Table of Contents

Letters

The future of family medicine

To the Editor:

As a family physician educator of more than 22 years, I was curious to hear what prominent physicians and health care leaders had to say in the article, "What Lies Ahead for Family Physicians?" [January 2000 special section: "Family Practice in 2000: The State of the Art," page 25].

My compliments on the diverse group of professionals interviewed. Their diverging views on the future for family physicians were very interesting, but it was disturbing that the elderly were not mentioned once in any of the interviews, considering that older Americans will play an enormous role in health care in the next 25 to 30 years.

Geriatrics may not be glamorous and may be a time-consuming and ego-deflating area of medicine, but it is where the future of family medicine lies. In fact, there is light at the end of the tunnel for those of us who work in geriatrics. It works this way: There are two classes of elderly. The minority are well elderly who are good HMO risks; the majority are plagued with chronic illnesses and multiple problems and are not good HMO risks. It is this high-risk Medicare population that appears to be the last bastion of fee-for-service medicine! Taking on these patients may be good medicine for what ails family physicians.

Charles A. Cefalu, MD, MS
New Orleans

A word of thanks

To the Editor:

I am giving a copy of Dr. William R. Phillips' article, "Building the Future of Health Care on the Foundations of Family Practice," [January 2000, page 41] to every family physician, resident and interested student that I know. It is a steady compass in a world full of lodestone. Thanks for doing this. It is a real service to our discipline.

Kurt C. Stange, MD, PhD
Cleveland

Practice Diary

To the Editor:

Dr. Sanford Brown's "Practice Diary" deserves special kudos. It is a delight every issue.

H. Wm. Bardenwerper, MD
Louisville, Ky.

Reducing medical errors

To the Editor:

The alarming rate of medical errors noted in the recent article "The Family Physician's Role in Reducing Medical Errors" [February 2000, page 45] certainly comes as no surprise to those of us who have been practicing medicine for at least the last two decades.

Probably the most significant reason for increased medical errors is the changing economic structure within which we practice. The onslaught of managed care has turned the humanitarian practice of medicine into a business (equivalent to selling hot dogs on the street corner) and has created an environment in which the labor force in nursing homes, hospitals and other settings is cut to save dollars. Until sufficient numbers of well-trained medical personnel are employed, the quality of care can only further deteriorate.

William S. Davis, MD, MDiv
Winchester, Ky.

Standardized admit orders

To the Editor:

I read with interest the article, "Using Standardized Admit Orders to Improve Inpatient Care" [November/December 1999, page 30].

As residents, we were told it was "lazy" to use standardized orders, but in rural private practice, where some of these high-risk conditions are seen only once every several months to several years, standardized orders are definitely an important safety tool for our patients. They're also a great starting point for any work-up. Thanks for sharing!

Barbara L. Allen, MD
Red Lodge, Mont.

Editor's note:

For copies of the 27 standardized admit orders developed by Robert Wiprud, MD, and his colleagues at Scott & White Clinic, College Station, Texas, visit www.aafp.org/fpm/991100fm/30.html, call the AAFP order department at 800-944-0000 and request item A-550, or send an e-mail to fpmedit@aafp.org with "send admit orders" in the subject line.

The orders cover such conditions as acute epiglottis, diabetic ketoacidosis, HIV pneumonia and postpartum endometritis.

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