Letters to the Editor - Jan. 26, 2004

Show of hands suggests why to expect a physician shortage - Violence and abuse are problems as significant as cancer or diabetes and must be addressed - Alternative to interpreter mandate: Patients can learn to speak English, as others have for centuries

Show of hands suggests why to expect a physician shortage

Regarding "Physician shortage predicted to spread" (Article, Jan. 5): I was at a medical conference recently and the room was filled with doctors sitting at round tables. Each table seated 10 doctors.

One of the physicians spoke up and asked, "How many of you have college-age kids?" Everyone's hand went up. "Now, how many of you have talked your kids out of going to medical school?" All but one hand went up.

I can sum up my feelings by saying that years ago organized crime was called the Mafia. Now it goes by the names "Medicare, Medicaid, HMO."

--Marcus C. Roberts, MD, Tifton, Ga.

Violence and abuse are problems as significant as cancer or diabetes and must be addressed

The news media remind Americans daily that tragedy is all around. Whether it is the drowning of children, the murder of a pregnant spouse, or classroom or workplace shootings, we are made aware of the fragile nature of our existence and our sense of security. We worry about strangers who may attack, rape or rob us, or death from unknown viruses or bacteria without cures. Yet, studies repeatedly show that the greatest dangers come from among those we know, from within our families and circle of acquaintances. Each year more than 900,000 children are abused or neglected and more than 1,300 of these children die; an estimated 1.8 million women are victimized by an intimate partner and more than 1,300 of these women die; more than 450,000 elderly persons experience abuse or neglect in domestic settings.

Violence and abuse affect the health care system in many ways. Victims of abuse suffer both physical and psychological consequences. The direct costs of violence and abuse are counted in billions of health care dollars. An even greater financial impact comes from long-term consequences of abuse. Adverse childhood experiences, including exposure to violence and abuse, lead to high-risk behavior, significant increases in chronic illness, and early death. This is a health care problem as significant as cancer, diabetes, or heart disease when measured by the number of people affected or by the dollars spent. As such, it demands the unwavering attention of the medical community and a financial commitment on the same order of magnitude as that given to other major chronic health issues.

Now that medicine is aware of the impact of violence and abuse on health, we are ethically obliged to act. As physicians, we have a professional responsibility to ensure that the prevention and management of violence and abuse among our patients remains a top priority. Improving our patients' health through the elimination of violence and abuse is a challenge that can only be met through broad participation. If your state medical society or national specialty association is not currently a member of the AMA National Advisory Council on Violence and Abuse, please urge them to consider joining this work.

--David McCollum, MD, AMA Advisory Council on Violence and Abuse

Chicago

Alternative to interpreter mandate: Patients can learn to speak English, as others have for centuries

Regarding "HHS eases interpreter mandate but doctors must pay the bills" (Article, Oct. 13, 2003): I don't remember going down the rabbit hole with Alice, but in the words of Lewis Carroll, things sure seem to be getting "curiouser and curiouser."

Doctors are required, at their expense, to provide interpreters for patients with "limited English proficiency," even if the interpreter cost is more than the service.

"Just accepting one Medicaid patient requires you to offer limited English services to all patients who have a deficiency in the English language," according to a source quoted in the article.

The example given was of a Hmong patient. I thought we were talking about Spanish, French and German, but Hmong? This has to be a humongous mistake.

Ignored is the U.S. communication program that has been remarkably successful for over 200 years and it certainly wasn't making thousands of individual doctors find access to the interpreters of hundreds of languages. (If this were proposed for other businesses, it would be ridiculed and defeated. Unfortunately the doctor abuse hotline does not exist and something too stupid for the general population is just fine for doctors.)

The successful program with the tremendous track record that applied to most of our ancestors went like this: Wake up, you are in America! If you want to communicate effectively with the population, provide your own interpreter or better still, learn English! Now language skills are a medical expense and the abdication of individual responsibility marches on.

Can you imagine me going to where Hmong is spoken and demanding they provide me with an interpreter at their expense?

--Edwin J. Masters, MD, Sikeston, Mo.