Letters to the Editor - Dec. 25, 2006

If Florida's Supreme Court can't speak tort reform, perhaps the state's medical and legal leaders can - Find the right limits for e-mail consults between doctor, patient

If Florida's Supreme Court can't speak tort reform, perhaps the state's medical and legal leaders can

Regarding "Medical liability: Florida voters speak, but no one listens" (Editorial, Nov. 20): I can only concur that the Florida Supreme Court let down the citizens of this state as well as the physicians. To strike down, in all effect, a constitutional amendment approved by a majority of the citizens to limit legal fees in a malpractice case is a slap in the face of our constitutional right to amend the state laws.

It was recently announced that the Florida Medical Assn. president is working with the Florida Bar Assn. president to form a joint committee to explore issues of mutual concern that cause tension between the medical and legal communities in Florida. I would suggest a meeting to discuss alternatives to the present civil court system for settling claims of medical malpractice.

Isn't it time to create an administrative court with judges who have professional knowledge of the issues instead of lay juries providing judgments based on their emotions as much as the science of the matter? With more efficient courts and more reasonable settlements, the financial burden of medical malpractice will be reduced and distributed better to the victims who have suffered the injuries. Anything less is trying to tread water in quicksand.

--William Voltaire Choisser, MD, Orange Park, Fla.

Find the right limits for e-mail consults between doctor, patient

Regarding "An e-visit primer" (Editorial, Nov. 13): Seventy-four percent of patients want e-mail consultation with their physicians. It was not reported, however, whether patients are willing to pay for e-consultations, nor whether they are willing to accept a lower level of care.

Despite the AMA's call for e-care to supplement, not supplant, face-to-face care, many stakeholders consider e-care a convenient and economical substitute for office visits. Some estimate that e-consults could save $7 billion by converting face-to-face visits to virtual visits.

Non-procedurally based specialties are perceived to be a perfect fit for electronic care. In the most extreme view, one might handle the majority of such visits by phone or e-mail and still approximate health care.

Yet physicians do more than just process digital data. The best health care is based on personal relationships and is dependent on nonverbal as well as verbal information. Truly informed and shared decision-making is built on mutual knowledge, trust and negotiation.

Patients may choose electronic care in a survey, and then be quite dissatisfied in reality. (No one explained my test results. All they did was order a thyroid test. I'm still tired. Now what do I do? It turned out I had heart failure and all I got was an e-mail about my blood work.)

Likewise, physicians may think it is a great idea to receive electronic information about patients' home blood pressures, blood sugars or symptoms of cough, without an appointment, but then wonder why it takes so long to finish the day's work, the revenue is so low and the joy is gone. A random flood of fragmented information, presented out of context, requires substantial physician time, ability and resources to manage appropriately. Remote management is neither cost free nor optimally informed.

There are clearly benefits to adopting electronic communication for some tasks, such as appointment reminders, healthy lifestyle promotions, patient education and even patient access to their medical records; the challenge will be to incorporate this technology in a fair and functional manner. Appropriate boundaries between electronic care and face-to-face care are needed to avoid shortcuts that in the long run could shortchange patients, physicians and even payers.

--Christine A. Sinsky, MD, Dubuque, Iowa

Vote refines AMA stance on health reform
The AMA House of Delegates rejected attempts to rescind support of a U.S. House health reform bill and any new government-sponsored health insurance plan during the 2009 Interim Meeting.
Story - AMA House - Slideshow