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Letters

From the January 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

Helping Russian physicians

I was interested to read about a new College effort to teach doctors in Russia. ("How we can help Russian physicians help themselves," September ACP-ASIM Observer, p. 2.) A University of Virginia program, INTERHEART-XXI, is attempting to prepare physicians in the newly independent states of the former Soviet Union for the next millennium by providing them with evidence-based education in cardiology.

The program is based on two different initiatives. The first involves developing state-of-the-art educational materials to be delivered to physician educators in more than 300 centers in Russia and Ukraine, combined with sending lecturers to Ukraine and Russia from our medical school. The second involves bringing medical professionals from Ukraine and Russia for short-term, intensive minifellowships at the University of Virginia. (For more information on the program, see our Web site at www.med.virginia.edu/docs/interheart.)

We have already developed instructional materials in both the Russian and Ukrainian languages on the most critical issues in cardiology: the diagnosis and management of hypertension, lipid disorders and heart failure. These materials summarize modern approaches developed in western medicine and are largely based on guidelines from North America, Europe and the World Health Organization. In an effort to adapt teaching materials for use in the former Soviet Union, we emphasize prevention and nonpharmacological treatment options. Monographs and slide sets were sent to more than 300 centers in Russia and Ukraine, including medical schools, major hospitals, institutes for post-graduate medical training, research institutes and medical libraries.

Vladimir A. Kryzhanovski, MD
Charlottesville, Va.

Working with nurses

As health care becomes more specialized, fractionated and impersonal, the relationship between doctors and nurses is threatened. ("Learning to work with nurses as partners in care," September ACP-ASIM Observer, p. 6.) There are many reasons why doctors don't work with nurses as partners, including ignorance of nurses' role, lack of time or effort to communicate with nurses, poor communication skills or just plain arrogance.

Personally, I have learned as much from nurses in the first few months of my residency as from any other health care provider, including doctors. Medical schools and residency programs should play a greater role in integrating doctors' and nurses' duties and educating residents about the nursing profession's functions and importance. As I progress in my career, I am increasingly learning to respect nurses' experience and skills. I hope others can learn to do the same so we can provide our patients with the best care possible.

Khalid Almoosa, ACP-ASIM Associate
Wauwatosa, Wisc.

Resident regulations

The Federation of State Medical Boards will require program directors to report all disciplinary problems and adverse actions of their residents to state licensing boards ("New rules for regulating residents? " October ACP-ASIM Observer, p. 1.) It is true that residents and interns commit mistakes, but lives are saved because trainees seek help and try to rectify situations as soon as possible. The Federation's new rules may force residents to hide their mistakes and avoid getting help.

Keshav Chander, ACP-ASIM Associate
New Orleans

Treating PACs fairly

I have to express my concern regarding the reporting of the ACP-ASIM Board of Governors' fall meeting, specifically with respect to the voting on the issue of whether the College should form a political action committee (PAC). ("Governors debate PAC, dues at first post-merger meeting," November ACP-ASIM Observer, p. 11.)

In trying to capture the complexity of the issue, the article spent significantly more space describing arguments against the PAC than arguments in favor of it. The article gave the overall impression that this resolution was barely accepted by the Board.

While the resolution was hotly discussed, it was passed overwhelmingly by voice vote, and as such represents the recommendation of the Board of Governors to the Board of Regents. The article, however, gives the impression that the Board of Governors opposed a PAC but approved it anyway.

Given that the Governors will have to explain the proceedings of this meeting to their constituents, this article makes that job more difficult. I would note that in many of the Governor's newsletters this fall, the PAC issue was portrayed more fairly, even by those Governors who opposed the idea.

Yul D. Ejnes, FACP
Cranston, R.I.

Editor's note: Dr. Ejnes is ACP-ASIM's Transitional Governor for Rhode Island.

Time-intensive medicine

As an internist of 30 years, a teacher of medical students and the father of a young physician resident, I am deeply concerned that insurance companies, especially managed care organizations, are not paying internists for their time. Right now, evaluation and management codes allow for only limited reimbursement for time spent face-to-face with a patient, and no reimbursement is allowed for the many hours spent doing patient-related work.

In order to make a living and pay the bills, internists are taking on too many patients, effectively reducing the amount of time they can spend with individuals. As a result, the internist's work load increases while his ability to stay on top of his patients' problems decreases. My internist friends are concerned about their own medical care in the future. Who will have time to spend on them?

I recommend that ACP-ASIM use newspapers, ads, etc., to let the public know that good medicine is time-intensive. In addition, we must look for ways to ensure that internists receive reasonable compensation for case management. (Many nonmedical professionals have an administrative charge that helps pay their expenses.)

In an environment of increasing expenses and a highly controlled, heavily discounted fee structure or a meager capitation payment, the internist cannot economically survive and do his job well. We must fight for both excellence in medical care and reasonable reimbursement. There can be no excellence if both time with patients and time to do our job well are ignored.

Harvey I. Hurwitz, ACP-ASIM Member
Ossining, N.Y.

Correction

"Physician pay remains stagnant" (November ACP-ASIM Observer, p. 1) incorrectly identified the College's Governor for the Washington Chapter. The current Governor for the chapter is David C. Dale, FACP.

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