letters

Taking care of children

I am glad to see that others realize we are giving away our specialty ["Caring for Children: Re-examining the Family Physician's Role," July/August 2005]. When you don't deliver babies, don't do hospital rounds and don't assist in your patients' surgeries, you really aren't doing any more than a physician assistant.

I am appalled at the laziness and apathy in our specialty. We can blame extrinsic factors ( government regulations, insurance companies, malpractice claims, specialists or "limited practice" physicians) for the demise of family medicine, but in the end we have no one to blame but ourselves.

R.A. Hagge, MD
Chamberlain, S.D.

Your article failed to suggest an important thing family physicians can do to increase the number of children in their practices: learn another language. For many immigrant groups, birth rates are on the rise, and new parents are looking for physicians who understand both their language and culture. Learning Spanish and working with the Hispanic community in my town has kept my practice busy with newborns and young patients.

Jean M. Riquelme, MD
Green Bay, Wis.

Is doing good good enough?

In his editorial, "A New Identity for Family Medicine: Physicians for the Underserved," [May 2005], Dr. Hans Elzinga writes that reinforcing our aim to help those who need it most might attract more students and improve our standing in medical schools and among patients.

The sad fact is that medical students are voting with their feet away from our specialty. An appeal to altruism will not trump considerations of lifestyle, compensation or prestige. If it did, our specialty would be turning away applicants to family medicine residency programs. Our specialty needs to find ways to compete with other specialties where these same issues are concerned. To remain noncompetitive is to become marginalized.

Robert Frank, MD
Milwaukee

Bravo to Dr. Elzinga. His editorial underscores the very reason I chose to become a doctor and to practice family medicine. I intend to work in an underserved area and can think of no better training than family medicine.

James A. Trent, MD
Omaha, Neb.

As a family doctor who has practiced in inner-city community centers for four years, I believe Dr. Elzinga's concept is genius. In a time when people often seem not to care, the desire of family physicians to serve in places where others won't go separates and defines us, as a specialty and as human beings. This idea should be nurtured in academic centers. I believe many budding family doctors would receive this call with enthusiasm and even, dare I say it, pride.

Michael Q. Fité, MD
Milwaukee

Diary missed already

Thank you for sharing Practice Diary with us over the years. Practicing physicians and students alike are looking for hope and pride in family medicine, and Dr. Sanford Brown's space provided it. Without his column, there will be little to counteract the constant stream of negative articles surrounding family medicine. I will miss Dr. Brown's frank and very real take on the family physician's world.

Ben Brewer, MD
Forrest, Ill.

How to change behavior

I agree that a motivational approach can lead patients to behavioral change more successfully than a monologistic approach. However, Dr. Manoj Pawar's article, "Five Tips for Generating Patient Satisfaction and Compliance" [June 2005], is as monologistic as the approach he hopes to avoid. Dr. Pawar states that to be successful in motivating a behavioral change one must make the change more palatable. But what is the motivating factor for physicians to change? And how do we motivate patients in the context of a 12-minute visit that already includes history, exam and treatment?

Brian Stello, MD
Allentown, Pa.

Author's response:

Dr. Stello raises two good points that I didn't address in the article because of space limitations. He is correct that physician change and motivation is critical for successful adoption of any new concept. We have found that a dialogue-based model has been successful in motivating change, even in groups facing significant crisis. One major challenge for physician leaders is to understand their colleagues well enough to know what drives them to change.

Dr. Stello also raises an excellent point regarding time limitations. Visits are rushed, and innovative approaches to the current patient encounter models are needed. The more we learn from experimentation, and the more we share this information, the more likely we'll be able to cope.

Manoj Pawar, MD
Wheat Ridge, Colo.

Helping patients help themselves

I read with interest the article by Dr. Lisa McTavish ans Susie Gray, "Helping Needy Patients Get Needed Medications" [June 2005]. They raise a number of good points and give much good advice.

I want to point out that there are resources that patients can use to learn more about patient assistance programs. Most patients who get the information can complete most of the paperwork themselves, thus saving the physician's office time and effort. NeedyMeds (www.needymeds.com), a non-profit organization of which I am president, is one such source. We provide information on pharmaceutical patient assistance programs, state programs, local programs and other types of assistance. Our data is updated on a regular basis, and it's free.

Rich Sagall, MD
Philadelphia

Clarification

Although Dr. Baretta Casey's practice originally purchased a $20,000 version of the Otogram, as explained in "Expanding Your Practice Through Niche Services" [June 2005], an upgrade that enabled them to perform otoacoustic emissions, acoustic reflex testing and tympanometry increased the overall cost of the equipment. The current price of the equivalent model is $37,500.