Letters to the Editor - Jan. 19, 2004

All physicians and medical students should write advance directives - It's time to examine best approaches to physician-dentist collaboration - AMA meetings helped this physician scale all 50 state high points

All physicians and medical students should write advance directives

Regarding "Advance directives: Talk now about plans for care" (Editorial, Dec. 15, 2003): The tragedy of the Schiavo case in Florida makes a compelling case for advance directives.

If there are technical problems with an AD in an individual state, they can be remedied by fine-tuning the document.

I propose that all physicians and their families create ADs now (I have done so). I also have proposed to the dean of the University of California School of Medicine, San Francisco, that every medical student be instructed to create an AD for themselves now.

The purpose would be to educate each medical student as to the content of the actual document and to give them the ability to counsel patients based on knowledge as they enter their clinical years.

--Michael J. Franzblau, MD, San Rafael, Calif.

It's time to examine best approaches to physician-dentist collaboration

Regarding: "Oral health: Doctors, dentists collaborate" (Article, Dec. 1, 2003): Thank you for highlighting a health issue that is often overlooked in the medical community, oral health.

A valuable contribution to further discussion of the issue took place in June 2003. The Children's Dental Health Project, a Washington-based policy research and advocacy organization, coordinated an unprecedented invitational meeting to explicate issues at the interface of medicine and dentistry. "Interfaces: Explicating the Interfaces between Primary Care Dentistry and Medicine for At-Risk Young Children" (www.cdhp.org) included representatives from the American Academy of Pediatric Dentistry, American Dental Assn., American Academy of Pediatrics, American Academy of Family Physicians, and other dental and non-dental health professionals, advocates and policy-makers participated in this invitational meeting.

Among the key issues discussed were the advantages and limits of augmenting access through physicians, the age of a first dental visit and its association with risk, the value and nature of a referral for dental care, and interprofessional education and training. Improved cooperation, coordination and communication between physicians and dentists are strategies to address oral health disparities and disease burden.

Numerous issues beyond just educating physicians about the oral cavity need to be addressed if a valuable interface of medicine and dentistry is to be achieved. Now is the time to address some of these issues, evaluate the existing efforts, find best practices and disseminate them for the health of our patients.

--David M. Krol, MD, New York, N.Y.

AMA meetings helped this physician scale all 50 state high points

Regarding "Mountain-loving doctor climbs to great heights" (Article, Aug. 18, 2003) and "More than two physicians have scaled every high point in all 50 states" (Letters, Oct. 27, 2003):

As a follow-up to the article that featured Douglas Butler, MD, and a subsequent letter to the editor concerning other physicians who successfully climbed the summits in each of our 50 states, let me add my name.

My accomplishing this had something to do with the AMA; therefore this letter.

I was an alternate delegate from California to the AMA House of Delegates for a number of years. With our meetings in Chicago and our December meetings in various other cities, I would add a few days to the meetings and take that opportunity to do some of the states' high points. From Chicago in various years, I would finish off Minnesota, Wisconsin, Illinois, Ohio and Indiana. At a meeting in Atlanta, Florida, Georgia, Alabama and South Carolina would fall. At our Washington, D.C., meeting I finished off Maryland, New Jersey, Delaware, Pennsylvania and West Virginia. The Dallas December meeting allowed Texas and Louisiana to be done. In a way, my association with the AMA helped me to accomplish this.

As a footnote, the AMA had nothing to do with it, but I have also accomplished the high points in six continents. On some of the expeditions I was the team physician.

The combination of the professional and personal life has been rewarding and fulfilling.

--Reinhold A. Ullrich, MD, Rolling Hills, Calif.