Letters to the Editor - Sept. 3, 2007

Medicaid should include incentives for patients in pay-for-performance

Regarding "Medicaid measures performance: The push to improve care and save money" (AMNews, Aug. 6): It is interesting to note the various ways Medicaid is measuring physician performance across the country.

As pay-for-performance grows, patient incentives should also. In some instances, it takes three requests from me for patients to complete requested laboratory tests.

If patients could be ranked or paid for completing a hemoglobin A1c test every year, they would likely be more compliant, which would contribute to better patient outcomes, the ultimate goal of good quality improvement initiatives.

--Victor O. Kolade, MD, Cheektowaga, N.Y.

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Allow compassionate and ethical involvement by doctors in executions

Regarding "CEJA: Ethics code does not allow physician participation in an execution" (Letters, Aug. 6): Mark Levine, MD, chair of the AMA Council on Ethical and Judicial Affairs, wrote that the AMA's Code of Medical Ethics has, for nearly three decades, held that physician participation in capital punishment is unethical.

After nearly 30 years, it's time to reverse the code guidelines.

I support Robert J. Cain, MD, of Starkville, Miss., and his contention that physician involvement in capital punishment is acceptable and should be rendered when necessary. The criminal who has violated the laws and mores of our society and has been found deserving of the ultimate punishment has, in essence, killed himself as a result of his actions, without any assistance from the physician who might place an IV.

To justify and strengthen the public trust in our profession, I call on all members of the AMA to lobby for change in the AMA Code of Medical Ethics to allow compassionate and ethical involvement in executions. There are times when the betterment of our world involves the removal of detrimental individuals. Certainly, physicians should support improvement in the quality of life.

--Stacey M. Fink, MD, PhD, Lititz, Pa.

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People want, need medical homes

Regarding "New evidence finds disparities aren't usually due to bias" (AMNews, Aug. 6): I agree with the AMNews article showing that medical homes reduce or eliminate health disparities. After our rural county's only ob-gyn died in 1989, our practice rotated sequentially through a three-month operative obstetrical training experience and returned to the county to provide obstetrical services (nonoperative and operative) as well as postpartum tubal ligations.

During a five-year period when only family physicians were delivering babies in our county, the minority infant mortality dropped 67% -- below white infant mortality.

Medical homes are what people want and need, but primary care is dying while insurance companies and hospitals make sure they profit. Our only hope is that more responsible leadership in the halls of government will prevail. It is my opinion that this will not happen unless more physicians run for public office.

--Oscar F. Lovelace Jr., MD, Prosperity, S.C.

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