Letters to the Editor - May 23/30, 2005

AAFP president: Don't minimize the problem of uninsured Americans - Nurse: Isn't it time we stopped coddling doctors about computers? - Drug rep visits actually improve care for patients

AAFP president: Don't minimize the problem of uninsured Americans

Regarding "Uninsured a hard problem to grasp, solve" (Article, April 25): For the U.S. Dept. of Health and Human Services to pronounce that the number of uninsured may be only 9 million, when nearly all experts agree that the figure is at least 45 million and growing, does a great disservice to the American people.

No, the problem of the uninsured is not hard to grasp. Family physicians encounter it every day when patients come in with an advanced condition that could have been treated earlier or even prevented if they only had insurance cards. And we're seeing more and more people who are underinsured with extremely high co-pays and deductibles they simply cannot afford.

We provide care regardless of ability to pay. But for too many Americans, the lack of affordable health insurance is truly a matter of life and death.

The department's effort to study the uninsured population is commendable, but only if they are serious about real solutions. Whether a person is uninsured because they can't afford an insurance premium or because they simply aren't offered coverage in the first place does not change the fact that everyone needs to be covered for our system to work more efficiently and compassionately.

If they truly want to understand the problem, I would advise the department to take a close look at a new study by Todd Gilmer, PhD, and Richard Kronick, PhD, that shows the clear relationship between rising insurance premiums and the number of uninsured, projecting the number to grow to 56 million by 2013.

America's family physicians have put a bold plan on the table that would ensure coverage for all. It is time for action. Having public officials sow confusion about numbers and minimize the problem does nothing to help us solve it.

--Mary E. Frank, MD, president, American Academy of Family Physicians, Mill Valley, Calif.

Nurse: Isn't it time we stopped coddling doctors about computers?

Regarding "Technology can cause medication errors, study finds" (Article, March 28): Your article states that computerized physician order entry systems "aren't created with physician workflow in mind."

Unfortunately, not all health care issues revolve around physicians. It is a team effort. We all know the importance of physicians to the health care team, but their input must be legible to pharmacists, resident physicians, interns, nurses and other members of the team for treatments, medications and smooth workflow.

Isn't it time we stop coddling these players and expect that they join the team, instead of giving them special treatment? If physicians aren't part of the solution, then they're part of the problem.

Nurses and pharmacists must have clear directives from the physicians or medication errors will continue. Physicians must know what other physicians say in consult or medical errors will continue.

This is no longer the Stone Age, in which we carve out our instructions on tablets like the Ten Commandments. Physicians need to shed their old habits and embrace the advancements of the 21st-century health care initiative, especially by the use of computers. Computer usage is highly evolved in other industries; why do physicians resist it in health care?

--Anne Nowlin, RN, Huntley, Ill.

Drug rep visits actually improve care for patients

Regarding "Iowa practice draws notice for its 'no-gift' policy" (Article, Feb. 14): In AMNews articles, there is a need for the clinician "street" view of drug company representative detailing.

Doctors' are not controlled by pharmaceutical "bribes." If patients do well in brief and lucrative visits, the practitioner gains an enhanced reputation, more referrals and the feeling of achievement. What ravioli dinner competes?
Physician feedback is taken seriously by drug companies, resulting in new dosages, vehicles of administration and instructions. Many adverse effects would go unreported to the Food and Drug Administration without manufacturer persistence in chasing the clinician to complete onerous forms. One type of feedback that is given to pharmaceutical company officials is the aggressive demand for off-label research. They provide insufficient support of costly research to substantiate the use of off-label prescriptions, causing doctors to define the standard of care by clinical experience, rather than by rigorous group data.
Pharmaceutical dinners result in physician exchanges of experiences. The paid speaker will learn pearls of wisdom from the veteran audience, with a long-term value exceeding any fee to speak. Including annoying travel time, even a modest-income speaker is losing money, compared with providing local patient care. At these dinners, bad-tempered physicians often publicly bash the product and interrogate the speaker, asking about their toughest cases. From a pharmaceutical company perspective, these dinners are a mixed experience. And all dinners and sponsored meetings are counteracted by competitor events. True, generics might be underrepresented, except that members of the audience frequently promote them in comments.
For five minutes of time listening to a detail rep, a physician will receive $200 to $400 worth of brand-name samples. It is often a choice of these samples or no treatment for uninsured patients.
Finally, most "propaganda" materials are reprints from the leading journals in medicine. After receiving 20 per month, one is only receiving a wide range of articles that one should be aware of anyway.

Drop the false caricature of physicians as naïve lemmings who are on sale for trinkets. We can eat and say what we think while accepting expensive life-saving samples all at the same time.

--David Behar, MD, Bethlehem, Pa.

--James L. Schaller, MD, Naples, Fla.