Letters to the Editor - June 5, 2000.

Physicians tolerate treatment by lawmakers that others would not - Small-town setting keeps this family practice alive and well - It's primary care, not unneeded care

Physicians tolerate treatment by lawmakers that others would not

Regarding "Doctors warned of fraud liability" (Article, April 24): Rep. Ed Bryant (R, Tenn.) is quoted as saying that the answer to Medicare fraud is "a simple solution -- look to the health care provider with the deep pockets. Doctors are smart people. They have to get the message that they will be held responsible."

This is fairly typical of the response we expect from the people in Congress. They create a system that is so complex that even a special agent from the Office of Inspector General testified that the third-party biller involved in one criminal investigation "appeared legal," yet they expect physicians to take the blame and suffer the financial repercussions of that system.

There is not another industry in the country that would tolerate that kind of treatment. I can just imagine what would happen if the auto workers were treated similarly. There would be a march on Washington with every auto worker in the country screaming for Rep. Bryant's head, and he wouldn't be able to get elected dogcatcher in his own hometown. We, however, are expected to tolerate that kind of behavior. I still cannot understand why physicians have not bailed out of medicine at a far higher rate.

--Edwin H. Charnock, MD Desoto, Texas

Small-town setting keeps this family practice alive and well

Regarding "Vermont doctor puts new twist in fee for service" (Article, May 1): The subject of your article, Lisa Grigg, DO, in Wallingford, Vt., seems to have found a great way to practice medicine. I have had a similar practice in Ball Ground, Ga. (population 905) since July 1998. I purchased the practice from a local hospital that year and have established a small-town country doctor setting. I do not accept any HMOs and only a handful of PPOs, Medicare and limited Medicaid. The practice has grown mainly from word of mouth far more than advertising, which I curtailed 10 months ago due to rising cost. I still do -- are you ready for this? -- house calls!

I have visited some of the most interesting folks here in the mountains of north Georgia. The genuine honesty and respect I get from the local patients are far more gratifying than any big-city practice just 50 miles south in Atlanta. Due to traffic and a hurried lifestyle, most patients who commute to Atlanta daily still do not want to go there for their health care.

Like Dr. Grigg, I deal in quality patient time, not quantity patient time. Some doctors a few miles away boast that they see 40 to 50 patients or more per day, and eventually some of those patients come to see me. My usual time with new patients is 45 minutes or more. It is not uncommon for us to converse about the local traffic problems and even which farm pond is better stocked with bass as often as we discuss their medical problems. Family practice is still alive and doing well in Vermont and Georgia, and I would venture to say in a great deal of small towns all across the United States.

I would say to all hard-working family practice physicians, keep up the ideals you learned in medical training and treat every patient as if he or she were your family member. You eventually will have a large, growing practice with a waiting room filled with your "friends-patients." Keep up the great work, Dr. Grigg.

--Charles L. Coster, DO Ball Ground, Ga.

It's primary care, not unneeded care

Regarding "Fee for episode" (Article, May 15): I agree that capitation can be an extremely complex and risky tool for physician reimbursement. But I am very dismayed at the comments made regarding capitation by Richard Baron, MD, president and CEO of University of Pittsburgh Physicians. The article paraphrases him as saying that "many primary care patients don't need much care, and it can be cut back without harming quality."

As a practicing pediatrician who works both as a specialist and a primary care physician, I find those comments insulting and divisive. My primary care patients and my referred patients would not view the care I give them as unnecessary or excessive. If you were to decrease their access to me by one visit, I guarantee that they would feel that I was not providing high-quality care.

All forms of reimbursement have the potential to harm patients and society by unethical people. One could say that third-party insurance and fee-for-service reimbursement have been significant contributors to the current fiscal crisis in health care. The form of reimbursement is not as problematic as the way it is applied.

We need to solve the complex issues of reimbursement. Physicians have been sitting on the sidelines for too long, and we need to get into the game. We have allowed nonclinicians to make decisions that strongly influence the way we practice medicine. I believe that physicians know best how to care for patients, and we need to show that by providing high-quality, appropriate care. The right care in the right amounts done right the first time is guaranteed to increase all measures of quality, decrease medical errors and decrease expenses.

--Neil Kaneshiro, MD Woodinville, Wash.