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Letters to the Editor
Primary Care February 2003
Saving American Medicine
To The Editor:
“Idealism of Medical Students: What Happens To It” was
the title of an article I read more than 40 years ago. I remember
thinking, “Those,
cantankerous old docs and their pessimistic views, that will never
happen to me.” Guess what? I was wrong! And judging from
your recent editorial (Don’t Just Complain…Write! 27[9]:11-12,
and the letters to the editor that followed, I am not alone in
my opinion. How and why did American medicine change so drastically?
How did all these “individuals smart enough to get to medical
school” allow themselves to be victimized by the insurance
industry and plaintiff attorneys? How did we permit the dismantling
of the best medical system in the world? To paraphrase William
Shakespeare, the fault dear doctor lies not with the insurance
companies or with the legal profession but within ourselves.
We have allowed the insurance industry to dictate how we can
practice our profession. We must justify prescriptions, treatments,
patient
visits, laboratory and radiological procedures, surgeries, and
referrals. The insurance companies have created a whole new industry
called medical coding, which is based entirely on minutely justifying
doctor’s procedures and diagnoses. And all the while the
companies reduce our compensation and infer to our patients that
we are charging over the “allowable and customary.”
Now add to this morass the white knights of the legal profession
who with their frivolous lawsuits are “protecting our patients
from all the bad doctors” of this country, and you have the
reasons physicians are quitting.
Why have all these negative intrusions into our practice of medicine
gone unanswered? Suffice it to say that we were too busy caring
for patients and thought that either the American Medical Association
or our specialty organizations would halt these intrusions. The
bottom-line is we failed to listen to the employers paying the
insurance premiums or to the patients who told us to monitor our
own profession.
The time has come for the physicians of this country to speak up,
defend themselves, and make recommendations regarding the future
of American medicine. We cannot remain reactive to the whims of
the insurance companies or the plaintiff attorneys’ derogatory
opinions. We must present ideas and solutions to this crisis before
others do it to us or for us. We, the ones who practice medicine
and not the ones who push the computer keys. We, the ones who care
for the patients and not the ones who putatively protect the patients
from the “bad doctors.” We, the ones who deliver those
babies at 3 am and not the ones who interpret the codes from 9
am to 5 pm. We, the ones who endure the vicissitudes and challenges
of surgery and not the ones who justify our surgery. We, the ones
who stop the buck and not the ones who explain to their shareholders
how many bucks are distributed.
We must speak as one voice: specialists, family practitioners,
academicians and clinicians. We, the ones who have spent all those
years learning how to care for people must again take control of
caring for them.
We must explain to our patients and their employers that it is
the physicians who care for patients, not insurance companies.
They have already come between us and our patients. They have
portrayed
us as the bad guys and reduced our stature by making us providers
rather than physicians. For the sake of our patients and American
medicine, we must act now.
Irwin J. Kerber, MD
Dallas, Tex
Creating Congenital Anatomic Defect
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To the Editor:
In the article “Recurrent Recurrent First Trimester Pregnancy
Loss: Is PGD the Answer?” [Chen SH, Escudero T, Sable DB.
2002;(12):14-26] one cell (blastomere) was removed among 6 to 8
cells; is it possible this will create congenital anatomic defect
of the future fetus?
Charles H. Chen, MD
Fountain Valley, Calif.
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Author’s
response:
There is potential for damage to the embryo (0.5% in our experience),
but this appears to be an “all-or-none” phenomena.
If embryo growth and cell division continue postbiopsy, it appears
that later development is not affected. There is no evidence in
the literature thus far that demonstrates an increase in the congenital
defect rate in babies born after embryo biopsy. However, new data
continue to be collected.
Serena H. Chen, MD
Associate Director
St. Barnabas Institute for Reproductive Medicine
Livingston, NJ
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