Hospitals dropping HMOs could be cure to managed care pressure on medicine
Regarding "Doctors dangle as hospitals jettison money-draining HMOs" (Article, Aug. 28): I am encouraged to see hospitals making wise choices. Virtually all physicians are dismayed to see the complete makeover of the profession by business-oriented entities. Therefore, when anyone within the health care system can play the "business card" back to the insurance companies, I feel a sense of delight and just retribution.
I recently was forced to leave private practice in a Seattle suburb. Clearly, in the insurance industry jargon, I was not capable of surviving in the new business climate of medicine. My threats to leave an insurance plan fell on deaf ears, whereas a major hospital pulling out of a plan must be taken seriously.
Perhaps if patients see hospitals dropping plans, they will then complain to their employers, the end result being a restructuring of the delivery of health care for their employees. After all, neither physician nor patient is the true customer of health care. It is the purchasers (i.e., employers) who truly matter.
--David Knoepfler, MD
Bellevue, Wash.
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Office based e-health systems effective, even as Web ones lag
Regarding "E-health fails to fulfill promise" (Article, Aug. 21):
Your article tends to tar office-based e-health and Web-based e-health with the same brush. Colorado family physician Steven J. Thorson, MD, is quoted in the article as saying he sees 25 patients a day and is always running behind. I see 30-plus patients a day and I do not run behind, thanks to e-health. Not e-health as found on the Internet, but e-health as found in a networked electronic medical record within my office.
It has taken me over 20 years on the bleeding edge of electronic medicine to get to a point where I can celebrate spending more good face-to-face time with my patient, thanks to scut-busting electronics. And I still have a long way to go.
Yes, electronic solutions are expensive. Blue-collar guys buy or lease $150,000 earth-moving equipment because a pick and shovel can't do the job. Are doctors so overeducated that they can't understand the same principle when it comes to the mountains of information we deal with?
--Peter Franklin, MD
Middlefield, Ohio
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Nursing shortage could be averted by use of nursing technicians
Your article "Money, responsibility key to alleviating nursing shortage" notes that nurses are giving up higher pay and looking for a greater scope of clinical responsibilities (Article, Aug. 14). Also, Geraldine Bednash, RN, PhD, was quoted as saying that doctors have a chance to take advantage of a scarce commodity situation if they offer more clinical responsibility.
I agree with this opinion. There are more allied health professionals, including nurse practitioners, physician assistants and midwives, nowadays working with physicians at various levels. They are performing admirable jobs where physicians do not go in adequate numbers, like rural areas and the inner city. So, I think "giving up a little ego" is not a problem at all.
Many years ago, the AMA proposed to solve the nursing shortage problem with the concept of nursing technician. If medical practice is being done by allied medical professionals and is allowed by law, I don't see why nursing care cannot be done by allied nursing professionals. If properly trained and supervised, nursing technicians can do a lot of work that is being done by nurses now, such as bathing, walking, transporting and even dispensing some medications.
Military corpsmen are not always nurses, and OR scrub techs and pump techs in open heart surgery perform excellent jobs. Another important thing is to relieve nurses from paperwork. Our hospital nurses are spending more time in front of computers than caring for patients. Nursing techs should be able to do some amount of paperwork for nurses.
Hospital nurses have to assume more responsibility and be able to examine, read charts and evaluate situations instead of being "a traffic officer" by calling physicians and not being able to answer questions about patients on the phone. Of course, they have to be paid more, reflecting their ability, experience, education and training, and they will assume more liability as well.
With fewer nurses and more allied nursing personnel, nurses will be happier because their clinical responsibilities and pay will be higher, physicians will be happier because patient care will be better, and administration will be happier because there will be fewer complaints from patients due to lack of answering calls from rooms or lack of prompt care.
--Ho Woon Lee, MD
Cortland, N.Y.
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