Letters

Improving office visits for patients and docs

To the Editor:

The checklist in "Focusing on Today's Visit" [June 2003, page 59] is a great tool for every physician's office. As a nurse, I know that many patients' needs are not met during their office visits. In our defense, the nurse or physician can only address what the patient brings to our attention. Sometimes we don't ask patients if they have other health issues to discuss because we know that several concerns may come up and, frankly, we just don't have the time to discuss all of them. However, if we know from the beginning that there are, for example, three issues to discuss, we can address those issues in about the same amount of time we would have spent with that patient anyway. Using such a checklist can foster more comprehensive care, reduce unnecessary calls and lengthy office visits, improve doctor-patient communication and decrease patient anxieties. These benefits will make everyone happier.

Sherry Knox, RN
Knoxville, Tenn.

Patients are our primary concern

To the Editor:

While it is in society's best interest to keep hospitals solvent as suggested in "Seven Ways to Help Your Hospital Stay in Business" [May 2003, page 27], our primary obligation as physicians is to the patient we are treating at the moment. We are already expected to manage their finances by finding the cheapest drugs, the cheapest tests, etc., and to manage their insurance by knowing what is covered, who is covered and how to advocate when claims are denied. Given these ever-increasing responsibilities, we may not want to change how we manage their hospital care. It will cost a patient with chest pain the same amount to be admitted overnight to rule out MI as it would to stay two days and have a cardiac catheterization. Let's face it, the system is broken.

Jaymi S. Meyers, MD
Seneca, S.C.

Bringing care to the home

To the Editor:

I agree wholeheartedly with "I Do House Calls!" [July/August 2003, page 69]. My first exposure to the benefits of house calls was during my residency training. Last year I became the first family physician in my hometown of 7,000 people when I opened a solo practice here. When I noticed that some of my elderly patients were frequently missing appointments and allowing greater intervals to pass between their follow-up appointments, I suspected that some of them were having mobility problems. I began doing house calls, and now I have a 100-percent house-call show rate. I find it very rewarding to care for the patient in the home, just like a true country doctor.

David L. Mitchell, MD
Shiloh, Ill.

Systems thinking: leading the way

To the Editor:

Bravo to FPM and Dr. Leif Solberg for "The KISS Principle in Family Practice: Keep It Simple and Systematic" [July/August 2003, page 63]. The Institute of Medicine (IOM) and the Accreditation Council for Graduate Medical Education (ACGME) are thinking innovatively, leaving the laggards behind. As a medical director of a busy residency practice, I have been fortunate to learn about systems and how they improve care. Unfortunately, I find that many of our residents and practicing physicians are disinterested in changing our systems to take better care of our patients. I recently gave a presentation on idealized practice design for a board review course through our institution and was jolted to discover how many experienced physicians were unaware of systems thinking. Many stated this was the first time they had ever heard of these concepts.

If we are to lead the charge toward health care in the future, we must be involved with designing and demanding better systems. In Oxymorons: The Myth of a U.S. Health Care System, J.D. Kleinke states that the problem with a poor system is no one is to blame. We must take responsibility for systems that we did not create and make them better. Along with adopting better systems, we must learn how to be early adopters of innovation. Medicine needs to move from a traditional, bloated hierarchy to a lean, flexible oligarchy. Dr. Solberg's article seemed to be just the tip of the iceberg and left me wanting more. Please keep the articles on systems thinking coming.

Julian T. Hsu, MD
Denver