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Letter to the Editor
OB/GYN 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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