Letters to the Editor - March 22/29, 2004

Pharmaceutical gift reporting is an example of intolerable micromanagement - Drug company gifts should be low priority given medicine's challenges - Physicians aren't what they used to be -- neither is a life in medicine

Pharmaceutical gift reporting is an example of intolerable micromanagement

Regarding "States ask drug firms to report gifts to individual physicians" (Article, March 1): Every time a discussion comes up on guidelines for pharmaceutical company gifts to physicians, I feel as if I need to take a blood pressure medicine to keep from a having a stroke.

Now I read where several states are considering having the pharmaceutical industry report to them the gifts that have been made to physicians. One state, Massachusetts, even is considering tying the reporting to licensure. How utterly ridiculous.

What we need is to have all state and national elected officials report to all of their constituents all of the junkets, meals, gifts, favors done for family members and donations received from the billions of dollars spent on lobbying them each year.

Of course all of this doesn't increase the cost of anything. (Yeah, right, just everything we buy in the good old USA.)

Yes, I know that our elected officials are much wiser and are immune from being influenced in any way compared with common physicians. Yes, I also know that buying my wife a meal will result in terribly inappropriate prescribing habits.

If you want to talk about cost and accountability, start where the problem is the greatest -- with lawmakers. Leave the hardworking physicians alone, and let them do what they were educated and trained to do. Medicine and physicians have had about all of the micromanagement that they can stand.

--J. Lee Valentine, DO, Meridian, Miss.

Drug company gifts should be low priority given medicine's challenges

I read with great interest the front-page article (Article, March 1) about the reporting of gifts to individual physicians by pharmaceutical companies.

I have very mixed feelings about this. It's hard to debate that gifts to physicians have an influence in our prescribing habits. But I'm dismayed as to why our lawmakers need to tackle this problem rather than the real problems facing medicine.

We are in a malpractice crisis, an insurance crisis, a reimbursement crisis and a drug-cost crisis. Perhaps after all of these problems are addressed we can look to how many steak dinners it takes to raise the price of medications.

Oh, and by the way, I wish I had time to go to a nice steak dinner. Unfortunately, I'm at the office most nights until 8 p.m. or 9 p.m. because I am in the middle of a malpractice crisis, an insurance crisis, a reimbursement crisis and a drug-cost crisis.

--James Dom Dera, MD, Fairlawn, Ohio

Physicians aren't what they used to be -- neither is a life in medicine

Regarding "Younger doctors less dedicated, hardworking?" (Article, Feb. 2): If young doctors are, in fact, less dedicated and hardworking, let me propose a few reasons why this might be the case.

As a young doctor about to enter practice, I am not naïve to the reality that the golden era of medicine is over. Much of what made internal medicine enjoyable has been lost.

In training, there are fewer positive role models, less time for and interest in teaching, and more testing/licensing hoops to jump through.

As we enter practice, deeply in debt from our medical school loans, we inherit a medical system in shambles.

Reimbursement is low.

Autonomy is low.

Job satisfaction is low due to ever-increasing levels of bureaucracy.

Rewarding, long-term doctor-patient relationships are a rarity now that patients must frequently change doctors as mandated by their health plans.

Amid this, we also see many older doctors with failed personal lives. I have a friend who delivered more than 6,000 babies during an esteemed career as an ob-gyn, only to have his marriage end in divorce and his children grow up resenting him because he was never around for them.

For those fortunate enough to sustain a healthy family life, it is likely that they had a stay-at-home spouse who managed the family affairs, allowing them to focus solely on their careers.

Such arrangements are rare these days; more participation in family matters is expected from doctors, both male and female.

This does not preclude a fulfilling career in medicine; we simply need to harmonize the realities of practicing medicine with our other obligations in life.

This is achieved through balance. We are looking for role models.

--David Liljenquist, MD, Chicago