November/December 2000 Table of Contents
Letters
The value of hands-on therapy
To the Editor:
Dr. Robert D. Gillette's article in the July/August issue ["'Problem Patients': A Fresh Look at an Old Vexation," page 57] was very informative and helpful.
However, I do take exception to his including hands-on therapy, such as chiropractic and massage therapy, in the same category as getting a pet. Dr. Gillette states there is little evidence these therapies offer more than palliative value.
As a licensed chiropractor for 16 years and a board-certified family physician, I've seen many studies that point to chiropractic being far more than a palliative procedure. The Agency for Health Care Policy and Research and the RAND Corporation did in-depth studies that found chiropractic had far more success with outcome measures and patient satisfaction for the treatment of low back pain than any other form of treatment.
I write this to be informative not antagonistic. Many physicians form opinions based on what they read, so I hope we can help each other and our patients by stating our opinions more objectively.
John S. Chomer, DC, MD
Elwood, Ind.
Author's response:
I did not intend to disparage palliative treatment when that's all we have to offer, but we should think clearly about what we're doing. I've been unable to locate any scientifically bulletproof support for your position, but in all fairness you should be given an opportunity to provide some citations that will prove me wrong. The studies cited should show benefits, in comparison to control subjects, that are objectively measurable by disinterested observers at least six months after the intervention.
Robert D. Gillette, MD
Poland, Ohio
Changing habits
To the Editor:
Thank you for "Same-Day Appointments: Exploding the Access Paradigm" [September 2000, page 45].
In the article I wrote for your February 1998 issue ["Solo Practice: The Way of the Future," page 16], I noted that in our office "if you need an appointment today, you get an appointment today" and "every problem is handled before we go home, and we go home on time." I think this kind of efficiency explains why our office can care for 4,000 patients without a backlog.
Dr. Murray and Ms. Tantau have proven what I did not know and would have doubted: Bad habits in an inefficient office can be changed (although not without pain).
R. Douglas Iliff, MD
Topeka, Kan.
Computerized house calls
To the Editor:
I don't think house calls today are an "anachronism" [see "A Bygone Era," Letters, September 2000, page 13].
I'm a solo, small-town family doctor who makes house calls and nursing home calls with complete patient records and references -- black bag in one hand and portable computer in the other.
On my computer I carry patient records and 15 major reference texts. The computer is more than just a fast list of cytochrome P450 interactions. It allows me to evaluate complex information patterns. On site I quickly produce typed notes, and in the nursing home I print my note or consult with attached references.
The computer allows me the efficiency to do my hospital and office work, make my house calls and still be home to eat supper and help my wife clean up the kitchen.
M. Jonathan Mishcon, MD
Tilton, N.H.
Getting with the program
To the Editor:
The articles in the May 2000 issue of FPM are the best I've seen in any journal about getting with the program. Health care and medicine have changed and should become evidence-based. It's time we focused on what to do rather than what not to do. Coding, documentation, strategic reorganization, risk and number needed to treat (NNT) are things practicing physicians must know and use.
John M. Tudor Jr., MD
Murray, Utah
Correction
The editors incorrectly assumed "doc" files in "A Palm-Top Computer in Every Practice?" [September 2000, page 59] referred to a file extension. In fact, "doc" refers to a file type and should have appeared without a period before it. The article also included an incorrect Web address. The correct address for Peripheral Brain is pbrain.hypermart.net. FPM
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