April 1998 Bulletin

Letters to the Editor

Caught in the middle

I found this article ("Caught in the Middle," February 1998 Bulletin) singularly unsatisfying. While Paul Collinsí complaints about HMOs ring true, and weíve all been there, Dr. Toozeís suggestion that we go to the insurance company or the state insurance commissioner when a patient complains about managed care restrictions implies free time that very few orthopaedists have. Or are we to do this on time otherwise spent on patient care?

Dr. Messineoís solution seems to be to accept that weíre all going to be doing a lot more free work. For those of us (myself included) approaching geezerhood, that may be an acceptable answer, but I doubt it will fly for the profession, in general, which has already seen its collection rates plummet.

Dr. Dornís answer is for us all to take a course in negotiation and conflict resolution, presumably of the type he teaches. Perhaps in the time left over after our courses trying to comprehend the new coding regulations! Also, his response to the patient who asks why he wasnít referred sooner, and thus avoid late pinning of a finger fracture wouldnít last two minutes in my practice. As soon as the physician says "I donít know," savvy patients will quickly cut to the (only) salient question: "Doctor, in your opinion, did the failure to refer me sooner fail to meet the standard of care required of a competent practioner?" I wonder how Dr. Dorn would negotiate his way out of that one!

In summary, I donít think this article provided any practical answers. Then again, perhaps there are none.

Jack C. Childers Jr., MD
Baltimore, Md.

I must admit that I felt ashamed to read the "Caught in the Middle" article (February 1998 Bulletin). Specifically, in regard to a child who may not have been referred in a timely manner, it is embarrassing to read the advice to "negotiate a mutually acceptable resolution." This is simply avoidance of the real issues of quality of care vs. any other interests. Until we confront head-on the abuses of managed care, quality will continue to deteriorate. While I realize that this is very difficult for most of us, I still feel that it is wrong for "our Academy" to publish this type of advice. Where is our leadership going to come from? Iím just about totally discouraged. I guess Iíll just pay my dues as a fellow for the discounts to the Annual Meeting which I need to go to for CMEs.

Andrew Wolff, MD
Sarasota, Fla.

(Editorís note: Unless specifically stated otherwise, the statements and opinions expressed are those of the identified author, sources or editor and do not imply endorsement by nor official policy of the American Academy of Orthopaedic Surgeons, which disclaims responsibility for them.)

Proper names

After reviewing the February 1998 issue of the Bulletin, I find I must write to prevent Charlie Heck, the late former executive director of the Academy, from spinning in his grave.

In the column, "A New Chapter," Editor-in-Chief Canale writes, in part, "From the beginning, the mandate of the Bulletin was to keep the membership informed on the business of the Academy, report on the activities of the Center Office and serve as a forum for the expression of the membersí ideas."

As Charlie Heck, on occasions too numerous to remember, pointed out to those of us active in Academy affairs at the time, the term "Central Office" is incorrect terminology because its use implies that the Academy also has a "Peripheral Office." Please instruct the Editorial Board that the two Academy offices presently in existence are called properly the "Academy Office" and the "Washington Office."

John J. Gartland, MD
Philadelphia, Pa.

(Editorís note: Dr. Gartland was my "chief" in 1972 and corrected me then just as he did now. He is correct about the names of the two Academy offices. The statement that was cited in "A New Chapter" appears in "Fifty Years of Progress," a book edited by Charles V. Heck and published on the 50th anniversary of the Academy. The statement was written by Harold Boyd, MD, former Academy president, in the first issue of the Bulletin, July 1953.)


I think the new format is terrific! Much more readable.

David E. Larson, MD
Alexandria, Va.

I think the new format of the Bulletin is GREAT! It is much easier to go over and has a better overview. It is a very significant improvement and you are to be commended for the result. Keep it up.

Paul Collins, MD
Boise, Idaho

Would you like to comment on something you read in the Bulletin? Letís hear from you. Send your letter to the Editor, Bulletin, AAOS, 6300 N. River Rd., Rosemont, Ill. 60018. Fax (847) 823-8026.

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