State eager to act against angry doctor, but not solve the real problem
Regarding "Working with managed care can take a toll" (Article, Sept. 11): I was astonished to read the article about Albert Ghassemian, MD, of Methuen, Mass. It appears that Dr. Ghassemian, in a moment of frustration, left several threatening phone calls on the answering machine at Blue Cross and Blue Shield of Massachusetts. Several of those threats were quoted in your article. To me they seemed as if they came from someone who was justifiably irritated at a capricious and senseless decision by Blue Cross.
The medical board sent one of its officials, accompanied by two police officers, to Dr. Ghassemian's home at 10:30 p.m. His license was summarily suspended. The board took an action that will forever remain on Dr. Ghassemian's record.
Admittedly, Dr Ghassemian's language was abusive. I do not condone this. But Dr. Ghassemian's outburst resonates with many of us in the trenches. The board seems to have made a mountain out of a molehill.
Instead of reacting so harshly to one of our own, could the board not seek a means to alleviate the frustrations that all of us who care for patients experience? A recent survey of doctors older than 50 stated that 38% of them would retire just as soon as they were able. How sad.
Unless there are facts which were not mentioned in your story, I for one will be happy to contribute to Dr. Ghassemian's legal defense fund.
--Ellen Spremulli, MD
Anniston, Ala.
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Internalizing anger at HMOs can take a toll
Your piece about physician frustration with managed care touched a nerve. While Dr. Albert Ghassemian vented his anger, I internalized mine. Two years ago, I developed major depression and had to close my practice of 10 years. I wish there was something more we physicians could do to let the public know what is happening. Unfortunately, medical school trains us to be stoic. "Physician burnout" is the medical profession's best-kept secret.
--Suzanne Tolbert, MD
Fort Worth, Texas
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Why doctors undercode
Regarding "Doctors alerted to pitfalls in Medicare undercoding" (Article, Sept. 18):
The difference between one Medicare code and another is just a few dollars, and basically Medicare patients are "money-losers," as evidenced by many insurance companies backing out of Medicare contracts. Medicare regulations are so complicated that many hours are spent trying to comprehend and comply. Meanwhile, the government has implied that it will look at an honest mistake as "fraud."
Undercoding will not prevent an audit, but even the Office of Inspector General would probably have trouble justifying fines and prison time for someone who has underbilled for their services.
--W. Charles Miller Jr., MD
Douglas, Ga.
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Include herbal use in patient history
Regarding "Herbal hype" (Article, Aug. 21): I believe all physicians should read this article and incorporate it into their practices. I was amazed at the amount of products that are available as herbal supplements. Many of us, including myself as a urology specialist, are really not attuned to the vitamins and herbs that patients are taking.
We have now included on our history and physical forms herbal supplements and vitamins underneath our medicine category, and I have included a handout to all patients on "herbal hype."
I also believe that the more patients who use herbal supplements, the more problems we will see with interactions with drugs and the greater chance of liability on our part.
We need to cover ourselves with advice to our patients, especially in written form, and document that in our medical records.
--Steven D. Rockoff, MD
Williamsport, Pa.
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