February 1998 Bulletin

LETTERS

Write to The Editor, AAOS Bulletin, 6300 North River Road, Rosemont, Ill. 60018-44262

Ethics

It is indeed a rare event when a professional journal such as the Bulletin prints an article about medical ethics let alone the ethical relationships between the profession and its business suppliers. I refer to the Point of View article entitled "Something for Nothing is Test for Ethical Behavior" by Richard N. Stauffer, MD. Dr. Stauffer cogently outlines the ethical dilemmas implicit in relationships with companies that supply products to us. I endorse his concepts and conclusions. I would add a fourth area of ethical concern, which is reward from a company for design of a product that the designer then uses in patients without disclosure that he is receiving a significant financial reward for using the product.

J. Phillip Nelson, MD
Scottsdale, Ariz.

DMEPOS

Recently a message contained in the December 1997 Medicare Newsletter titled, "Physicians Not to Dispense DMEPOS in Their Offices," will severely hamper and interfere with the effective and timely care of our Medicare patients. Many of us who gave up the dispensing of durable medical equipment prosthetics, orthotics and supplies (DMEPOS) in our offices because the Stark rules made it so complicated it would be an accounting nightmare to abide by the regulations, then used local suppliers to maintain our stocks. We then were able to service our patients with the necessary DMEPOS such as crutches, canes, soft collars and other needed devices that are immediately needed for the proper care of the patientís problem.

It seems that the National Supplier Clearinghouse standards states: "The supplier is responsible for the delivery of Medicare covered items to Medicare patients." What they, in all their questionable wisdom, have accomplished
is to take away the doctors care and judgment of what to treat and fit in the office and give it to some person or persons who has neither an MD degree or knows anything about the patientís problem. The item will likely be given out to the patient with little or no instruction. In addition, the Medicare patient will be required to travel to another site, at great inconvenience, just to get a pair of crutches or a cane.

John T. Makley, MD
Cleveland, Ohio

Wrong-site surgery

Wrong-site surgery could indeed be devastating, but is easy to prevent if you have protocol that you go through on every patient without exception.

The easiest technique is always making sure to talk to patients in the preop area before they have any type of sedation. I once had a patient who did not know right from left and he kept telling me the wrong side. I now have every patient not only tell me which side, but also point to it. I have a copy of my office records and an MRI if available. If this all correlates, then I write a big "YES" with indelible marker on the knee. This not only makes me feel much better, but patients are always grateful that you have taken the extra time to make sure of the correct site.

John D. Kaufman, MD
Santa Clarita, Calif.

For the Adult Reconstruction Service, we have made water-soluble four-color University of Michigan tattoos that our patients apply to the operative site the night before surgery. Patient acceptance is enthusiastic and the tattoos easily wash off with isopropyl alcohol.

Andrew A. Freiberg, MD
Ann Arbor, Mich.

Retirement

According to your survey on retirement in the July 1997 Bulletin most of your respondents (54 percent) said that what is now enjoyable is "reading for pleasure." I wonder if that will last. How many books/novels can one read before the similarity of the plots and characters becomes boring?

My personal experience has been rather unique. In 1984, tired with paperwork, attorneys, court depositions in liability and workersí comp cases, getting approval for surgery from a high school student with little knowledge and ever-rising malpractice premiums, I opted for an environment of pure medical practice: the United States Navy (as also would be the case in any of the other branches of the services). For 10 happy years, the sole mandate was to restore the patientís health. Then I was called to the ministry.

Study (in this case, seminary) has been the greatest tonic anyone could find. The material is new, much of it intellectually demanding. To those about to retire, I would wholeheartedly suggest not recreational reading, but the definite study of some subject close to their hearts. Do you like gardening? Study botany and entomology as well if the bugs eat your prized plants. Before traveling, learn a new language - not merely the few sentences of "Where is the bathroom?" but learn it in-depth. Do you like to get into deep thoughts about wisdom, temperance, justice? Read Plato. It will provide exercise for your brain.

Hugo Verbruggen, MD
Swansboro, N.C.

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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