Letters

Cover critique

To the Editor:

It appears that the January cover illustration was intended to depict a typical family practice front office, but something important is missing: Not one of the three staffers is making eye contact with anyone.

The receptionist is focusing on the paper in front of her while a patient puts a note in the suggestion box nearby. Ideally, she should be thanking him for taking the time to give the practice some constructive feedback. At least she should look up and acknowledge his presence.

The woman in the foreground is doing some one-on-one patient education, but her focus is on the table instead of the patient. She should be trying to make the patient feel comfortable.

Finally, the three women have their backs to each other. This makes teamwork difficult. What happens if the telephone must be answered while one of them is talking on another line and the other one is responding to an urgent call from nature?

Robert Gillette, MD
Youngstown, Ohio

Editor's note:

Dr. Gillette's points are well-taken, but in defense of our imaginary practice, we should point out that it does at least show a box for patient input, someone who takes time to do patient education and perhaps even, judging from one of the computer screens, someone who is in e-mail contact with patients.

Broke and miserable

To the Editor:

I am currently doing locum tenens work in Australia, now broke and miserable after watching my stock in a physician practice management company (PPMC) go south. Due diligence does not guarantee that you'll find a PPMC with a sound financial picture (see "When a Physician Practice Management Company Comes Calling," June 1998). For the thousands of doctors burned in the stock-market crash of FPA Medical Management, there was no possibility of uncovering poor accounting procedures and misinformation from FPA directors. Every business deal poses risk.

Any group considering amalgamation with a PPMC should negotiate an escape clause that protects against bankruptcy, fraud or failure to deliver on the business plan. The best bet is to sell only for cash, avoid any stock transaction and take out an insurance policy that prevents the individual physicians from losing a practice that was built with blood, sweat and tears.

Robert D. Budman, MD
Queensland, Australia

Patients should pay

To the Editor:

The proper way to manage fees is for the patient to pay them (see "How to Handle Problems With Self-Pay Patients," September 1998). If physicians can't figure this out, our profession is in trouble. Especially considering the number of patients who are uninsured, self-pay patients should be the basis of the practice, not the exception.

By charging $30 per visit and negotiating with laboratories and radiologists, one can drastically reduce the cost of medical care for the benefit of the patient. It's easy to chuck the clerks, coding specialists, extra computers, telephone lines, explanation-of-benefit forms and other associated silliness with which we have allowed ourselves to be saddled.

We are our own worst enemies.

Tad Lonergan, MD
Desert Hot Springs, Calif.

The benefits of the hospitalist movement

To the Editor:

The hospitalist movement (see "What the Hospitalist Movement Means to Family Physicians," November/December 1998) is the most significant benefit to primary care physicians and their patients in this century.

Primary care physicians have been indoctrinated to be "complete physicians" for their patients. While this is a lofty goal, most young doctors soon become weary of the demands on their time and energy that trying to fulfill this difficult role entails. Perhaps at the beginning of their careers it is possible to "do it all," but once their patient loads increase and the incessant demands of daily practice take their toll, family doctors limit their hours just like any other specialists.

Trying to keep up with the burden of hospital medicine, running an office practice and making home visits doesn't make sense. Primary care doctors are basically outpatient physicians. That is where their expertise lies, and it is where they should concentrate their energy.

The idea of hospitalists is one that is long overdue.

Edward J. Volpintesta, MD
Bethel, Conn.

Copyright © 1999 by the American Academy of Family Physicians.
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