IOM: AMNews erred when describing our position on preventive care
Your story "Medicare pushed to cover prevention,"
(Article, Jan. 17)
which discussed a recent Institute of Medicine committee report, contained several errors.
First and most generally, the IOM report does not "push" prevention, as the headline and introductory paragraphs suggest. Rather, as the article much later stated, the report very clearly advocates an evidence-based approach to clinical and policy decisions about coverage. The article's introduction invented a position and a conflict with other experts that simply does not exist.
Second, the article incorrectly stated that the IOM had recommended coverage of skin cancer screening. In fact, the IOM committee stated that "evidence for the effectiveness of skin cancer screening is insufficient to support positive or negative conclusions about a new program of clinical screening of asymptomatic Medicare beneficiaries." But the panel did encourage clinicians and patients to be alert to the warning signs of skin cancer and to investigate suspicious signs further. Medicare already pays for such investigation of symptoms.
Third, the committee did not advocate broad coverage of preventive dental care. It reported that limited evidence supports a tooth-conserving strategy rather than an approach limited to aggressive tooth extraction for head-and-neck cancer patients prior to radiation to the jaw. It also reported that weak evidence supports treatment of acute dental infections for leukemia patients prior to chemotherapy. For the three other medical conditions the panel investigated, the evidence was inconclusive or lacking.
--Robert S. Lawrence, MD
Johns Hopkins University School of Public Health
Chair, IOM Committee on Medicare Coverage Extensions
Washington, D.C.
Editor's note: AMNews regrets the errors.
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Important to enjoy life and medical practice on a daily basis
I enjoyed reading "Capturing a bit of vacation can help fight daily stress" by Christopher Patterson, MD
(Article, Jan. 17). Certainly, many of us in practice are experiencing the same feelings that Dr. Patterson expressed.
But I think that one important take-home lesson from his article is that while vacations are a great way of relaxing and recharging one's self both mentally and physically, they are generally too few and far between to be a consistent substitute for enjoying one's life and medical practice on a daily basis.
While Dr. Patterson, I'm sure, will continue to enjoy traveling, he learned that it took a change of lifestyle and practice style to find the happiness he was really searching for. It always disappoints me when I hear colleagues say that they went on a cruise to Mexico because they "were stressed out" or traveled to the Caribbean because they "couldn't stand their practice." Shouldn't they be sailing because they like cruises or are looking forward to the ports they are stopping at in Mexico? Shouldn't they visit the Caribbean because they want to explore the sites and lifestyles of that area? Perhaps these people need to rethink their value systems.
I'm convinced that we all have a finite amount of energy with which to go about our lives. If we overstep the limits, we "max out" and fall victim to negative forces such as stress. Hopefully, we have set aside a certain amount of this energy for family, recreation and personal pursuits. A certain amount thus remains on a daily, yearly or lifetime basis to devote to our medical practices.
In the "good old days," almost all of this could have been directed toward issues dealing with direct patient care. But as Dr. Patterson mentioned, today's world is more complicated, since other factors such as malpractice worries, hassles with managed care and hospital takeovers of private practices have crept into the picture. If we are forced to devote a good portion of our energy to these distractions and still try to give the same amount as previously to our patients, we go over the "limit" and fall off the proverbial cliff.
This is known in more common terms as "professional burnout," a state in which we aren't of much good to anyone -- especially our patients. Sometimes it takes a total change of pace just to get one's self back on track. I guess this is why experts have come to call the practice of modern medicine a difficult juggling act.
I remember speaking to a former associate who retired a decade ago after a rewarding 30-year career. When asked what he enjoyed most about being out of medicine, his answer: "not to have to stay up at night and worry about sick people." I'd like to conduct a survey of doctors by posing a single question: If you could walk away from medicine today and still receive your current income with no strings attached, would you do it? I'm sure we'd be surprised (or maybe not so surprised) by how many takers we would have from our "noble profession."
--Bruce D. Greenberg, MD
King City, Calif.
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A 37-minute lesson on how health plans should not handle a call
It is with a sense of humor that I relate the events in dealing with what could be a simple matter. If I didn't maintain humor in this circumstance, I think otherwise I'd need soft restraints and a gag.
A patient of mine was told by her insurance company that she needed her physician (me) to give authorization for a certain medication. She relayed this to me, along with the contact number she was given.
Upon calling the contact number and going through the maze of "push one for this, push two for that, oprima numero tres para espanol," I got to a live person after about 2.5 minutes.
I introduced myself to the first person who took the patient's information and then transferred me to another number for providers. Once again I was caught in a network of choices that could only be made more intricate by a spider spinning a web. Then person number two answered after three minutes on hold. I introduced myself and let her know of why I was calling. She then transferred me to person number three, who took information and transferred me to person number four, who seemed like the person I was looking for. She took a lengthy amount of information, most of which I had to repeat because the "connection was bad," which, I surmised, was due to all these transfers and resultant signal degradation.
After about five minutes of repeating information, including slowly spelling the name of the medication three times (she obviously had no medical training whatsoever and obviously had not even heard of the medication despite its popularity in the lay press), she stated that I should hold for a short while so this can be sent to the proper person. (At this point I almost fell off my chair at the prospect of being tethered to my desk waiting for either another prolonged hold time or another vexing algorithm of touch tone button pushing.) It was the former, and the tether was 15 minutes long.
So there I was, 37 minutes into what should be a routine call, still on hold with patients stacking up in my office waiting to be seen. I had no choice. It was inevitable. I hate doing it. But I did it: I told Carol, one of my staff, to sit at her desk, stare at the phone, listen to the on-hold music blaring from the speaker and pounce on it at the first sign of a human voice. Diligently she did so, and after briefly removing me from a patient examination room, the matter was resolved.
Perhaps the reason so many people are dissatisfied with managed care in regards to customer service is that there are too many managers hampering what could be good quality customer care.
--Jordan Goetz, MD
Ledyard, Conn.
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