Letters to the Editor - Nov. 27, 2000

Advice from a doctor who did: "Throw off the chains" of third-party payers - Samples can be a lifeline for patients - The "killer app" for doctors is likely to be mobile - It will tak e time for doctors to adopt and adapt to the Internet

Advice from a doctor who did: "Throw off the chains" of third-party payers

Regarding "How should doctors bill for services? Follow the example that lawyers set" (Letters, Nov. 6):

Like letter writer John Hunt, MD, of Charlottesville, Va., I used to wonder why we had Medicaid and Medicare but no Legicaid or Legicare. The answer, of course: Lawyers constitute the largest single group of legislators, both state and national -- doct ors are rare.

I stopped participation with all insurance plans in 1993. My income went down a bit but my autonomy soared. I urge all of my fellow doctors to have the courage to follow suit -- throw off the chains of the third parties. If half the physicians reading this did so, we could get back to the way it's supposed to be -- only the doctor and patient deciding the course and payment of treatment.

--Mark Dillen Stitham, MD Kailua, Hawaii

Samples can be a lifeline for patients

Regarding "More clinics ban drug samples, citing cost, safety concerns" (Article, Oct. 16):

I have read your article about an academic physician group deciding to prohibit samples and institute a funded voucher program for patients who cannot afford medication. The group was contracted to be responsible for the cost of drugs, a component of t heir decision.

For practices that cannot afford to subsidize such a program, and for patients who cannot afford medications, however, samples may be a lifeline. Until the insurance industry does something to rationalize its pricing policy, or the nation realizes the need to support the cost of prescriptions, samples will remain a necessary evil.

--Steven Wolfson, MD New Haven, Conn.

The "killer app" for doctors is likely to be mobile

Regarding "In search of the killer app" (Article, Oct. 9): No one can agree on what the killer app would be to bring physicians online for two simple reasons.

First, one must consider both the types of networks and platforms on which these applications will be based. Second, because of a complex health care system, a modular suite consisting of multiple applications, rather than a single application, is more likely to achieve this goal.

It was ironic that in the same issue, another article announced the formation of the Mobile HealthCare Alliance, whose goal is to speed up acceptance of mobile wireless devices in health care ("Medical group, tech industry unite to tout wireless use").

In the opinion of many experts, mobile handheld wireless networks are the technological answer for the beleaguered administrative entanglement in which we find ourselves. Tethering the physician to a desktop application is unwieldy.

Of the two major handheld platforms, applications based on the Palm operating system have already had a major impact on streamlining and enhancing health care information technology workflow. As an early adopter and beta tester for the Palm-based handh eld wireless electronic prescription system, I have accomplished significant practice workflow improvement. Prescription-writing accuracy, appropriateness, speed and formulary compliance have increased, not to mention the significant time, security and sa fety advantages afforded to patients.

As mentioned in the first article, physicians want killer apps that are fast, cheap and secure. Companies that successfully develop and implement modular suites, consisting of individual wireless handheld applications that are efficient, inexpensive an d confidential, will likely become market leaders in the rapidly emerging wireless health care sector.

--Orin M. Goldblum, MD Pittsburgh

It will take time for doctors to adopt and adapt to the Internet

Regarding "The plugged-in crowd" (Article, Nov. 13): After working several years in the electronic health media arena, from medical television to interactive telephonics, and for the past five years or so, the Internet, I would suggest a simple phrase: Use common sense about the use of the Internet by physicians.

Unfortunately we don't account for the time it takes for busy people, especially physicians and other health care professionals, to adapt and adopt. Most studies of the Internet seek to demonstrate a major shift of physicians to Internet usage, primari ly to attract funding by the companies that fund those studies. In fact it is more like a gradual adoption process.

Carefully designed studies with adequate numbers of respondents reflect that busy doctors don't have a lot of time or access in their offices. They will make time, it seems to me, if the information is easy to use and will help them with their practice .

--Dan Mjolsness Chicago