Letters to the Editor - Oct. 25, 2004

Tax incentives for physicians would be effective in providing care for indigent - FP recertification test lacks focus on what front-line doctors need to know - If immaturity should preclude execution, then apply same standard to adolescent abortion decision - Verdict a victory against sham review

Tax incentives for physicians would be effective in providing care for indigent

Tax credits or vouchers will work in the effort to provide health care for the indigent. The physician that provides the service should receive a credit for each balance that he would otherwise write off. A tax break can be a meaningful incentive where little currently exists. If states feel they must regulate this, they can provide vouchers much like food stamps that the physician may accumulate and apply as a loss when filing income tax.

The humanitarian obligation is not exclusive to our profession. There will always be poor, and their needs will be great. The goal of "health care for all" is admirable, but reeks of socialism. In our otherwise capitalistic society, a provider (of any service) must enjoy some compensation for his efforts in order to continue providing that service.

--David Rankin, DO, Winchester, Va.

FP recertification test lacks focus on what front-line doctors need to know

Regarding "Testing ... testing" (Article, Sept. 27): As a member of the first group of family physicians to face the maintenance-of-certification process, I was actually excited about it.

Who could argue with what should be a better method of maintaining a better level of knowledge for the benefit of our patients? That lasted until I took the test. About 75% of the questions required knowledge so esoteric and academic that I had never had to use it in 28 years of family practice.

As always, the devil is in the details. If the American Board of Family Practice could figure out what a front-line practicing family physician really needs to know and test to that level of knowledge, then there is not much wrong with MOC.

--Everest A. Whited, MD, PhD, Pflugerville, Texas

If immaturity should preclude execution, then apply same standard to adolescent abortion decision

Regarding "Death penalty for minors: Cruel and unusual" (Editorial, Sept. 27): If the American Medical Association believes that, as described in the words of your editorial, "adolescents, even at the age of 16 or 17, underestimate risks, overvalue short-term benefits, and are more emotionally volatile, more impulsive and less capable of controlling their emotions than adults," would the AMA make as strong of a statement regarding teen pregnancy and abortion?

Would the AMA be willing to say that state laws permitting pregnant minors' emancipation and the right to abortion to minors without parental consent are wrong? It is obvious that a 16-year-old who gets pregnant is not mature enough to manage birth control or to comprehend the ramifications of getting pregnant. Why do we naturally assume that they are mature enough to handle the physical and psychological ramifications of abortion?

If the AMA is basing its stand on the death penalty on science and a teen's ability to comprehend consequences, then they should make as strong of a statement against the right to abortion and emancipation to pregnant minors.

You see, unlike adolescents, the adults engaged in this argument have the powers and foresight and an ability to grasp the consequences of their actions. Thus, the AMA should do the right thing: Form a unified statement speaking out against the minors' right to emancipation and abortion when they become pregnant.

--Derek Johnson, MD, Grand Rapids, Mich.

Verdict a victory against sham review

Regarding "Defamation award could chill peer review" (Article, Oct. 4): The recent win for ethical medicine, the case of Lawrence Poliner, MD, vs. Presbyterian Hospital of Dallas and three physicians, should indeed "send shivers down the spines" of unethical physicians and unethical hospital CEOs everywhere, who utilize sham peer review as a tool to silence physician whistle-blowers, eliminate competition or rid themselves of physicians they dislike.

Hospital CEOs and physicians who set out to destroy another physician's career, under the pretext of peer review, deserve to be punished severely. Physicians who conduct or participate in sham peer review also should have their medical society memberships terminated for their egregious violation of medical ethics.

The increasing prevalence of sham peer review damages not just the targeted physician victims, but also the integrity of the entire peer review process itself. Sham peer review is also doing great harm to quality of care and patient safety, as many physicians are afraid to point out deficiencies, problems or safety issues in the hospital setting, lest they risk retaliation by the hospital and the end of their careers.

Ethical physicians must support good-faith peer review, must condemn the practice of sham peer review and must hold the shammers fully accountable for their professional misconduct.

Eliminating the absolute immunity provision of the Health Care Quality Improvement Act, which has been used as a shield to protect the shammers, is absolutely essential for accountability and the return to ethical medicine.

--Lawrence R. Huntoon, MD, PhD, Jamestown, N.Y.

Editor's note: Dr. Huntoon is editor-in-chief of the Journal of American Physicians and Surgeons and chair of the Sham Peer Review Committee of the Assn. of American Physicians and Surgeons Inc.