Letters

Managed care vs. MSAs

To the Editor:
In recent issues, some of my colleagues have suggested that patients should be more grateful of the benefits bought with the loss of freedom under managed care (see "Letters," October 1998, and "Monitor," June 1998). Perhaps we should all reread what the Declaration of Independence says about liberty and freedom of the individual.

Care as offered by HMOs is dictatorial and not for the benefit of the patient but rather for those executives who, in today's environment, are becoming millionaires at the expense of both the physician and the patient.

I believe that tax-deferred medical savings accounts, which give the patient the right to choose a physician and to purchase catastrophic insurance, would be of much greater benefit than managed care since they would give the patient a greater incentive to avoid known factors that contribute to poor health. At the same time, a nest egg would be available at retirement that would cover other costs as a person reaches age 65 or older.

William M. Fuchs, MD
Huntington, N.Y.

On MDs and DOs

To the Editor:
I just finished reading the interview with Nancy Dickey, MD ("The New AMA President Answers Your Questions," June 1998). My interest was piqued when I saw a reference to osteopaths -- until I read her comments about the relationship between osteopaths and allopaths: "We see increasing numbers of programs that are actually seeking accreditation from both osteopathy and medicine ... ."

Statements such as these make it seem as though we are not really doctors. We take the same classes as allopathic physicians; plus, we take additional classes and exams in our manipulative skills. In fact, many allopathic physicians are now taking classes from us in manipulation.

The American Osteopathic Association has chosen at times like these not to defend our honor, but this type of insult must be addressed by at least one osteopath who is proud of our differences -- and similarities!

Gail Dudley, DO
Radford, Va.

Dubious comfort from Medicare

To the Editor:
Oh how comforting are the words of HCFA Administrator Nancy Ann Min-DeParle in the Medicare Update article ("Changes Proposed for the E/M Documentation Guidelines," June 1998): "I want to assure you that physicians will not be punished for honest mistakes and we will not make referrals to the Office of the Inspector General for occasional errors."

It would be helpful if HCFA would define "honest mistakes" and "occasional errors." I see these as dishonest, politically correct, side-stepping communication techniques. Statements like these translate to grossly dysfunctional policies -- unless the new HCFA E/M documentation guidelines turn out to be a health care advancement for all Americans. Hamilton, Jefferson, Franklin and Washington are rolling in their graves with disgust while we remain above ground tolerating these intrusions and losses of liberty.

William J. Epperson, MD
Murrells Inlet, S.C.

Patient education

To the Editor:
I found your articles on demand management very interesting and timely, especially the one about patient education handouts ("Demand Management: The Patient Education Connection," September 1998). Recently, I put together a brochure for our family physician group with the primary goal of educating our patients on the scope of family medicine within a predominantly multispecialty organization. The secondary goal was to emphasize our availability and inform patients of our after-hours procedures. This information was included because, with our large number of capitated patients, we are trying to be proactive in the management of ER visits.

We also use computer-generated handouts from other sources on topics such as the expected course of a disease and "when to call" recommendations. Patients have found these to be so helpful that we now use them for nearly every patient encounter. They have the added benefit of not needing to be kept in inventory, which costs money and takes up space, and of being instantly accessible.

Daniel Parker, MD
Hartford, Wis.

Into the wilds of the Web

To the Editor:
Thank you for the guided tour of the Internet ("World Wide Web 101," July/August 1998). I was searching for a "101" and found it! Now I'm ready for The Internet for Dummies.

Frans Koning, MD
Bellevue, Wash.

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