. John's Lutheran Hospital
... call them pharmacists
Regarding your March 7 cover story, the time has long passed when the term "druggists" is an acceptable designation for our nation's pharmacists.
Edward DeLucie Jr.
Director of pharmacy services
South Nassau Communities Hospital
A specialty-hospital alternative
I have been following with interest the continuing battle over physician-owned specialty hospitals ("Healthcare's talking points," Feb. 28, p. 6). One thing both sides agree on is that competition and free markets are not inherently evil.
Why not do as the Federal Trade Commission mandates, which is not to allow restraint of trade? What would happen if the law prohibiting self-referral were changed to allow physicians to have partial ownership of hospital departments and/or services? Allowing hospitals and physicians to participate in joint ventures where profits and losses are shared would motivate hospitals and physicians to control costs, deal effectively with suppliers and negotiate with third-party payers.
Through alignment of interests, coupled with financial risk, hospitals and physicians would jointly work together to reduce costs, package services and demonstrate outcomes. This in turn would help develop a more cost-effective health system.
Orthopedic Specialists of Texarkana (Texas)
Money, time and litigation
I enjoyed Neil McLaughlin's editorial on the Joint Commission's study of medical malpractice issues ("Holy tort! A reasoned JCAHO study," Feb. 28, p. 28). In particular, I agree with his comment: "First of all, there wouldn't be any lawsuits if there weren't any errors." However, in 10 years in risk management, I have spent the bulk of my time dealing with claims that had no basis.
I hesitate to use the term "frivolous," because in my experience, there are many attorneys trying to get into malpractice law who don't know enough about healthcare to know whether or not a case has any merit. Even before there is a lawsuit, a great deal of money and time is expended to answer the letter of intent and go through the pre-litigation process.
Of course, this is in no way comparable to a huge award from a jury decision or even an out-of-court settlement, but it wastes a lot of time (the hospital's and the physician's) and it does jack up our healthcare costs. There ought to be some way to deflect some of these types of cases even earlier. There is a lot of litigation where there are no errors.
Director of quality and education
Jordan Valley Hospital
West Jordan, Utah
Lab automation pays off
Your recent survey on healthcare information technology ("This time they really mean it," Feb. 14, p. 42) correctly identifies clinical improvement as the top priority for IT spending. But as so often happens in discussions of healthcare IT, the contribution of the clinical laboratory was overlooked.
The Joint Commission on Accreditation of Healthcare Organizations reports that the laboratory provides as much as 80% of the objective evidence used for patient care. Thanks to automation, the data are available to clinicians far more quickly and reliably than before, speeding patient care and reducing risks of error. Although new solutions such as computerized physician order entry receive much of the attention, lab automation is already paying off both clinically and financially.
For example, automation so significantly reduces testing costs that it can provide a relatively quick return on investment, even as testing volumes rise.
Professor and director of clinical chemistry
Oklahoma University Medical Center
What do you think?
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