Patients hear what they want to hear
Health law attorney S. Allan Adelman is right that unrealistic patient expectations is one of the key factors that can trigger
a malpractice suit ["Malpractice Consult: Be careful what you promise," Jan. 4]. Unfortunately, even the best efforts by physicians to create realistic expectations are not always enough.
I'm very diligent about laying out a reasonable differential diagnosis for a patient's symptoms and discussing all the possible
outcomes and side effects of treatment options. This frustrates some patients who just want to be told, "This is what you
have and this will make you better." However, I feel it's important for them to be partners in healthcare decisions. Despite
my efforts, I've had patients claim they never heard me say something that I had clearly told them and documented in the chart.
It's human nature to focus on what you hope to hear and ignore the rest. While I agree that we need to make every effort to
prevent our patients from having unrealistic expectations, there is only so much we can do. When will the day come when we
stop blaming doctors for everything and ask patients to take some responsibility for the problems that lead to lawsuits? Michael Melgar, MD
Great Neck, NY
Negotiating with health plans?
I found "You can negotiate with health plans" intriguing [Jan. 4]. Your examples cited managed care companies paying 103 to 105 percent of Medicare. Here in Northern
NJ, not far from New York City, many plans are paying about 60 percent of Medicare. In the past, Medicare was the lowest payer,
but now it's becoming the highest payer in our area.
Your article said that in many metropolitan areas—where there's no shortage of doctors—negotiation is apt to be a "take it
or leave it" proposition. Does anyone have any thoughts on how to negotiate in such a hostile market?
Michael V. Macri, MD
Westwood, NJ
E-prescribing is overrated
My recommendation regarding e-prescribing is to stick with faxing and save yourself some major headaches ["E-prescribing: The rewards and risks," Jan. 4].
The consensus in the San Francisco Bay area is that the problems we're experiencing are 100 percent on the pharmacy side.
High pharmacy staff turnover, inadequate training, and poor pharmacy software are the main culprits. Our office has to play
phone tag all day with many pharmacies, following up on requests we successfully transmitted and explaining to angry patients
that we sent their prescription—but the pharmacy never checked for it!
I strongly think e-Rx systems are overrated by the media and have a long way to go before they are a worthwhile addition to
anyone's medical practice.
Jeffrey Mendelssohn
Practice manager
Castro Valley, CA
The value of dinner lectures
Virtually all physician education outside of academic centers is sponsored by pharmaceutical companies, and community physicians
welcome expert speakers to dinner meetings. These physicians do not have much contact with colleagues outside their offices
anymore, due to the increasing use of hospitalists.
Practice Tools
