Published 10/1/2011

Readers respond to editorial, articles

I really appreciated Dr. Canale’s editorial (“A 12-step program for politicians,” AAOS Now, July 2011). Politicians work hard at making governing “rocket science” and, although they all claim to be working toward the same end (a balanced budget, lower taxes), their actions say otherwise. I wonder where all of the common sense and personal responsibility went in our society.
James B. Benjamin, MD

Tucson, Ariz.

I applaud your editorial. Our political system is broken. Until we repair it, nothing meaningful will be addressed by government at any level. Our political system has been taken over by special interest groups and large corporations, which finance multimillion dollar campaigns that the system demands. Establishing term limits, implementing campaign finance reform (public campaign funds and 3-month campaigns), and prohibiting earmarks or special interest money to politicians would be a good start. Until politicians can be concerned about more than repaying their campaign contributors and/or looking for new ones, they will continue to be bought and sold before they ever get into office.

Politicians from both major parties are consumed by this corruption, and we need to vote all of them out until we find people who will do what is necessary. Revolution anybody?
Todd A. Anderson, MD

Ventura, Calif.

Call Congress’s bluff
Don’t waste time and money fighting the cuts in the Medicare Physician Fee Schedule (“
Physicians face Medicare cliff,” AAOS Now, August 2011). It’s not worth the worry and frustration. Congress always cancels the cuts at the last minute in favor of a trivial token increase.

If Congress doesn’t act, we need to call their bluff so they see that the financial consequences will force doctors to not treat Medicare patients to avoid having to close their offices. Members of Congress will also experience the wrath of all Medicare patients and will be considered unfit for office. It will create a crisis, which may be what it takes to get Congress to act appropriately and to come up with a permanent fix for the problem; nothing else so far has accomplished this. The most our efforts have accomplished is a temporary delay, which has delayed the crisis that would stimulate a permanent fix.

As unpleasant as it may be, a temporary change of mindset may be required. By not fighting the cuts, by taking the risk that the cuts may go through—which will drive many doctors out of Medicare and affect the health care of Medicare patients—a crisis will occur and the problem will get fixed. Standing by and allowing this to occur goes against our humanitarian mindset, but allowing the government’s unethical threats to continue is wrong also.
Douglas M. Duncan, MD
Springfield, Mo.

Residents and business education
I think it is unlikely that orthopaedic surgeons will be running their “businesses” in the future (“
Residency training programs need to add business education,” AAOS Now, August 2011). I suspect most smart orthopaedic surgeons have business managers now.

In addition, we already have too much medicine/orthopaedics to teach during residency and adding business to this seems inappropriate. We are trying to educate orthopaedic surgeons to be quality orthopaedic surgeons not smart businessmen/women. Before we add business to resident education, we need more justification than a survey of residents. Even though 97.8 percent of residents said they would attend business-related conference, my bet is that current attendance at in-house conferences is less than that. Our profession is headed in the wrong direction if more residents attend business conferences than medical conferences.
Dempsey Springfield, MD

Brookline, Mass.

Medical liability reform
I am writing to clarify Dr. Seligson’s comments regarding medical liability reform (
Sound off: Malpractice reform? AAOS Now, August 2011).

It appears to me that Dr. Seligson believes the “cap” of $250,000 applies to medical costs, which, in fact, it doesn’t. As used in California, it applies only to punitive damages—damages perceived by the community to be a punishment to physicians above and beyond compensation for all medical costs and lost wages past and future. Awards for lost wages and medical expenses are not limited or decreased by the cap.

Without the cap on punitive damages, there would be no way to limit the angry or uninformed from assessing excessive awards. Case law setting guidelines for caps in other legal arenas does exist. Without a cap on punitive damages, insurance companies—particularly physician-owned companies that have the goal of providing coverage where it is most needed (as opposed to commercial carriers that have profit as their goal)—cannot determine reasonable premiums based on actual losses, which results in a destabilized marketplace.
Jerrald R. Goldman, MD

San Ramon, Calif.

I recently read Dr. Seligson’s interesting commentary. On the one hand, he quotes the Kentucky State constitution and says it is just right as written, but when he disagrees with something, he prevaricates. The prevailing party is entitled to reimbursement of their costs. That is true justice. If you bring a lawsuit, you need to make sure it has merit. It’s only fair, right, and balanced.

It is not the insurance companies that are at fault; it is a system with no checks and balances. It is not economically feasible to defend a lawsuit all the way through court. Even if you win, the costs are obscene.
Robert D. Simon, MD

Palm Beach Gardens, Fla.

Disruptive physicians
I certainly agree that disruptive individuals need to be dealt with in an effective manner to avoid the negative impact on patient and staff relationships and adverse patient outcomes of care (“
The law and the ‘disruptive physician,’” AAOS Now, August 2011). What needs to be addressed is the fine line between behaviors associated with an acute stressful event where the physician needs to take control and get things done versus a truly disruptive outburst.

Most physicians don’t intentionally plan to be disruptive and many are unaware of the downstream negative effect of their actions on patient care. Chronic abusers and severe events definitely need to be addressed. My recommendation is that before the events lead to the point of censure, look for opportunities to address the situation with the physician (or others) in a proactive supportive manner. Let’s try to help them by reducing some of the factors that may lead to disruptive events.
Alan H. Rosenstein, MD, MBA
San Francisco, Calif.

Editor’s Note: Dr. Rosenstein is a practicing internist in San Francisco and Medical Director for Physician Wellness Services, Minneapolis, MN. He has previously written for AAOS Now on “Physicians under stress” (April 2010).