Letters to the Editor - Feb. 9, 2004

Reduce problem of uninsured Americans through a volunteer medical corps - Children and adolescents should not have access to morning-after pill - Cultural competence and communications skills are best learned in practice

Reduce problem of uninsured Americans through a volunteer medical corps

Change in American health insurance has long been a political football, advanced in downs marked by periodic waves of public outrage or legislative initiative. From a physician's point of view, the answers to public access and cost containment have never been that clear, primarily because so many of the cost issues (e.g., pharmaceuticals, insurance companies, corporate health plans) have been out of reach.

The problem with the politics of modern medicine is no different than that of Congress. We have become handicapped by our reliance on statistics, numbers and plans. American doctors and nurses would be better served to adopt positions of principle and vision, and then go to their constituents to find a way to make their goals a reality. One case in point is that of the uninsured.

In the United States, it is estimated that more than 40 million Americans are without any form of health insurance. Many of these individuals and families constitute the working poor. This is unacceptable, and many of these millions could be aided by a simple gesture of goodwill by the field of health care providers. Here is how I would do it.

I would start with the establishment of the American Medical Corps. Every licensed physician and nurse in the United States would be eligible to sign up to serve. Service would be for two-year terms, and every participant would be eligible for tax-deferred benefits and/or retirement plans in exchange for their work, based on hours contributed.

An average doctor, for example, would donate four hours per week. During this time, patients would be seen and treated who have no insurance. Surgical or facility expenses would be tallied by those affected hospitals, surgery centers and clinics in exchange for tax-related write-offs.

What I'm proposing is a form of community volunteerism. Something that would not be that difficult to organize and institute.

I actually e-mailed this same idea to the White House months ago. I didn't receive a response, and I didn't actually expect one.

But what I would expect from the health care establishment in this country is a positive response to an idea that translates a broad-based, hand-to-hand effort to deliver needed health care services to more citizens of this great land.

--Adam Frederic Dorin, MD, San Diego

Children and adolescents should not have access to morning-after pill

Regarding "Doctors assess impact of morning-after pill going OTC" (Article, Jan. 19):

With respect to your article concerning the proposal for nonprescription availability of the "morning-after" pill, the physicians of the American College of Pediatricians respectfully disagree with those who support such a change.

We are especially concerned for the health and safety of children and adolescents who cannot even access simpler, less dangerous, drugs without prescription and, usually, parental consent.

We are concerned about the lifelong dangers of frequent use. We know that adolescent reasoning and judgment is not yet mature and that they need our support. We want to safeguard them because we strongly believe that there is potential for physical and emotional harm in the uncontrolled use of levonorgestrel.

We therefore recommend that no matter what else is decided, children and adolescents should be protected. For the sake of their health, they should not be permitted to access this drug as has been proposed. We must always ask, "What about the children? What is best for them?"

--Joseph Zanga, MD, president, American College of Pediatricians, Greenville, N.C.

Editor's note: The American College of Pediatricians describes itself as "a national organization of licensed physicians and other health care professionals whose mission is to 'enable all children to reach their optimal physical and emotional health and well-being,' by valuing science above political correctness."

Cultural competence and communications skills are best learned in practice

Regarding "Patients say best doctors are ones who look like them" (Article, Jan. 12): I feel that your article is misleading. I agree that the language barrier is the main obstacle to good patient care. Patients' perceptions that they received better care when they visited doctors of their own race may be because of the elimination of this barrier.

"Cultural competence" and "patient-centered communication" cannot be taught in a classroom and are acquired skills that a physician develops over time by taking care of patients from various backgrounds.

As an individual who hails from India, I had to prove that I was a competent surgeon with interpersonal communication skills with my patients and colleagues. Almost all my patients were neither of my race nor religion. In 30 years of practice I never felt that any of my patients received inferior care because of their color or creed.

--Sully Ahamed, MD, Mystic, Conn.