American College of Physicians: Internal Medicine — Doctors for Adults ®

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Letters

From the May 2000 ACP-ASIM Observer, copyright © 2000 by the American College of Physicians-American Society of Internal Medicine.

Avoiding burnout

I read the article, "Burned out? Ask patients about their quality of life" (February ACP­ASIM Observer, page 3), with mixed feelings. While I was happy that the author learned a valuable lesson that he will hopefully impart in his teaching, I felt anger that an educator could discover so late in his career that much of medicine is learning about the people we care for and interact with.

One of my great teachers taught me a long time ago that physicians' goal should be to make every patient encounter a positive one because cure is so rare. Our mission should be to make life a little better or death a little less bad—not just to prolong it.

Norma M.T. Braun, FACP
New York

Office labs

"How an office lab can help patients—and your income " (February ACP­ASIM Observer, page 6) gave excellent information about the Clinical Laboratory Improvement Amendments (CLIA) of 1988 that every office laboratory must comply with if conducting moderate/high complexity testing. I would like to add, however, that COLA can also assist office laboratories with this process.

COLA was established in 1988 with the College as a founding member to help physician office laboratories comply with CLIA regulations. In 1993, HCFA granted "deeming authority" under CLIA, which allows laboratories to undergo certification through COLA instead of a state or federal program.

Since being founded, COLA has surveyed more than 13,000 laboratories to meet CLIA compliance and offers a wide range of help. More information is available on the Web at www.cola.org.

Julie A. Owings
Columbia, Md.

Editor's note: Ms. Owings works in COLA's department of corporate communications and marketing.

Recertification

As an internist who is currently undergoing mandatory recertification, I find the process totally unrealistic. ("How ABIM is changing recertification for internists," March ACP­ASIM Observer, page 3.)

You must complete five modules of questions to even qualify to sit for the final recertification exam. By the American Board of Internal Medicine's own account, each module takes between 10 and 20 hours to complete. Thus, you have to spend 50 to 100 hours of time just to sit for the exam, which then consumes another full day. For physicians with busy practices or families, this is an unreasonable and intrusive time demand.

The majority of questions asked during the recertification process are so esoteric and subspecialty-oriented that they tend to frustrate more than educate. (I am currently completing my fifth module, so I speak from experience.) Many of the questions are so obscure (insulinomas and gastrinomas are the horses, not zebras, in these modules) that a practicing general internist would consult an appropriate specialist for assistance.

I've spoken to several colleagues from my current practice and from my residency program, and no one is enjoying the recertification process or finding it an educationally valid experience.

Contrast this process with recertification in other specialties. Urologists, for example, take a one-day exam, and they are allowed to consult reference materials and textbooks.

If the ABIM is really interested in meeting the needs of its diplomates, it should open the entire recertification process to discussion and review. I encourage other physicians going through recertification to send their comments to leaders of the College and to the ABIM. Only then will we achieve a truly meaningful and educational recertification process.

Glenn S. Ross, FACP
Newport News, Va.

The bull market

In an effort to stem medical inflation, entrepreneurs and businessmen have been allowed to make substantial changes to the practice of medicine. ("In the country's best bull market, many in medicine feel left behind," April ACP­ASIM Observer, page 1.) While these changes have been almost uniformly bad for physicians and patients, the response of physician organizations such as ACP­ASIM and the AMA has been anemic at best.

Our medical societies should have conducted a public information campaign to tell patients about the deleterious effects that entrepreneurs were having on the practice of medicine. We should have also established a national data bank to keep track of poorly performing health plans and health executives. If physicians can be tracked for malpractice claims, we should use the same techniques to track these health plans.

Ultimately, patients control these plans. If patients are fully informed about the performance of many of these plans, they won't purchase health coverage from them, and the plans will die a natural death. We as physicians need to do more to inform patients about the risks they take when they select a cheap but ineffective or dangerous health plan.

I implore ACP­ASIM to become more involved and more effective in informing patients about these health plans, and to assist physicians in their efforts to expose these plans to public scrutiny.

Duane J. Jeffers, FACP
Lovelock, Nev.

I'm sure others were struck by the lament of one physician about constant financial pressure, even as her practice spends $1 million on "vaulted ceilings, wood floors [and] beveled glass windows." The real complaints of our profession about market distortions will ring very hollow if we can't distinguish between the real needs of our patients and window-dressing for the rich. I'm glad the physician cited in the article returns phone calls the same day and sees some low-income patients, but the larger question remains: Is good, attentive health care a basic social right or a marketing technique to help attract profitable self-pay patients?

Andrew M. Davis, FACP
Chicago

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