Sample ban hurts patients
The decision to ban drug samples by the University of Wisconsin Hospitals and Clinics in Madison (Article, Oct. 16) is money-saving-friendly, but is also extremely patient-unfriendly.
I've been in the practice of internal medicine for over 30 years, and I can in conscience say that there are subtle differences between drugs and how a patient feels on and/or reacts to them. No two patients are alike. One ARB may cause palpitations when another ARB antihypertensive won't.
Only a front-line clinician, along with the patient, is in a position to discern these subtle differences. I can say before God that these minor subtle differences may not mean much to pharmacists and insurance companies, but they mean everything to the patients whose ability to function and feel their best depends on the doctor-patient discovery of these nuances.
In my opinion, banning drug samples, frankly, is an act of cruelty. It comes from a well-intentioned but ignorant position. You need to be on the front lines, folks. In regard to the security issue, step up audits if necessary, but please don't hurt my patients!
--John Kuhn, MD
Weston, Wis.
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The cure for case review: A quick insult followed by hanging up
Regarding "Pediatric hospital stay goals questioned" (Article, Oct. 16): In your article, the spokesman for Seattle-based actuarial and consulting firm Milliman & Robertson Inc. seems to suggest that their length-of-stay goals are ideals worth striving toward.
In my world of ideal medicine, nobody would get sick because everyone would be immunized against everything, including cancer and atherosclerosis. I doubt that my ideal is any more out of reach than Milliman & Robertson's.
Any physician who is suffering the misfortune of getting caught on the telephone with a case reviewer who uses Milliman & Robertson's "guidelines" might try some of these lines to keep their conversation short:
"Would your medical director like to come do a consult on the patient and put that recommendation in writing?"
"Who is your medical director, and is he or she licensed to practice medicine in this state?"
"Who are the consultants behind your guidelines? I'd love to ask one of them to consult in this case."
"Case reviewers" are telemarketers trying to peddle inadequate medical care. We shouldn't let them mess with our minds. Insult them quickly and hang up.
--David Grant, MD
San Antonio
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Medicine now just a job; we're all just cogs in the machine
It's interesting that many physicians now are aligning themselves with the Democratic party, apparently because of the HMOs and what they have done to the practice of medicine.
Isn't it ironic that we who are such apostles of the free market suddenly change our tune when our bailiwick is threatened?
If the free market is such a cure-all and the HMOs are such abominations, then won't they simply die and be replaced by something else?
It's the old story, just like the teachers and the post office: Competition is good for your field but not mine.
Face the facts, guys: Medicine is no longer a vocation nor even a profession -- it's a job. Each one of us is simply a cog in a huge money machine and we'd better produce or suffer the consequences.
We brought it on ourselves.
It began when the very first physician or administrator signed the very first insurance form and accepted payment from the first insurance company.
If we want to return to being professionals, then we should accept payment only from the patients.
--Roderick T. Beaman, DO
Johnston, R.I.
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