Letters to the Editor
Dr_Dredd
Published Letters: 42 Editor's Choice: 1
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@tara21, @anonymous, and @borinquena
[Read the article: My ex wants our 14-year-old daughter to witness his new wife's childbirth]
[Read more letters about this article: Here]Tara21: Thank you for posting the link to some of the statistics regarding hospital versus home birth. Many of those studies are what's called case-control. They take women undergoing home birth and matching them on certain characteristics with women who didn't undergo home birth. The problem is that correlation is not causation. For instance, one statistic that was quoted was that fetal distress rate was 6 times higher in hospital. We don't know whether that was caused by the hospital environment or whether the women who chose to go to the hospital did so because they knew they were at higher risk to begin with.
Anonymous @ 3:00 p.m.: The Cochran Database, an organization that collects and organizes data from studies all over the world, concluded that, overall, there's no difference in mortality between hospital and home birth. So, saying that "the specific intervention of doctors" increases risk just doesn't hold up.
@borinquena: You said: Babies born in the hospital are more likely to be premature and to be born to women with HELLP, preeclampsia, diabetes and other life-threatening conditions. That's why death rates are higher in the hospital. If you compare low-risk women in the hospital with low-risk women at home, there is a small but statistically significant increase in the death rate at the home births. Exactly! That's the point I was trying to make.
I guess the bottom line is that the decision regarding home birth versus hospital birth is going to vary depending on the situation of each unique woman. For some women, home birth will be a viable choice, and for others, would be extremely dangerous. That's a far cry from what the poster expatriot implied, which was that hospitals were Frankenstein's laboratories and ob/gyns were vivisectionists. Rhetoric like that won't solve the controversy, which is fairly long-standing, and is frankly insulting to the women and men who choose ob/gyn as a career.
How does this relate to the original LW's question? Just as the home birth versus hospital birth question depends on each woman's unique circumstances, the question of whether or not to let the 14 year-old in the delivery room will depend on the personality, level of maturity, and wishes of the 14 year-old in question. I personally think it's rather creepy of the father to insist on this, but that's just my opinion.
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I don't think it's melodramatic at all
[Read the article: A friend is doing chemo. What should I say?]
[Read more letters about this article: Here]Sometimes, talking about an emotionally charged issue can be exhausting. The LW's friend may be desperately wanting to confide in someone but afraid that it will lead to an emotional roller-coaster. ("Will talking about my cancer cause the LW to run away? Recoil in horror? Will the LW start spouting stupid platitudes or start metaphorically digging my grave?") The friend may be looking for a sympathetic, non-judgemental ear, and this is her way of testing the waters about the LW.
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Will you really see a doctor?
[Read the article: Wal-Mart can be good for your health]
[Read more letters about this article: Here]Many of these retail clinics will not be staffed by physicians; instead they will be run by nurse practitioners or physicians' assistants. The vast majority of the time, this will be fine. However, there will be times when decision-making isn't so straightforward. Someone who looks like a textbook case of X will turn out to have Y instead. I recently saw some data comparing physicians' and nurse practitioners' responses to patients coming in with elevated cholesterol. The physicians changed medication doses more frequently than the nurse practitioners. While the study did not attempt to determine which groups' decisions were more appropriate, the fact remains that physicians and nurse practitioners aren't trained the same way. I personally would rather err on the side of caution by seeing a physician.
In an ideal world, such walk-in clinics would be part of already-existing medical practices. (I think a previous poster said this was already happening in some pediatric groups.) That way, a mid-level provider could see and treat the patient, and could provide immediate follow-up to the patient's regular provider. Faxes and telephone calls are nice, but nothing beats having collaborators on-site.
I think retail clinics are okay as supplements to medical homes and primary care providers, but should not replace them. My parents get all of their medical care from retail clinics, and I've been trying to change their minds. (But who the hell listens to me, anyway...)
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@Fredrick Bernancke
[Read the article: Wal-Mart can be good for your health]
[Read more letters about this article: Here]If there were more Medical Schools in the United States, graduating, say, two or three times the current number of MD's, the price value of each MD would naturally decline...not something the AMA would be thrilled about.
The AMA isn't the one who regulates the doctor supply. Organizations like the AMA and the Council on Graduate Medical Education make recommendations, but it is really Congress who does the regulating. How does it do that? By setting reimbursements for graduate medical education. We could have 50 new medical schools opening up tomorrow, but it wouldn't change the number of residency training slots. That's the real rate limiting step.
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@lister
[Read the article: Wal-Mart can be good for your health]
[Read more letters about this article: Here]Have you asked your doctor why he only allows one refill, and whether he would consider increasing them? Maybe he wants to see how you're responding to the meds (or maybe he's just on autopilot). Either way, it probably doesn't hurt to ask.
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@Anonymous
[Read the article: Wal-Mart can be good for your health]
[Read more letters about this article: Here]You're proving my point. You said you chose your primary medical group based on the fact that they employee nurse practitioners. In my post, I pointed out that the ideal model is for such clinics to be associated with primary care facilities, where nurse practitioners can easily communicate with physicians. It sounds like that's what you've found.
In my own work as part of a large group practice, I rely very heavily on nurse practitioners. However, every state has a law saying that NP's must have a collaborative relationship with physicians. A retail clinic, with no real patient follow-up, probably won't do that.