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To the Editor: I am an unyielding optimist and an idealistic podiatric practitioner, yet even I am beginning to lament the current state of our profession. There are too many graduating doctors with too few surgical residencies, and even fewer job opportunities. I am seeing more patients while making proportionately less income due to increasing practice expenses and lower patient reimbursements. But what disturbs me the most is what I feel has been a slow decline in our values. Remember the Hebrew National hot dog commercial? They didn't skimp on their ingredients, because they had to "answer to a higher authority." As learned professionals who are often looked upon as leaders in the community, should we not also hold ourselves to a higher standard? Recently, I had an incident with an insurance-directed second opinion in which the doctor attempted to assume care of my patient. Instead of providing a valuable service to the patient, he seized the opportunity to falsely denigrate my care in order to promote himself. He undoubtedly had ulterior motives, such as adding another surgery to his resume and collecting a fee. Performed correctly, the second opinion could have enhanced patient care by reinforcing my recommendations or by providing new insights into treatment. We must resist the temptation to enter into the "hero complex" in which we promise miracles to the desperate patient. It is not fair or ethical to play on patients' fears by falsely contradicting prior treatments or by magnifying small imperfections in order to win the patients over. I can only imagine how many lawsuits have been initiated in this manner when a patient was led to -believe that he or she was mistreated by the previous doctor. Even when I truly feel that I may be able to provide better care, I choose my words carefully and am aware of the delicate nature of the situation. I prefer to look forward and to offer new opinions to make the best out of the patient's present situation. Adhering to high values should be compatible with making a living. Unfortunately, our written and unwritten codes have become more pliable in order to help us keep pace in the competitive marketplace. Fighting for a smaller health care dollar, practitioners, who for years survived by simply word-of-mouth referrals, are now developing ad campaigns. Radio and television ads seem to promise quick cures while minimizing the risks -such as the case with- EPFs A colleague who barely speaks Spanish lures Hispanic patients into his office through misleading television and radio commercials. How did it get to the point where supposedly dignified professionals do mass mailings of coupons for free visits? There must be other alternatives we can use to educate the public about our services and skills without sacrificing our professional integrity. I have to believe that those practitioners who repeatedly stretch the truth will eventually be reprimanded. Sooner or later the public catches on, or the insurance company audits or finds the outlier. In the long run, it doesn't pay to overutilize services (such as physical therapy), exaggerate systemic conditions so that routine foot care will be reimbursed, or be overly aggressive in recommending high-priced items such as orthoses and surgical procedures. We must remember that bad news travels fast and that the indiscretions committed by a small minority are detrimental to the entire profession, Past indiscretions have probably resulted in a backlash that 'at least partially contributed to the shift in control of medical dollars from doctors to managed care administrators. Finally, the profession seems to be on the' offensive with the formation of a union. Now, maybe if we band together, we can battle these managed care companies (instead of each other) to regain lost ground. I am optimistic and hopeful that this strategy will live and podiatric medicine a stronger and more unified voice. Without a doubt, we doctors need to work together to maintain the
respect of the public, our patients, and each other in order to solidify
the reputation of our profession and help shape our future. We can accomplish
this only if we let our Adam K Spector; DPM |