Letters to the Editor - March 8, 2004

Many younger physicians less willing to get out of bed at 2 a.m. - Superhero-style dedication not the only way to practice good medicine - Work force planning requires looking at both the number and distribution of physicians - Primary care doctors need to ask patients about restless leg syndrome

Many younger physicians less willing to get out of bed at 2 a.m.

Regarding "Younger doctors less dedicated, hardworking?" (Article, Feb. 2): I am 57 years old and have been practicing maternal-fetal medicine as well as obstetrics and gynecology for more than 20 years. I have been in academic medicine for about 15 of those years.

Indeed, I can readily attest to the fact that many of today's (Generation X) doctors are "9 to 5ers." They do not want to get out of bed at 2 a.m. to see their patients. I have watched this unfortunate trend both in and out of academia.

Moreover, it is true for both male and female doctors. I put in about 60 to 70 hours a week. When my patients need me, I'm there. Not so with the "9 to 5ers."

Obstetrics is a beautiful specialty between the hours of 9 and 5; less glamorous between 5 and 9. The health and well-being of my moms, dads and babies are paramount! They are not a "sideline."

Nobody twisted my arm to get into medical school and residency. When my daughter gets to the point of needing an obstetrician, my advice will be to find someone with lots of gray hair. They have seen it and done it -- not just read about it!

Less dedication will not translate into better doctors, but more grumbling and unhappiness at 2 a.m. by the unwilling "9 to 5ers."

--Frederick E. Harlass, MD, El Paso, Texas

Superhero-style dedication not the only way to practice good medicine

To those doctors who came before me I say: You are right. I am less hardworking and dedicated to medicine than you are (Article, Feb. 2).

I finished residency in 1994. I am not available to my patients at all hours. I do not practice obstetrics. I do not accept frequent call and after-hours responsibilities.

All of us in medicine owe a debt to our predecessors and to society for supporting medical education. We all pay differently. For some it is simply to provide good service and compassionate care. Others work the late shifts and take lots of phone calls. Some superheroes do it all. (God help the spouses and families of the superheroes.) We all have strengths and weaknesses; let's support each other and strive for our best as a team.

--Anne Cooper, MD, Austin, Texas

Work force planning requires looking at both the number and distribution of physicians

Regarding "Medicare law aims to bring Alaska physicians in from the cold" (Article, Jan. 19) and "Evaluating the need for more doctors" (Editorial, Jan. 19):

In the mid-1990s I was an active participant in the AMA Young Physicians Section. Back then, we kept hearing about an imminent glut of physicians -- specialists in particular -- and the need for more primary care doctors to offset this problem.

All along I maintained the problem was maldistribution of specialists to the larger urban settings. Meanwhile, I've observed the use of increasing numbers of physician extenders to the point where "clinician" is used to describe almost anyone directly involved in patient care.

Your article on Alaskan physician work force issues reminds me of when I was stationed at Elmendorf Air Force Base as an Air Force psychiatrist; I was one of those on-base docs available to see military and retired family members. I am saddened to read about their transfer to a less-familiar care system as much as I'm dismayed at the dwindling numbers of military specialist physicians. Sacrificing the needs of the very young and the elderly is a common way to "improve programs" while diminishing service.

--Raymond M. Reyes, MD, Fairfield, Calif.

Primary care doctors need to ask patients about restless leg syndrome

Regarding "Patients toss and turn with restless legs, but don't tell," (Article, Dec. 15, 2003): Your article points out why restless legs syndrome is the most undiagnosed, common, morbid condition in primary care: Patients do not ask their doctors about symptoms.

But that is only half the reason. The other half is that we physicians do not ask patients about RLS symptoms. Why not? Time constraints of a busy, overworked office, and competing, more serious common issues for screening: diabetes, hypertension, lipids, smoking, diet, exercise, depression, social anxiety, sexual dysfunction, headache, etc. Another screening questionnaire is just too much!

I did it for RLS for three months, but my office staff rebelled. But, just as physician organizations are recommending reducing screening to just a few questions, so RLS screening can be reduced to just one question. "When falling asleep, or during the night, is your sleep disturbed by restless legs (crawling or aching feelings, and inability to keep your legs still?)" If that is too long, ask: "Do you have trouble sleeping at night? If so, why?" This question at all new patient comprehensive assessments, and periodic screening will uncover the large number of primary care patients silently suffering, losing precious sleep at night, and experiencing dangerous daytime fatigue.

--Robert Werra, MD, Ukiah, Calif.

Editor's note: Dr. Werra is a member of the Restless Leg Syndrome Foundation Advisory Board.