Divestment isn't only approach to advance public health, and other letters

The Aug. 4 cover story “Health systems urged to divest fossil-fuel stocks as UK doctors act,” highlights a vital issue for socially conscious organizations. However, the article seems to imply that divestment is the only credible way an organization can align its investment practices with its mission of improving the community's health. The alternative strategy of shareholder engagement, alluded to briefly, is never clearly explained.

Divesting from fossil fuel companies is a one-and-done approach. It makes a public statement and seems to leave the investing organization with clean hands. But it leaves no basis for further influence on a company's practices. Continued investment permits shareholder engagement, in concert with other investors and advocacy groups, to exert ongoing leverage on the company and its conduct. This approach may be less “pure,” but organizations committed to shareholder dialogue and high-profile proxy resolutions may have more impact on a company's practice than organizations that divest. At most, the jury is still out on which strategy is to be preferred. Of course, an organization that claims an engagement strategy must genuinely pursue it, not cynically use “engagement” as a cover for investment as usual.

David McCurdy

Regarding the story “ICD-10: Is it for clinicians or reimbursement,” this is a direct result of the crazy way we physicians get paid. There's such a conflict of interest built into the process that almost forces us to document to code rather than document for clinical reasons. We spend so much of our time having to describe the “leaves” in order to prove our productivity that we forget about the trees, let alone managing the forest that we are actually expected to do.

Dr. David Voran