Letters to the Editor
Published Letters: 283 Editor's Choice: 20
-
In Defense of Physicians
[Read the article: Don't be happy, worry]
[Read more letters about this article: Here]I do not think most doctors prescribe antidepressants to make money. Visits for depression do not pay particularly well, since they take more time than, say, a simple blood pressure check, and doctors are not reimbursed for that extra time.
Most primary care doctors have had little or no training in the management of depression. But patients see the commercials, they talk to friends, and they come. A wait to get into a psychiatrist's office can be months sometimes. Therapy is not usually covered by insurance. So the doctor has a choice -- he can either do therapy himself, which most doctors are completely untrained to do, or he can write for a pill. Or he can tell the patient to buck up and sally on.
Doesn't leave a lot of options.
Doctors often write for medications to get rid of patients. After 10 minutes of listening to a patient cry in the exam room, with three patients waiting and the ER on hold to discuss a new admit, the doctor finally says, "Here, let me prescribe you something."
No, it's not the best solution a lot of the time. But like teachers, doctors find themselves performing many of the social functions that families and friends used to take care of. Like getting people through grief. Like trying to improve a kid's grades at school. Like convincing an 86 year old man he has no business driving. Like questioning a woman with a black eye to make certain she is not being physically abused. People will come to a family doctor to unload all kinds of problems they would never tell to a spouse, parent, priest, or friend. Or maybe they have no parents or friends, in which case the doctor is basically the friend of last resort.
The other day a family brought their confused mother to our local ER and left her, saying they couldn't take care of her at home. There was nothing wrong with her except that she had Alzheimer's. Now why would a doctor be better able to manage a confused patient than her own family? And why, when the family is tired of dealing with her, does she become the responsibility of her doctor? This is how things work in our society. Medical professionals became the final common pathway for all problems society can't solve. Then doctors get blamed for not being able to solve a problem no one else can.
With the TV commercials, and the health spots on the news, and the "very special" episodes of "ER" that scare the hell out of patients and make them run to their doctor to see if they have the same disease, doctors end up sorting out a lot of problems that maybe they shouldn't have to sort out. When the Cymbalta ad, and the Viagra ad, and the Lipitor ad all prod patients to "ASK YOUR DOCTOR" about every little concern, doctors end up contending with a lot. So, without resources, they write prescriptions.
Big pharma knows this. They know that if enough patients come in to a doctor asking for the same thing, eventually the doctor will relent. Doctors get tired too.
The solution to this problem is more education, and a lot more mental health professionals. But we can't even get the government to agree that all Americans deserve health insurance. Expanding mental health is a pipe dream.
-
Super Bowl Logo
[Read the article: King Kaufman's Sports Daily]
[Read more letters about this article: Here]Whoever gets SB 50 could ace all the others by doing away with the Roman numerals. A simple "50" would stand out among all the logos.
All the Xs and Ls and Vs is getting pretentious.
-
What Kills Me About This
[Read the article: McCain wins, and conservative heads explode]
[Read more letters about this article: Here]Is that McCain is INTOLERABLE to the conservative "base" (though who knows what that is -- they are freely electing McCain, after all) but they are completely fine with GW Bush.
Are you kidding me? There is no way a horse's anus could be a worse president than Bush. I guess I would pick Bush over Mussolini, but that is about the extent of it. It appalls me that the "base" is mum about Bush but psychotic over McCain.
I intended to vote Clinton in my state primary, but I am tempted to cross over and vote for McCain, just to see what it would do to the Republicans.
-
High Stakes Testing Is Flawed, But There Is A Point To It
[Read the article: We're failing our kids]
[Read more letters about this article: Here]Ultimately, the best way to solve a problem is scientifically. In society many things can't be quantified, but for the most part measurements help.
High stakes testing forces schools to measure their progress in a standardized fashion that allows comparisons among different groups and even across state lines. With the old letter grade systems, this was not possible.
I am a medical doctor and medicine is going through similar throes itself: It is called P4P, or Pay For Performance, and it is based on the idea that doctors should get paid more for good outcomes, and effectively penalized for poor outcomes. The idea is to hold doctors accountable for their performance.
The objections to P4P are oddly reminiscent of the NCLB complaints. People worry that doctors will practice defensively, protecting their statistics, instead of helping patients. That there is incentive towards medical treatments that improve payment rather than treatments that truly benefit patients.
Nonetheless, P4P is coming, and it needs to. Medicine is in a wilderness in which doctors do whatever they want and are not held accountable for it. Unless you start measuring results, there is no chance for improvement.
NCLB is a mess, but its underlying principle, that schools should measure their kids' progress in a standardized fashion and publish them, is a good one. If my neighborhood school stinks, I have a right to know about it.