Prescribing under pressure
Since graduating from medical school in 1978, I have witnessed the progressive dismantling of medicine as a profession, and its conversion to a business no different from any other in this country. Within the private sector, corporations—both employers and insurers—have relentlessly attacked physicians and their relationships with their patients, all in the name of saving money. We all know the true motive is increased profits.
The October issue of ACP Observer carried an excellent piece on the latest battlefront: prescription management. (Prescribing Under Pressure, p. 1.) I participate in approximately 40 managed care plans and see an average of 20 to 25 patients per day. Probably half leave the office with multiple prescriptions for their myriad of medical problems. If each insurance plan insisted on its own formulary, it would be virtually impossible to practice medicine. If third-party payers want to restrict the drugs a patient may take, let them also take the responsibility of changing the patient's prescription. Let them also take responsibility for the inconvenience, side effects and possible ineffectiveness their formulary drugs may cause.
As a member of ACP, I would expect our organization to be marching down Main Street decrying such intrusive behavior by insurance companies. But what is the College's response? A story titled " Six tips to hold the line on prescriptions." How about six tips to help return American medical care to patients and physicians? We're printing brochures to explain what an internist does; how about some brochures explaining to my patients why their health is being sacrificed on the altar of corporate profits?
Paul Sokal, FACP
Your article about osteopathic medicine (Osteopathic medicine's growing pains, November ACP Observer, p. 1) shows how the house of medicine continues to resist change. I've been a practicing osteopath for 14 years and am proud to be a DO. The article refers to osteopathic medicine as a specialty, but osteopathic medicine is a separate profession that has been around for more than 100 years. Osteopathic medicine has always been a complete school of medicine that incorporates a manual aspect that makes us unique with the medicines and surgeries of the times. We are not—and have never been—chiropractors.
I did a residency that allowed me to become board certified by both osteopathic and allopathic specialty boards. I chose to be certified by ABIM because I didn't want any limitations placed on me. It was also an economic decision; there have been hospitals that would allow DOs to practice only if they had a year of allopathic training.
As for the argument that people go to osteopathic medical school because they can't get into an allopathic school, it's time to stop deluding yourselves. There are a lot of us, myself included, who didn't even apply to allopathic schools. I took the same licensing exam and board exam as my MD colleagues, and I did very well. In 15 years, I've never been sued. My father was a DO practitioner for more than 30 years and he was never sued.
There are good and bad DOs, just like MDs. We all have good days and bad days. The most important thing to remember is that we're on the same side. Our training is nearly equivalent in everything except manual medicine, so quit talking down to us. We're not a specialty, we are a profession. Maybe you should make sure you live up to our quality.
Thomas M. Flowers, DO
Fort Worth, Texas
I am a student member of ACP currently at the Michigan State College of Osteopathic Medicine. Due to my love of osteopathic philosophy, I chose only to apply to DO medical schools. Being a minority has not been without its price. I have constantly been belittled by the uninformed, including those who could not get into medical school themselves.
When I see comments by Michael Grossman, FACP, the College's Governor for Arizona, tearing apart a fledgling osteopathic medical school and comparing it to the best established programs in the nation, I become alarmed. How many new allopathic medical schools could stand up to this scrutiny? I also wonder whether what the article described as "smart maneuvering" on the part of the American Osteopathic Association was anything more than hard work. I highly doubt that a 100-year-old profession needs to "maneuver" and sneak around.
I also challenge comments from Herbert S. Waxman, FACP, the College's Senior Vice President for Education, questioning whether osteopathy's top students go as deep as at allopathic schools. At my school, basic sciences are combined with the allopathic school, with which we share facilities throughout the first year. After the allopathic students have all left the building to study anatomy, physiology, biochemistry, or play Frisbee in the courtyard, we are still in the manipulation lab, taking osteopathic history and integrated clinical skills courses for the remainder of the afternoon. We must also earn extra credits in the fall and summer semesters, but we are still deemed less qualified when we graduate.
ACP needs to decide whether it wants osteopathic medical students such as myself to join its organization, and it needs to understand the improvements that have been made in our education. We as students of a new osteopathic generation are eager to show our abilities and talents. We only ask for a fair chance to compete in the workplace without discrimination.
Tiffany M. Lasky, ACP Medical Student Member
East Lansing, Mich.
The embers of distrust between allopathic and osteopathic physicians apparently continue to smolder. Although both allopaths and osteopaths have a common foe in today's corporate medicine, the two professions continue an enmity that should have expired years ago.
In the mid 1960s, as medical education director in a Midwest hospital, I helped develop a medical residency program that included clinical conferences. Since a number of osteopathic doctors practiced in the area, I invited them to attend. A firestorm ensued. A number of physicians labeled me an Eastern liberal and accused me of improprieties ranging from naivet‚ to betrayal. Some complained to the hospital administration and demanded my dismissal.
The local osteopaths remained silent, but not the state's osteopathic society president. His vitriolic letter characterized me as an AMA spy, a Judas and sundry other titles of deceit, although he never did explain what he considered my ulterior motives. (At the time, I was not even a member of the AMA.)
A few years later, I enrolled the first osteopathic residents in another training program. By then, my hide had thickened and the new deprecations seemed trite.
Today, with physicians facing competition from nurse practitioners, optometrists and a variety of alternative care healers, the petty allopathic-osteopathic bickering is self-destructive. It must make health insurance executives smile, since divide and conquer has always been one of their favorite corporate techniques.
Lee Sataline, FACP
Although, I do not agree with some of the material presented in the article on osteopathic medicine, I think you have done a good job. (I am a second-year DO student.) This is a difficult and hot topic among DOs and MDs, and I am sure you will have a lot of unhappy DOs and MDs writing you. But for what it is worth, I believe it is a job well done.
Reza S. Borhani, ACP Medical Student Member
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