Care should be supervised by allopathic or osteopathic physician
Your Nov. 22/29, 1999, article regarding chiropractors ("Illinois Blues HMO OKs chiropractors in primary care role") led readers to a misconception of the Illinois Academy of Family Physicians' position on the issue. Because the story used only the first half of a point made during my interview, readers are led to the assumption that IAFP supports the idea of chiropractors functioning in the role of primary care physician.
We support the idea of chiropractors working in integrated health care group practices, which include primary care physicians. But this does not make them primary care physicians in the full scope of the definition.
To clarify the position of the Illinois Academy of Family Physicians, we believe our patients are best served when their care is supervised closely by an allopathic or osteopathic physician. Many primary care physicians have referral relationships with chiropractors, just as we have with podiatrists, optometrists and others. Patients who regularly see chiropractors for musculoskeletal treatment may want to discuss other issues with their chiropractor. Chiropractors, though unable to prescribe drug medications, are licensed physicians under Illinois state law. But the final delivery of health care, from diagnostic testing to treatment and medication, is best provided by a family physician who is coordinating the care.
Family practice encompasses continuing health care for all age groups and both sexes. Family physicians treat and evaluate the whole person, taking into account every factor that can affect one's health -- genetics, family history, diet, prevention, mental health and disease management.
When asked, "Why would someone want to see a chiropractor as a primary care physician?" I replied, "I have no idea -- in my view, everyone should have a family physician as their primary care physician."
--Christine A. Petty, MD
President, Illinois Academy of Family Physicians
Rockford, Ill.
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Question prescriptions that are illegible or nonsensical
Regarding "Jury blames doctor's bad penmanship for patient death"
(Article, Nov. 22/29, 1999): I agree that a lot of physicians have poor penmanship -- as do many other professionals. It is something that I struggle with myself. There are times that neatness does not matter, and times when neatness is of utmost importance. As I read your article, I was rather perturbed the jury found the doctor negligent.
When I examined the image of the actual prescription, I, like the pharmacist, decided that Plendil was indicated. Then, I, unlike the pharmacist, read the rest of the prescription and saw that "20 mg Q 6 hours" is not how Plendil should be prescribed.
The next time I place an order for a prescription, there will be a line at the bottom that reads, "If any part of this prescription is illegible or not understood, it is your duty to call the doctor for clarification."
There must be a physician out there for whom this is not even an issue, someone who never would let an order leave his or her hand that could not be read at the second-grade level. But for those of us who struggle with writing and typing, I am grateful for the occasional times the pharmacist has questioned what I have written -- even when it was read correctly. If the physician and pharmacist are not willing to take the time to keep each other in check, then it's time, for the sake of the patient, to find a new job.
--Mark Pinkerton, MD
Monte Vista, Colo.
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Likely byproducts of safety report will be more bureaucracy, less care
I am deeply concerned about the way our country's leaders have responded to the Institute of Medicine's report on medical errors. While no self-respecting physician should fail to participate in developing and implementing solutions, our political leaders using this report to score "brownie points" with the voters is shameful.
What is this going to get the people of the United States? It will result in more bureaucracy and more paper work for health care practitioners and institutions, but less actual health care for patients.
Attempts by government and regulatory agencies to improve health care has needlessly increased the complexity of medicine. Consider the ongoing evaluation and management coding fiasco: Now I have the distinct privilege of being able to commit fraud by not putting quite enough words in the progress note.
I never have had the freedom to practice medicine in a time when all one had to be concerned with was patients. Now every encounter engenders thoughts about correct coding, malpractice, insurance denials, fraud etc. Medical practice itself is becoming more technically challenging with wider therapeutic options and more opportunity for adverse interactions. Therefore, if fewer errors are wanted, we need to simplify our lives.
If our leaders really want to reduce errors, they need to find ways to reduce physician fatigue, anger and frustration. Scrap the E&M complexity. Get that arcane dinosaur, the Joint Commission, off our backs. Don't let HCFA make our patients part of their "fraud posse." Give us real malpractice tort reform. Limit insurers' ability to question our judgment -- or at least make them responsible for their decisions. Simplify our lives; don't make them more complicated by empowering more government and private third-party intrusiveness.
--Jeffrey A. Pruitt, MD
Defiance, Ohio
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