Letters to the Editor - May 1, 2000.

Take television cameras out of the emergency department - Concern over drug reps targeting PAs is "unwarranted and premature" - Drug reps give PAs useful information - Don't forget emergency department's role in health care safety net - American medicine R.I.P. Take television cameras out of the emergency department - Concern over drug reps targeting PAs is "unwarranted and premature" - Drug reps give PAs useful information - Don't forget emergency department's role in health care safety net - American medicine R.I.P. Take television cameras out of the emergency department - Concern over drug reps targeting PAs is "unwarranted and premature" - Drug reps give PAs useful information - Don't forget emergency department's role in health care safety net - American medicine R.I.P.

Take television cameras out of the emergency department

Regarding "Acting in the ER" (Article, March 27): Regarding filming television shows in emergency rooms: It is outrageous that such behavior is permitted, much less encouraged.

The invasion of privacy is deplorable, but there is an overarching issue.

The patient's well-being must always be the top priority. At best, television filming is a distraction to the doctors, nurses and other staff who should be concentrating on care of the patient. Worse, it changes their behavior. (Yes, they are human; it really does that!)

Then there is the matter of consent. Patients and their families are under the pressure of an emergency; they are not in a position to give valid informed consent. At a time of crisis, they should not even be asked. The physicians, television producers and others who claim that "ER," "Chicago Hope" and others are not sufficiently realistic or accurate have an alternative: They can create their own shows to their liking without abusing sick patients and their families.

Consent obtained after the fact is similarly invalid. The damage has already been done.

The AMA, the American Hospital Assn. and the American College of Emergency Physicians should act immediately to stop this harmful and unethical behavior.

--Charles Aronberg, MD Beverly Hills, Calif.

Concern over drug reps targeting PAs is "unwarranted and premature"

Regarding "Drug reps targeting nonphysicians" (Article, March 27): Although this article addresses several important points about the topic of drug company influence on prescribers, I feel that the concern directed specifically at nonphysicians is unwarranted and premature.

As a prescribing physician assistant, I accept the responsibility to educate myself from several sources so that I can best utilize medications to benefit and protect my patients. When representatives visit our practice, they see all prescribers. Subsequently we discuss new indications, drugs, etc.

For PAs, where the team approach to patient care is central, consistency among clinicians is maintained.

In this model, it matters little whether a drug company is "targeting" me directly as a prescriber. My goal is seamless care for our patients, and adopting my physician's approach to prescribing is essential to this effort. As PAs are supervised clinicians who adhere to this team approach, I feel that [the concern of some physicians, noted in the article, regarding] "nonphysicians practicing independently or without adequate physician supervision" does not apply to our profession.

Furthermore, the blanket characterization by Dr. Hil Rizvi of Fairmont, W.Va. [quoted in the article], of physician extenders as "lack[ing] the knowledge base to understand pharmacology and the complexities of medicine" is unwarranted. My education included pharmacology, medical management, statistics and competence interpreting research. This characterization is unfairly broad, and the insinuation that physician extenders will prescribe inappropriately for the price of a dinner is ludicrous.

Tracking prescribing habits with increased attention to nonphysician prescribers will eventually provide data to objectively evaluate marketing effects. Certainly the effect of marketing on all parties must be addressed.

--Roberta Knittle, PA Lakeland, Mich.

Drug reps give PAs useful information

I'm insulted that you've implied physician assistants are gullible practitioners who prescribe based on detailing and not on what is best for our patients.

As a PA, my supervising physician reviews my charts and is pleased with my prescribing. Also, when I trained at the University of Iowa School of Medicine, there was one pharmacology course taken by PA students and medical students. My knowledge base isn't lacking any more than a graduating MD.

Drug reps give me very useful information, not only on their products but also on cost and formulary issues. Plus, the samples they leave are much appreciated by the uninsured.

--Amy Beth Osborn, PA Tulsa, Okla.

Don't forget emergency department's role in health care safety net

Regarding "Report warns of breakdown of health care safety net" (Article, April 17): This article fails to mention the largest safety net -- emergency departments and the physicians who staff them. This is a huge burden and emergency physicians have been trying to highlight this to our local and state medical societies; local, state and federal representatives and senators; HCFA; state departments of insurance; third-party payers and anyone else who will listen.

Most of us are part of contracted groups that provide this uncompensated care out of our own pockets. We are not employees of hospitals that may or may not be able to apply this expense to more profitable areas.

We are required by federal mandate to evaluate any patient who presents to an emergency department for care without guarantee of any payment. Many of our patients are indeed uninsured and/or poor; but even for those covered by insurance, we not only are being forced to accept fewer dollars per relative value unit, but are also receiving increasing denials and downcodes by third-party payers -- much of it in contradiction to established "prudent layperson" statutes and CPT/HCFA documentation guidelines. We do need a focused effort in this area or indeed will face a collapse of the emergency safety net.

--David Packo, MD Canton, Ohio

American medicine R.I.P.

Regarding "Nonphysicians are simply not qualified to prescribe" (Letters, March 13): My first bit of advice for letter writer Jan Leard-Hansson, MD, is simple: Be patient.

With the current state of affairs in American medicine, one goes to school until he or she is in early middle age, only to enter a profession where he or she has all of the responsibility for the unrealistic outcomes demanded by the public but with none of the authority to make them happen. Then one must bludgeon an already slashed-by-insurer fee for service, and then face the possibility of a government accusation of fraud. See correction.

Soon, instead of applying to medical school, any college graduates with an ounce of sense will enter a career where their talents are valued -- and as far away from the government as possible.

Those whom, according to Dr. Leard-Hansson, "natural selection" has heretofore kept out of medical school will be the only ones left who are willing to enter medicine as a career.

My second piece of advice: Don't get sick. These people, "delusional" or not, will be our physicians in the years to come.

American medicine, you were once the envy of the entire world. Rest in peace.

--James A. Savage, MD Mount Pleasant, S.C.

Correction

An editing error changed the meaning of a passage in this letter. The published version indicated that, in the current state of medical care, physicians "must bludgeon an already slashed-by-insurer fee for service." However, the author's message was that physicians nowadays are forced to fight with insurers to receive a slashed fee for service. AMNews regrets the error.