Letters

Rediscovering house calls

To the Editor:

Thank you for Dr. James Giovino's article, "House Calls: Taking the Practice to the Patient" [June 2000, page 49]. I'd finished it before I'd made it from my mailbox to my desk.

I recently opened a practice in a small town, and the article so closely matched my personal experience -- right down to the picture of the patient's home and my own black bag -- that it was almost eerie! Incidentally, the list of the bag's contents matched my own but excluded injectable medications (for the inevitable sick, elderly patient who stubbornly refuses hospitalization); an Ana-Kit, just in case; and a list of specific local pharmacies that deliver.

I hope that Dr. Giovino continues to train his residents to make house calls, just as I was trained, and I hope this lost art is rediscovered.

Jim Gatto, MD
Oconomowoc, Wis.

The American way?

To the Editor:

In the July/August issue, the article "Is Universal Coverage the American Way?" [page 33] argues that universal health care coverage by the government is "the American way." On the contrary, the American way is to have as limited a government as possible.

The Founding Fathers drew up the Constitution to deliberately limit governmental interference into anything except the proper spheres of activity, such as defense, police, courts, etc. Providing health care for the populace was the furthest thing from their minds! Government involvement in health care has led directly to higher prices, lower availability, ethical muddles, and less physician and patient autonomy. Increasing that involvement will bring only more of the same.

Unfortunately, now that medicine has gotten used to feeding at the government trough, we're addicted to it. I fear for our profession. Soon we will become faceless technocrats doing what the government says when it says to do it. Medicine will no longer be a noble calling; it will just be another cog in the machine.

Jeremy Klein, MD
Louisa, Ky.

The time has come

To the Editor:

I was dumbfounded and ecstatic to read the article in the July/August issue about the effort to push for universal coverage. Of course, it only makes sense that the AAFP and the AMA, among others, are behind this initiative. It is an idea whose time has come.

As family physicians, we must push for universal health coverage. We're the people on the front line who see those with inadequate or no insurance. We're the ones who agonize over getting good health care for them when they can't afford what they need. In the richest country in the world, health care coverage is a right that every citizen must have. I'm ashamed that this great country of ours does not provide for our citizens what some of the poorest countries in the world are trying to provide for theirs.

How can family physicians get involved and make a difference so that this initiative becomes a reality?

Dave Hibbard, MD
Boulder, Colo.

Editor's note:
We asked the AAFP for a response and received the following reply from Lanny Copeland, MD, chair of the AAFP Task Force on Universal Coverage: I believe as family physicians we have a moral imperative to push this agenda along. We must take every opportunity to talk in our communities about universal health care coverage. Civic groups are a good forum, and many newspapers welcome physician-written articles on topics such as this. Reform must be done on a national level, but where it begins and where it eventually will be implemented is at the local level.

More wisdom

To the Editor:

I enjoyed Dr. Virginia Mohl's article, "Words of Wisdom for Patients and Physicians," [July/August 2000, page 82] that recommended good books for physicians' offices. I'd like to make some recommendations as well.

I'm Scared, one of a series by Elizabeth Crary, gives children choices for dealing with their fears, shows possible outcomes for each choice and even explains a method of desensitization.

Learned Optimism and The Optimistic Child, by Martin E.P. Seligman, PhD, are useful resources for those who are anxious, depressed or underachieving. In easily understood terms, Dr. Seligman, a past president of the American Psychological Association, discusses his research, screening tests for resilience and a proven method of decreasing the incidence of depression in the adolescent years.

Love Is Never Enough, by Aaron T. Beck, MD, discusses marital discord from the point of view of a cognitive therapist. Beck explains the relationship between unspoken expectations and the partners' associated feelings about the marriage in a way that could substantially strengthen the relationship.

These are wonderful mental health resources for us and for our patients.

Patricia Blochowiak, MD
Cleveland Heights, Ohio

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