Letters

Affirming a difficult choice

To the Editor:

Dr. Carrie Nankervis put a personal face on the tension many of us feel among evidence-based medicine, patient-centered care and systems improvement ["Choosing Between Clinical Practice and Administration," January 2003, page 39]. She tried to use her business-school protocol for rational decision making to guide her own career. Management methods pointed her to full-time administration, but patient relationships drew her back to practice. I trust she is a better doctor with the added training and broader interests. Her experience demonstrates what most of us feel. Management expertise does not provide understanding of the deep joys of patient care and the fulfillment of family practice. In this doctor's final analysis, warm heart prevailed over cool head. Let's give her a hand.

William R. Phillips, MD, MPH
Seattle

Electronic MOM Care forms

To the Editor:

In "Sharing Maternity Care" [March 2003, page 37], the authors mention an electronic version of the Management of Maternity (MOM) Care program used by the Carilion Health System. The MOM Care pages on the AAFP Web site (www.aafp.org/momcare.xml) only offer a paper format. Is an electronic version available? If not, has the AAFP considered developing one?

Mark English, MD
College Station, Texas

Editor's response:

The AAFP has not produced an electronic version of the MOM Care program. Dr. Boyle has modified the OB template in her electronic medical record with questions from the MOM Care chart documentation form. It would be extremely costly to develop an electronic form that could be integrated into each of the many EMR systems available. The AAFP has considered offering an electronic version for personal digital assistants and a portable document format (PDF) version and may do so in the future.

PDA software features

To the Editor:

In "10 Quick Tips for a More User-Friendly PDA" [January 2003, page 70], Dr. Anil Chandrashekhar lists a number of features he says are available under "Classes ­ other" in the ePocrates drug reference guide. I can't find any of them in the free version (newly upgraded Rx 6.0). Are these features only included if you purchase the software?

Tiffany Clemons, PA-C
Westland, Mich.

Author's response:

When the article was written, those features were available in the free version of ePocrates. Currently, they are available only with ePocrates Rx Pro, which costs about $50 per year. Details are available at https://www.epocrates.com/catalog.do.

Anticipating open access

To the Editor:

I read with great anticipation and curiosity Dr. John Giannone's article ["Open Access as an Alternative to Patient Combat," January 2003, page 65] on his experience with creating an open-access system in his office. I have spoken with many colleagues, and they have mixed opinions. I must offer that I could have reliably predicted negative responses (and the positive ones, as well) based on what I knew of my colleagues' personality types and expectations.

I do not have open access in my office yet, but I plan to soon. I also plan to borrow heavily from the expertise of my other chosen profession, which is psychiatry. Any shrink worth his or her weight knows that the best way to modulate (or mollify) patients' angst and complaints is to see them more frequently, rather than less.

Christopher Morache, MD
San Diego

Expanding the role of nurses

To the Editor:

I enjoyed "Ideas for Optimizing Your Nursing Staff" by Rick E. Weymier [February 2003, page 51] and its emphasis on ensuring that activities are performed by the appropriate level of staff. Nurses can assist in many additional aspects of patient care. Nurses can perform repetitive parts of the subjective and objective patient evaluation. They can assist in documenting pain parameters of location, duration, character radiation, etc. for patients with injuries or abdominal pain. Nurses can also use a flow sheet to determine and complete preliminary orders for preventive services, and they can readily perform and document the diabetic foot exam using a stiff filament as well as other repetitive exams. Nurses are also exceptionally qualified to educate patients on disease prevention and chronic disease management.

Peter A. Cardinal, MD, MHA
Gettysburg, Pa.