OPINION

Letters to the Editor - March 24/31, 2008

Predominance of hospitalists has quality assurance implications - Motherhood is daunting but should not be recast as a disease

Predominance of hospitalists has quality assurance implications

Regarding "Study ties hospitalist care to shorter patient stays" (AMNews, Jan. 28): The lead author of this study published in the New England Journal of Medicine,Peter Lindenauer, MD, described hospitalists on a path to becoming the "predominant" method of inpatient care.

I can confirm this trend in my community. I worry about the quality assurance implications.

The role of the medical staff quality assurance apparatus is generally compromised by difficulty finding noncontracted members sufficiently free of conflicts of interest to serve. I'm concerned that if we further disable local medical staff ability to warrant safety of hospital care, outside interests will fill the void with agendas we all would just as soon avoid.

--Norman Joseph Harris, MD, Tustin, Calif.

Motherhood is daunting but should not be recast as a disease

Regarding "Beyond the baby blues: A spectrum of postdelivery conditions" (AMNews, Feb. 18): The acceptance of the ever-expanding DSM-IV, in a profession that views itself as scientific, is an amazing phenomenon.

As an MD mother of five, I have thought and felt every emotion described in the article, and I do not seek to make light of the horror of it. But the Edinburgh Postnatal Depression Scale, Speak Up When You're Down, and the granting of government funds will not produce the apparent goal of laughing mothers, peaceful fathers, and infants with advanced motor and cognitive skills.

It is a dark religion that tells mothers that the responsibility of caring for dependent human life is a matter best handed over to psychologists and support groups.

What sounds so compassionate will depress both patient and doctor as laws mandating depression screening bring yet more litigation against the obstetrician who recalls that no one slept well and all cried often when a newborn infant entered his or her own home.

The list of diagnoses reflects our efforts to build fantasyland in a fallen world and to accomplish it via increasing bureaucracy. Our determination to label human struggle as disease will soon make Huxley's Brave New World appear to be a child's bedtime story.

--Carol K. Tharp, MD, Winnetka, Ill.