Letters

Foolhardy advice?

To the Editor:

I'm a bit perturbed by Dr. Sanford Brown's recent advice in Practice Diary.

In the June issue [page 44], he describes an ER patient with blunt flank trauma and hematuria. While I agree that Dr. Brown (or I) could have provided more efficient service to this patient in the office, I'm not sure I would have omitted the abdominal CT, as he seems to suggest. Passing off the hematuria in this setting could be foolhardy.

In the May issue [page 48], Dr. Brown's comments about nutrition seem to reflect a disdain for basic, up-to-date nutritional concepts. I believe our patients deserve better than that.

Doug Trotter, MD
Snohomish, Wash.

Author's response:

The patient referred to in the June issue had occult hematuria following minor trauma and did not, I believe, require a CT scan.

The point of the piece was that emergency departments run up big bills on workers' compensation cases, and more employers are now turning to family physicians to see their workers with minor injuries. My advice is that this represents a revenue stream that we should not ignore.

Regarding diets, mea culpa! I like cheeseburgers and doughnuts in moderation, but I don't guilt-trip anyone for eating oatmeal -- even my friend who insists on having it with skim milk and dry toast!

Practice Diary is meant for the pure enjoyment of FPM readers. So take it with a grain of salt -- unless, of course, you're hypertensive.

Rewarding work

To the Editor:

I was so pleased to see Dr. Robert Thompson's letter [Letters, June 1999, page 9] about the article, "A Physician's Guide to Locum Tenens," [February 1999, page 41].

My husband has been doing locum tenens work for three years. I do all his paperwork and set up his assignments. From my point of view, locum tenens has been a godsend.

I would advise caution, though, because all locum tenens companies and their staffs are not equal. Some promise lots of assignments, and, after you fill out volumes of paperwork, you find out they really have nothing. Others hold paychecks too long.

Overall, though, both of us are very happy with locum tenens work.

Cynthia Lyman
El Paso, Texas

Sexual harassment update

To the Editor:

The Equal Employment Opportunity Commission (EEOC) has issued guidelines that further explain employer liability for harassment, the subject of our recent article in FPM ["Preventing and Responding to Sexual Harassment," October 1999, page 32].

The guidelines state that employer liability will be determined by whether the harassment results in a tangible employment action, such as firing, hiring, failure to promote or demote, change in work assignment, change in compensation or benefits, etc.

If harassment results in a tangible employment action, the employer is automatically liable for a supervisor's actions. If harassment does not result in a tangible employment action, the employer must present affirmative defenses to avoid liability for the supervisor's actions. The employer must prove that it exercised reasonable care to prevent and correct promptly any harassment and that the employee unreasonably failed to take advantage of the employer's preventive or corrective opportunities or to otherwise avoid harm. The EEOC noted that there is no affirmative defense when the harasser is the president or owner of an organization.

The Supreme Court rulings mentioned in the article and the EEOC guidelines make it clear that the best way to protect yourself and your practice is to institute a harassment approach that includes the following:

• A clear, detailed written policy that outlines your position against all types of harassment;
• Periodic management and employee training and programs that communicate the practice's position on this issue;
• A complaint procedure that encourages employees to come forward with any harassment complaints and assures confidentiality, and;
• An investigation strategy that assures immediate and appropriate preventive and corrective action and protects the privacy interests of the alleged victim and the accused offender.

T. Hensley Williams, JD, and
Nancy M. Williams, JD
Des Moines, Iowa

Editor's note:

The case citations included in the article were to lower-court rulings rather than the Supreme Court rulings referred to in the article. The correct citations are Faragher v City of Boca Raton, 118 S. Ct. 2275 (1998), and Burlington Industries v Ellerth, 118 S. Ct. 2257 (1998).

The correct citations, as well as the information given in the authors' letter, have been incorporated into the online version of this article at www.aafp.org/fpm.

Copyright © 1999 by the American Academy of Family Physicians.
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