Letters

Observations on MOC

To the Editor:

A few observations about the American Board of Family Medicine's maintenance of certification program:

1. I have taken the ABFM exam four times and I don't feel it has ever made me a better physician. I, like many, continue to recertify out of fear that without it a hospital, insurance company or even Medicare will prevent me from continuing to take care of my patients.

2. Several of my contemporaries who are osteopathic family physicians have been grandfathered by their specialty board. Since their specialty board did not require recertification until several years ago, they will not have to take exams or do maintenance of certification to announce that they are board-certified family physicians. I am jealous.

3. The ABFM makes and enforces the rules and answers to no one. Often, organizations in this position justify their decisions by convincing themselves that they "know better” than the people who are affected by their actions. I have yet to see any scientific evidence that maintenance of certification will make us better physicians.

I recertified when I was 28, 35, 42 and 49, and I don't think I have much choice except to adapt to MOC by the time I am 56. I hope to keep practicing for a long time, but don't bet the rent that they will see me when I am 63.

John Naveau, MD
Coldwater, Ohio

MOC signals end of the road

To the Editor:

I am 54 years old and disabled because of three neck surgeries, but I continue to work part time. My neurosurgeon wants me to retire, but I still enjoy seeing my patients. I have been watching all the changes in recertification, and I do not like what I see.

I probably will not renew my membership in the American Academy of Family Physicians after 2005. I do not feel the AAFP is working in my best interests any longer. The American Board of Family Medicine looks as though it has stopped trying to help us and is now trying to find new ways to take more money from us. I refuse to participate!

George C. Aycock, MD
Greenville, Tenn.

Bigger is better

To the Editor:

Dr. Louis Spikol's article "Purchasing an Affordable Electronic Health Record” [February 2005, page 31] speaks to how the more affordable EHRs allow small offices most of the advantages of big systems. However, when it comes to return on investment, bigger EHR systems are probably better.1 Our three-physician practice serves a community of about 25,000 people. I used SOAPware for several months before throwing it into the garbage can and upgrading to a more expensive system. There really is no comparison. SOAPware did not allow for better workflows, decrease costs or provide decision support at the point of care. Bottom line, it ended up costing me a lot of time and money.

Christopher M. Herndon, MD
Duncan, Okla.

1. Wang SJ, Middleton B, Prosser LA, et al. A cost-benefit analysis of electronic medical records in primary care. Am J Med. 2003;114(5):397-403.

Older is wiser

To the Editor:

We have been using an EHR since 1981 and have a fully integrated system. We lack some bells and whistles but have all the basics.

Our four offices provide more than 40,000 patient encounters each year. We upgraded to a mini-mainframe with a tape back-up about seven years ago and have not had to delete records yet. Our file retrieval rate is about 15 seconds for a moderately large chart.

While our in-house computer enthusiast has made some modifications, we are still using the original 1981 EHR. Our vendor is an older provider with a smaller operation. Both our system and our vendor could be described as "off the beaten path,” but 25 years later, we couldn't be happier.

Christian Madsen, MD
Charlotte, N.C.

Is it OK to treat your kids?

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To the Editor:

I can't help but respond to the article titled "Should You Treat Yourself, Family or Friends?” in your March 2005 issue [page 41]. I am a family physician who works full time in an emergency department.

Over the years, I have noticed a gradual but deliberate replacement of common sense with political correctness. Today physicians and nonphysician health care providers refer patients with simple complaints to the emergency department out of fear of litigation or uncertainty about documentation requirements or some other ethical guideline. It isn't uncommon for an emergency visit for an ear infection to cost hundreds if not thousands of dollars depending on what tests are ordered. I've treated many of my children's infections and saved thousands of dollars, not to mention several rads of radiation exposure. I don't see anything unethical about treating my children, but I'm sure the money-driven health care system would not agree.

John McMichen, MD
Greeneville, Tenn.

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