Letters to the Editor - Dec. 6, 2004

Preauthorization ploy promises safety and savings but delivers hassles - Advice to bright students: Don't go into clinical medicine nowadays - Turn off the waiting room TV

Preauthorization ploy promises safety and savings but delivers hassles

Regarding "Tightening the leash" (Article, Oct. 18): Before physicians and the AMA invest their entire focus and energies on tort reform as the most urgent issue confronting medicine, we should reread the article cited above to remind us that our long-term battle is as much, if not more, with the private insurers as it is with malpractice attorneys.

We have prior authorization programs for medication and now for diagnostic imaging. Compliance requires our time, and a lot of it, during our working day. That time translates to lost income for physicians, transferred from our wallets directly to utilization management firms that tout their ability to lower private insurers' imaging expenses. We can expect only further intrusive oversight programs disguised and marketed to payers and patients as premium savings and safety measures.

We must regain control over our practices. The AMA and the state societies must vigorously support us on issues like this. There's much more to the difficult situation physicians find themselves in than just tort reform.

--Michael E. Miller, MD, Boston

Advice to bright students: Don't go into clinical medicine nowadays

Regarding "Women leading climb in med school applications" (Article, Nov. 8): What struck me most about your article was the significant overall decline in all medical school applicants.

I presume that young people have seen the writing on the wall for American clinical medicine -- especially primary care -- in terms of shrinking salaries, the need to churn out patients faster and the hassle of working with insurers, regulators and lawyers looking over our shoulders.

I have been a family doctor since 1992, and I have taken great pride in helping patients take advantage of advanced diagnostic techniques, less-invasive surgery and better drugs. But I am fighting low-level insurance bureaucrats to get patients the care they need. I never thought I would tell a bright college student not to go into clinical medicine. But now I would.

--M. Dean Havron Jr., MD, Winchester, Va.

Turn off the waiting room TV

Regarding "New TV season, old problem: Entertainment violence" (Editorial, Oct. 11): I appreciated your editorial on TV violence and its effects on children. You urged doctors to get involved by discussing the issue with parents and youngsters. A laudable idea, but will it happen, given the time constraints faced by most family physicians?

Here's a more realistic way for doctors to get involved at the local level. They can start with their own offices. I can't tell you the number of times I've walked into a doctor's waiting room and confronted a blaring idiot box. In most cases, neither patients nor staff seem to care what's playing. Car smash-ups, shootings, explosions, risqué humor -- it's all become standard fare in doctors' waiting rooms.

Patients with the quaint notion that a waiting room should be a calm, peaceful, intelligent environment try to avert their eyes from the boob tube. They make attempts at reading or conversation. But the TV inevitably dominates the room, spewing out its offensive mix of daytime sex and violence. At times I have asked other patients, "Is anyone watching this?" and gone ahead and shut off the darn thing. I tend to get looks from receptionists as if I just landed from Mars.

Hats off to the few doctors who have not succumbed to this trend and who refuse to subject their patients to this lunacy.

--Mitch Mirkin, Baltimore