O U R R E A D E R S W R I T E
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Partners in good health
The high cost of medical liability
Doctors and lawyers
Can you cite that source?
The Wickwire legacy endures
Respect life at any stage
I enjoyed [Michael] Anft's thorough, thought-provoking analysis of our health care crisis [ "Search for an Rx," November]. I am a general surgeon practicing in Lancaster, Pennsylvania, and agree with the 60 percent of physicians who believe a single-payer system is an important aspect of dealing with this crisis. To simply dismiss this because of the political and financial clout of the insurance industry is a fatal mistake. We cannot continue to pay 30 percent of health care dollars for administrative costs.
I believe the second crucial aspect of improving not only our health care system, but the health of our patients, is a cultural one. The medical profession has fostered dependence in our patients. They rely on their physician to make them better. Give me a pill and make me better. Bariatric surgery is booming. Is Brazil's exercise program to combat obesity working, or will they adopt bariatric surgery? We must develop health education and maintenance from elementary school, during employment, and in retirement. Everyone must be a partner in maintaining their health and understanding the importance of exercise, a healthy diet, and wearing seatbelts and motorcycle helmets, etc.
The third crucial aspect of developing a rational, effective health care system in this country involves a drastic change in physicians' behavior. We have been hypnotized by the pharmaceutical and medical technology industries to adopt every new drug and gadget without any critical analysis of cost effectiveness. Does every patient with heartburn need Nexium?
I agree wholeheartedly with the importance and benefits of
efforts to improve quality and consistency, such as the
intensive-care checklist, but it is time to challenge the
influence of the sacred cows, the insurance and
pharmaceutical industries. We must partner with our
patients in promoting health, not simply treating
The article "Search for an Rx" provided an excellent summary of the many issues of health care in the United States. As a physician, I can describe the health care system today with one word: crazy!
The health care practitioner and staff must devote much time to unravel the many arcane rules, restrictions, and hidden agendas promulgated by the kaleidoscope of health care plans. Professional reimbursement is dependent on an understanding of a "numbers" game that is often changing.
I was surprised this report did not mention the issue of medical liability. Contrary to comments from medical economists and politicians, the rising cost of medical liability insurance has an inflationary and adverse effect on medical practice.
One hundred years ago, the Flexner Report, based on
the Hopkins model, provided the foundation for development
of excellence in the quality of American medical education.
It is evident that we need another Flexner Report
that can provide guidelines for the delivery of health
I'm surprised your article regarding our current health care crisis barely mentions how high patient expectations and the fear of litigation play a role in driving up costs. Patients have come to expect (right or wrong) a certain level of care. If those expectations aren't met, there is a perception of malpractice.
A good example is how so many antibiotics are incorrectly prescribed for viral respiratory tract infections. Academics note this contributes to rising patient costs and complications and call for restricting antibiotic use. That's easy to say when faced with statistics. It's harder when faced with an individual patient who comes in expecting to get an antibiotic. A good doctor-patient relationship can reassure most patients that antibiotics are not necessary. But some may never be convinced that less treatment is better. And it only takes one upset patient to start a lawsuit.
What other profession carries the constant threat of being sued, for real or imaginary reasons, where if you lose, you could lose your honor, your profession, your retirement, and even your home? Fear of litigation drives many physicians to consciously or unconsciously request millions of "unnecessary" tests, as they search for an objective piece of data to back up their clinical judgment, or to eliminate that one chance out of 1,000 that the patient's symptoms are some rare but dangerous condition. Physicians are expected to have perfect foresight. If they don't, a lawyer with perfect hindsight will judge them. It used to be that good clinical judgment was the key to being a good doctor. Now it's been replaced by expensive tests, as lawyers know clinical judgment is subjective, and can be disputed in court with an "expert" witness who reaches an opposite, yet equally valid, conclusion. Besides ordering extra tests, physicians have increased their referrals, either to a specialist or to an already crowded emergency room. It's a way to offset the burden of responsibility with others in the field, but ultimately increases overall health care costs.
Physicians are caught between the general notion that health care costs must be somehow reduced, and individual patients (and their lawyers) who demand their health expectations be met. What is one to do?
The prescription for a healthier America is very simple:
exercise more, eat less, drink less, and quit smoking. This
is generally ignored, as it is easier to expect the doctor
to cure years of bad habits with a pill. So long as
patients behave like consumers, expecting 100 percent
satisfaction or your money back, physicians will continue
to behave in a risk-averse manner, ordering tests or
consulting a specialist to confirm what they already knew,
not to satisfy their clinical judgment, but that of the
patients and the lawyers standing behind them.
In her very interesting article "American Girl" [November], Elizabeth Evitts Dickinson spoke of "John Winthrop's essays in the late 1600s about the promise of the new American city." If she meant the governor (mostly) or deputy governor or other assistant of Massachusetts Bay throughout his 19 colonial years, the timing was wrong, as he had died in 1649. If she meant the namesake son whose various offices included 18 years each as an assistant in Massachusetts and governor of Connecticut (dying in office in '76, at the very least close to late century), and who was America's first Royal Society member, to avoid confusion she could have cited him as John Jr., or John Winthrop "the Younger." Similarly, if Ms. Dickinson meant John Jr.'s namesake son, who at his death in 1707 was in his 10th year as Connecticut governor after a distinguished military career, she might have cited him as Fitz-John Winthrop.
The passage quoted may have been defective in terms more serious than chronological or referential clarity. I've found no mention of any such writings in well-reputed 1966 and '92 biographies on my shelves of respectively John Jr. and Sr.; or the American biographical dictionaries, three with extensive early Winthrop coverage, issued by Appletons, 1888-9 (6 vols.), Boston's Biographical Society (corrected ed.) in 1904 (10; Sr. only), and, in their original series, the American Council of Learned Societies from 1928-37 (Dictionary of American Biography, 20 plus index) and in 1999 (American National Biography, 24).
Having read precisely one primary source (from an anthology alluding to "speeches" by John Sr. presenting "governmental theory"), quoted below, I assuredly am no Winthrop scholar. Maybe Ms. Dickinson would be vindicated within Winthrop's Journal, "History of New England," 1630-1649 (1908 title, two vols.), great4-grandson Robert C. Winthrop's 1864-7 two-volume The Life and Letters of John Winthrop, and/or (collectively?) the Mass. Historical Society's 1929-47 five volumes of Winthrop Papers, 1498-1649. In The Writing of American History, rev. ed (Norman, OK, 1985), Michael Kraus and Davis D. Joyce depict the Journal (20, 22) as invaluable "disconnected annals" that, amidst "sensationalistic" material, in telling "much about the creation of society that built itself homes, schools, ships, and taverns . . . told of the construction of a social organization more enduring" than such. In journal-centered John Winthrop's World (Madison, WI, 1992) James G. Moseley does notice a rather modest trend toward (sometimes autobiographical) narrative, with (90) "group[ing of] events according to their significance," and commentary.
Despite timing, Ms. Dickinson may have leaped hugely to
conclusions from Winthrop Sr.'s proclamation (invoking
Matthew 5:14) in a deeply religious lay sermon, from the
eve or days of passage to the New World in the spring of
1630, "that wee shall be as a ['shining' for President
Reagan!] Citty vpon a Hill, the eies of all people are
vppon us." Later in office, especially in the '40s, the
governor is seen (Moseley, 94) to have "helped set a course
that would guide New England long after" his own very
Editor's Note: Good catch. The Winthrop piece referenced is John Sr.'s famous 1630 sermon delivered aboard the ship Arbella, "A Modell of Christian Charitie." This oration is generally regarded as the earliest statement of "American exceptionalism" — the idea that these settlements were special, different, and superior to what had come before.
Thank you for your moving tribute to Dr. Chester "Chet" Wickwire ["Remembering Chester Wickwire," Wholly Hopkins, November]. At his memorial service, family members, former U.S. Senator Paul Sarbanes, and others paid homage to Chet; the family issued his poetry books Longs Peak and The Wonder Horse; and the musicians who aided in fund raising in the 1970s for the Tutorial Project played jazz.
Whether Chet championed integration, civil rights, ending the Vietnam and Cold Wars, peace in Central America (exposing corruption), literacy, workers' rights, or, more recently, dialogue between the Israelis and the Palestinians, his legacies endure.
Thanks also to Ralph Moore, who assisted Chet with the Sunday Experience, where Chet and others gave firsthand accounts of varied world conditions. I was able to share with Chet, the family, and friends that the Hopkins Odyssey Program offers a similar series. Led by Professor Mark Croatti, the series' titles vary from "Flashpoint 2008: The Next President's Foreign Policy" to "Controversial Supreme Court Cases" (and the future of the legal process), and "The Updated Modern Presidency: From World War II to the Present." The series includes lectures (with Q&A) by academic, diplomatic, military, and media experts sharing insights, presenting all sides, fostering understanding and peace.
Lastly, Chet mentored many, and his guidance, encouragement, and example continue to inspire. I was honored to share with him the words and music I wrote in tribute to him. Please see "Ways to End School/Campus Violence, and Foster an End to Hate Crimes," www.visionlearningdifferences.com, and listen to the music "America, Peace and Justice," members.fortunecity.com/americapeaceandjustice.
Thank you, Chet, and God bless you and yours.
I began reading your article "Growing Stem
Cells for Blood" [Wholly Hopkins] in the November issue
with great interest, but my interest turned to dismay when
I realized that the stem cells being grown at the Institute
for Cell Engineering are human embryonic stem cells. Each
human embryo has a full complement of human genes and is
indeed fully human. Such embryos deserve to be treated with
the respect due to the human beings which they are. The
research discussed in the article is apparently contingent
upon the destruction of a human embryo (i.e., the taking of
a human life), and thus would have serious moral and
ethical consequences. Although research of the type
discussed in the article may ultimately have certain
benefits for society, the end does not justify the means.
Moreover, disrespect for human life at any of its stages
will lead to disrespect for human life at other stages.
Hopefully, it will be possible to use adult or umbilical
cord stem cells to conduct research to achieve the same
In the November "Vignette," we incorrectly referred to Senator Barry Goldwater as a governor. The magazine regrets the error.
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