PAs are not seeking to take over role of physicians in patient care
Regarding "Physicians' special knowledge lets us land the plane"
(Article, Feb. 14): Columnist Eric Anderson, MD, used an excellent metaphor when he wrote about physicians and flying. Pilots rely on a cohesive team in the cockpit, in the galleys and on the ground to make sure the planes fly well. In today's delivery of care, physicians, too, need a team to ensure patients receive coordinated, comprehensive, quality medical care.
Physician assistants, unlike other health care professionals, have always recognized the physicians as the pilot of the health care team. So I was concerned when Dr. Anderson wrote that PAs "want to play doctor."
Our role is to help fly that health care plane -- to provide quality medical care services within our field of knowledge and experience and as delegated by a physician. We strive for an interdependent team based on mutual trust, open communication and respect for the skills of each profession. It is quality teamwork that will make a difference for patients.
--William C. Kohlhepp, PA
President
American Academy of Physician Assistants
Alexandria, Va.
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Simple and free cancer screening test exists in form of the "MVROCST"
It appears that still, after nearly a century of misdirected effort, the medical establishment continues to be unable to clearly see beyond the forest because it spends such an extraordinary amount of time chopping down each individual tree.
"Early screening for lung cancer gains renewed interest"
(Article, Jan. 17) seems to indicate that continued research is needed to determine at-risk individuals for lung cancer. The article points to promising areas of research, which include x-ray, CT, genetic markers and biomolecular markers.
Nine years ago, I published instructions on the use of a "simple, noninvasive, cost-effective and efficient screening mechanism that is nearly 100% sensitive in identifying potential lung cancer in asymptomatic persons." The MVROCST (monosyllabic verbal response office cancer screening test) requires the physicians to state clearly, "Do you smoke?"
Based on the results of this test, the patient is either at risk or not. If at risk, intervention can be instituted immediately, right on the spot. This test is far more efficacious than waiting until cancer actually occurs and grows to the point where it shows up on x-ray or CT.
What's more, the therapy (smoking cessation) is far simpler, more effective, less costly and carries significantly less morbidity than intervention after detection by other proposed "screening" methods.
Spending additional millions on research to gather more data on "screening" is not the answer. The MVROCST is far more accurate, free and available universally now. The answer is getting the physician to use the MVROCST and, thereby, become more involved in prevention.
--John W. Richards Jr., MD
Martinez, Ga.
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Care compromised by PA sites only remotely supervised by physicians
Regarding "Georgia is ground zero for scope-of-practice firefight"
(Article, Feb. 7): The piece doesn't mention the vast corruption in the use of physician assistants. Once prescriptive license was given to PAs, the HMO/Medicaid/Medicare industry (all state and federal agencies are behind this) pushed forth with physician extenders setting up sites remotely supervised by off-site physicians.
The care and quality is now at the bare-bones customer service level; frequent and unnecessary use of antibiotics, frivolous consultant referrals and ignorance of emergent conditions are rising. Urgent care units have been taken over by PAs and nurse practitioners and, consequently, referrals to emergency departments are widespread. Physician extenders are simply using these sites to mill-process patients, and supervising physicians at remote sites are given politically correct instructions and incentives to refrain from intervening.
Never did I imagine that modern medicine would be watered down in such a pitiful fashion. Primary care is widely misunderstood by HMOs, legislators and government bureaucrats.
Who can argue that without the in-depth graduate-level basic sciences in medical school curricula, clinical decisions are even feasible?
Every product literature requires an in-depth understanding of complex pathophysiologic, pathologic, pharmacologic, biochemical, physical diagnostic and differential diagnostic features.
Organized medicine needs to gather its resources, because the ship is on its way down.
--Hil Rizvi, MD
Fairmont, W.Va.
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Tired of health plan telephone troubles? Bill plans for lost time
Regarding "A 37-minute lesson on how health plans should not handle a call"
(Letters, Feb. 14): I suspect that I am just one of many who can empathize with the telephone troubles of letter writer Jordan Goetz, MD. Fortunately, as a surgical subspecialist, I rarely find myself in the situation he so eloquently related.
I have, on a few similar occasions, taken detailed notes including names and times for purposes of documentation. I have then sent a letter to the offending insurer, detailing the experience, along with a bill for the time spent at a rate of $500 per hour, making sure to send a copy to the plan's CEO and medical director.
At the very least, this action has usually resulted in a telephoned or written apology. One insurer actually paid the bill.
Think of how satisfying it would be to send them to collection or file suit in small claims court for nonpayment.
--Mark S. Soberman, MD
Washington, D.C.
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