Letters

Enough, already!

To the Editor:
Almost every issue of every medical journal has an article about what I'm supposed to do differently so that managed care companies can make more money and patients won't suffer (see "Decrease Hassles and Costs by Integrating Your Plans' Formularies," November/December 1998). I'm all for helping patients, but primary care has done too much already to make life easy for insurers.

Although the effects of managed care formularies on office staff and physicians are hard to measure, my instinct tells me they are significant and adverse to patient care. It's time for primary care physicians to draw a line in the sand and say, "Enough, already!"

The fix is not for doctors to do more, but for the system to be more supportive of professionals who are trying to do a good job.

Joseph J. Baum, MD, and Lynn Terry, RN
Floyd, Va.

Managing patient expectations

To the Editor:
In "Why I Fired My Family Doctor" (January 1999), one reason for the patient's dissatisfaction was that the doctor clearly did not manage patient expectations. The patient had multiple complaints and was frustrated because the physician did not set clear boundaries and goals for the office visit.

A physical should include the gathering of information, an exam, and a discussion of prevention and health maintenance issues. It is not the time for treating problems. If a patient has pressing health concerns, however, I offer to handle those problems first and postpone the complete physical until a subsequent visit. Usually, patients appreciate this compromise.

Physicians must ensure that patients have reasonable expectations for the office visit. If too many objectives are crammed into one visit, patients are dissatisfied and health maintenance goals are not achieved.

Charles H. Cummings, DO
Tiverton, R.I.

Two-way communication

To the Editor:
The tone of the article "Why I Fired My Family Doctor" disturbed me. As humbling as it is to serve as someone's personal physician, we are not our patients' employees to be hired and fired. We are people serving other people.

Patient X had a compendium of complaints (including being scheduled for a 10-minute physical), but it seems that the patient may have been quick to judge the physician. Many of the problems sounded more like mix-ups at the front desk or conflicts with insurers, not mistakes by the doctor. I'm bothered that the patient made no attempt to address the problems constructively; perhaps the physician had no idea they were occurring. Instead of writing an anonymous article, Patient X should have written to the physician and discussed the complaints, enabling a more constructive approach to the problem.

Only if we fail with gracious dialogue can I accept that patients and physicians can't be partners with each other. Both sides must try.

Jean Antonucci, MD
Kingfield, Maine

This is the future?

To the Editor:
Can you convince me that merging family practices into mega-groups saves time, money, frustration and tears? Every big group I've observed is mismanaged, inefficient, difficult for patients to negotiate with and expensive. There's no accountability: The receptionists can't make decisions, the nurses rotate and the managers are in meetings.

How can a large group justify $250,000 for a CEO when its only source of revenue is the same as mine -- patient fees? It can't charge more just because it's big, and as far as I can tell, it has more, not fewer, employees per physician. The doctors can't see more patients than I do, because they don't know them as well. And if they do see more patients, they aren't providing the same service, since every day is a new day, every patient a new patient.

Where is the continuity of care, unique to family practice? It's not in the big groups. They run at a loss, and unless they're bailed out by a hospital, they go out of business. This is the future?

I may be stuck in the '60s, but I'm a reasonably content solo physician. I expect to still be in business when a number of the big clinics go bust.

Thomas S. Duncan, MD
Astoria, Ore.

Editor's note:
Groups clearly aren't the answer for everyone. But in this issue's special cover section, several family physicians in groups organized and led by doctors offer their perspectives on why they're succeeding. The answer seems to be, largely, because the groups are physician-led. The section begins on page 38.

Copyright © 1999 by the American Academy of Family Physicians.
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