Computers work. So when will doctors get the message?
Regarding recent articles and media broadcasts on doctors' bad penmanship and medical errors: Bad penmanship and illegible scrawls can be cured with printouts from the dumbest of computers. If one wants to save time and improve readability, add a few "smarts" to a machine's program and one key-press can create, sign and authenticate one to thousands of chart entries, orders and prescriptions all day long.
With a little more software engineering, patients' charts can be automatically presented. This alone can cut a diagnostician's errors simply by rereading the old data. Any encounter, transaction or chargeable procedure can be automatically machine-coded to satisfy the Health Care Financing Administration and any other fussy insurance payer. Overhead expenses drop, transcription typing is slashed and net income inevitably increases to some degree. But try and tell hard-headed docs the good words.
As a group, they are awful about taking up new things. I can write this because I "are" one.
Physicians still need more "telling" about information processing. The military does it this way: 1. Tell raw recruits you are going to tell them. 2. Tell them. 3. Then, tell them you told them. So, some of us who have messed with medical informatics for a long time are telling our friends (again) that computers can work.
--Karl T. Dockray, MD
Lubbock, Texas
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Nonphysicians are simply not qualified to prescribe
Regarding "Georgia is ground zero for scope-of-practice firefight"
(Article, Feb. 7): I don't get it ... or maybe I do! Who are these nonphysicians who want to prescribe? Why would natural selection keep individuals from these small, vociferous, renegade subgroups (within these professions) out of medical school? Answer these questions, and you'll understand the pseudo-delusional belief that they, too, can function as physicians.
As a former licensed Canadian pharmacist and a current resident in my last months of study, I have written to governors of states where this issue has come up. My message is simple: To prescribe medication properly one must understand patients from head to toe. This requires (even demands) one to gain knowledge and experience by years of intense study in most subspecialties of medicine. A few pharmacology courses is only a small piece of this process.
As a psychiatry resident, I have seen this ongoing battle waged by psychologists. A key part of their argument centers around the need for care in rural areas. They state that by gaining prescribing privileges they would be able to provide care for these patients. Here is the funny part: There exist innumerable articles stating that cognitive behavioral therapy is as effective as medication in mild to moderate depression. So why do they not go to these communities and treat these patients with skills they are actually qualified to use? What are they really up to?
In fighting these repetitive battles to protect patient care, physicians use time and resources. I am no lawyer, but why not sue these organizations for reimbursement of our time and resources in protecting patients? Maybe this will put a stop to this waste.
--Jan Leard-Hansson, MD
Rochester, Minn.
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Physicians have valid reason to bring own staff along to hospital
Regarding "Specialty societies sue HCFA over denial of staff time pay"
(Article, Feb. 7): It is true that it is not typical for most specialists to bring their employees to the hospital with them. But those who do, do so to provide better patient care.
I just finished two neurosurgical operations where the experience and training of physician assistants and nurses employed by the neurosurgeon made a difference in the timely preparation of the patient, the smooth flow of the surgery and in the post-op recovery program. Having to use nurses or techs who do not do neurosurgery frequently could be detrimental to our patients.
When I entered practice, our group employed RNs and individuals who assisted us with anesthesia preparation and maintenance of equipment. I am no longer part of a large group; the hospital took over providing us with an anesthesia nurse and equipment technician. I can assure you that when we hired our own they worked long and hard and helped us provide better care for our patients.
--James R. Moyes, MD
Lubbock, Texas
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Next time just skip the Bill Clinton photo (and Al Gore, too)
Your Feb. 14 cover shows President Bill Clinton in a very photogenic pose. I think that you could have done this report without showing his (and, for that matter, Vice President Al Gore's) face.
You are portraying him in a positive light, and I resent that. After all, he wants to socialize medicine, not to mention take away my guns and my cigars.
--John E. Pipas, MD
Syracuse, N.Y.
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What New Jersey society president really meant by "real doctor"
It was quite apparent that my quotation in "N.J. governor wants tobacco money for health coverage"
(Article, Jan. 24) appeared out of context from the larger issue being discussed -- New Jersey's proposal to use tobacco settlement money to subsidize health care programs for the uninsured.
In describing the position of the Medical Society of New Jersey, I stressed the following points:
- The use of emergency services for relatively routine illnesses is costly and an undesirable application of emergency department physicians' special training and skills.
- Insured persons are more likely to have a primary care doctor, which is a more appropriate and cost-effective setting for routine health care services.
- Subsidized health insurance would cut the need for hospital-based Medicare and uncompensated care.
I greatly admire the job that emergency physicians perform under difficult circumstances. Use of the colloquialism "real doctor" should not be misconstrued as an aspersion on this vital specialty or those representing any of my fellow physicians.
--Irving P. Ratner, MD
President, Medical Society of New Jersey
Lawrenceville, N.J.
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