Letters
Patient privacy
To the Editor:
I was disturbed to see a full patient name mentioned in "Professional Courtesy" [Practice Diary, January 2001, page 61]. After reflection, I concluded that the editorial process of FPM would not allow an actual patient's name to be printed, so it must have been a pseudonym. However, without a specific explanation in the article or footnotes, the reader is left to ponder: Is the name a pseudonym, a name printed with prior patient consent or a confidentiality misstep?
As family physicians concerned about the welfare of our patients, we should emphasize the importance of patient privacy in all of our written communications.
Donald C. Spencer, MD, MBA
Chapel Hill, N.C.
Editor's note:
We would never intentionally publish a patient's name, and the name used in Practice Diary was indeed a pseudonym. Your point is well taken, though, and Practice Diary now includes a note explaining that patient names are changed.
Finding the balance
To the Editor:
How do we encourage - or force - people to take responsibility for their own health? This is one of the pervasive, vexing questions our society faces as we struggle to achieve a balance between personal and societal responsibility for health.
Now arguments are appearing for the defined-contribution approach to health insurance [see "The Future of Health Care Financing," January 2001, page 31] that would allegedly save money and provide strong incentives for a healthy lifestyle and appropriate utilization of health care. The dreamers who designed this program don't seem to have done their homework: Where's the evidence that individual control of health care resources leads to appropriate utilization without jeopardizing health? On one end of the scale, the more affluent will continue to get whatever they want and can afford (I seldom hear my colleagues complain about frivolous utilization of their services in exchange for cash on the counter). On the other end, there's ample documented evidence that when there are restraints on access to care, people tend to forgo or delay seeking help until treatment is more difficult and expensive.
Defined-contribution insurance or medical savings accounts would be a boon for the relatively affluent, educated, motivated and healthy segments of our population since the cost of their insurance and health care would be substantially lower. However, sicker, poorer and less educated individuals would be forced into a much more expensive risk pool, which would effectively deny them health care or make them a tax burden on society. The two-tiered health system would be further promoted.
Defined-contribution insurance and medical savings accounts are a ploy to re-institute fee-for-service health care. They're a giant step backward and must be resisted.
Richard C. Braun, MD
Pleasant Hill, Tenn.
The other side of the EMR story
To the Editor:
Your review of EMR systems ["Electronic Medical Records: The FPM Vendor Survey," January 2001, page 45] was comprehensive and accurate - if you're a salesperson for the different companies surveyed. For this reason, an obvious follow-up article might be a survey of practices actually using the systems.
Our practice recently contracted with one of the highly rated EMR systems and has had a frustrating four months attempting to implement the system. After wasting time and money, we have a network but no functioning software. Despite our constant complaints, the company never got our EMR system functioning.
I hope we're the exception in this case, but I would be interested in hearing other practices' opinions on implementation and support on the same companies surveyed in the article. I remain positive that our practice will eventually have a functioning EMR system, but we must all remember that a convincing sales pitch or a good software program does not guarantee a good implementation process.
Gary S. Schenk, Sr., MD
Gastonia, N.C.
Editor's note:
The EMR vendor survey does have its limitations, as you and the authors of the article have pointed out. We're looking into practical ways of getting similarly detailed information about purchasers' experiences with the systems and the companies.
The Practice Pearl titled "Tax Time" [Monitor, February 2001, page 17] was in error. Tax payers cannot decrease their 2.9 percent Medicare tax by claiming the first $100,000 of their income as salary and any subsequent earnings as bonuses, as originally reported in the Nov. 15, 2000, Physician's Money Digest. All wages are subject to FICA (Medicare and Social Security) taxes.
However, self-employed physicians can decrease their tax burden by incorporating their practices (as S-corporations) so that they receive salaries. The corporation would then pay a "reasonable" salary. Physicians would be entitled to all remaining money earned by the corporation, which would be characterized as S-corporation distributions and would not be subject to FICA taxes.
Copyright © 2001 by the American Academy of Family Physicians.
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