Physicians Practice - June 2008 - (Page 14) LETTERS terminal patients daily. But the expense of Medicare and the idea of medical care are skewed. In the last 30 years, the price of living and dying in the hospital has risen exponentially. The deaths of many patients have become sterile events in an isolated booth with a curtain between them and a hallway of busy activity. The families and the patient are allowed just a few minutes daily to visit, often rightly so due to the activity in the ICU. My thought is that there should be less emphasis on Medicare spending on the very shortterm terminal patient and an increase in hospice care where death can be met with dignity. Despite that, Ben Franklin, many generations ago, said, “An ounce of prevention is worth a pound of cure.” Most people do not abide by that. As a family physician for more than 20 years, I have noticed a progressive decrease in prevention. Mr. Keaveney’s generation and the one after him, in which many if not most exercise less, weigh more, eat more fried fast foods, drink more soft drinks, and indulge in high-fat and highcalorie coffee mixtures, may catch up with my generation’s mortality rates by the time we are ready for our 3 a.m. “Clear!” in the ICU. There may be just as many 75-year-olds in the beds with paddle burns on their chests as 40-year-olds recovering from their second MI. I think boomers are the fittest generation and the luckiest, with new medications available to extend our lives and last ICU visit. Mind you, not all of us are fit, but when I go to the gym I see more over-50s than under-30s sweating and having happy dyspnea. Procrastination is rampant in the U.S. when it comes to preventive medical care. Why care for that hypertension, obesity, diabetes, or hyperlipidemia today when doctors promise to make us better 20 years from now? So let’s increase primary care and the family physician and make exercise and healthy foods into “What’s Hot.” Let’s make living “good and happy,” and the ICU the worst place to be, not the last place to be. —Patrick Hanford, DO Lubbock, Texas I read your March Editor’s Note with great interest. I agree with you that we have the best medical care in the world and we are also cursed by this. People in this country have grown accustomed to the high level of care received here, expecting this delivery at all times regardless of cost. As a healthcare provider, it amazes me how expensive it is for a person to die in this country. Time and time again, I have seen elderly patients (90 years and above) in the operating room undergoing advanced “salvage” cardiac surgery, requiring OR time of eight hours or more with countless units of blood products and expensive drugs. One can easily spend $250,000 in the last few hours of a person’s life. We are on a rapid course of selfdestruction. As distasteful as healthcare limitation is to consider, we need to consider it. —Sayuri Pearson, MD Green Bay, Wis. 14 | PHYSICIANS PRACTICE | JUNE 2008 PA PRACTICE POLICIES I am writing to you in response to the question asked regarding “PA as Independent Contractor” in the March Ask the Experts section. I found this question a little odd. I have been a practicing PA for 23 years. A lot has changed with PA practice over the years, especially in the area of independent practice. To my knowledge, the one thing that has not changed (and is in accordance with the PA national standards): PAs practice under the supervision of an MD. Even though a PA has the capability to practice “independently,” with autonomy in many situations, in the end the attending MD is responsible for overseeing the PA’s practice. This does not mean that the supervising MD has to physically watch over the shoulder of the PA for every little decision the PA makes. The PA and MD work together as a team to ensure quality medical care to the patient. For a PA to practice as a “contractor” implies complete independence in the absence of supervision and is not a matter of IRS regulations. In contrast, many MDs and hospitals are hiring PAs under a practicing “arm,” a corporation. This is for billing purposes and is mainly practiced by nonprofit institutions. Having a PA in a practice in any discipline of medicine adds to the quality of patient care and should always be a collaborative relationship. In the case of a PA, independence is a state of mind, not a matter of IRS guidelines. —Isabel Brodersen, PA-C, MS Waterbury, Conn. Mad as heck about something we wrote? Couldn’t agree more? Just want to add your 2 cents? Write us: bkeaveney@physicianspractice.com PATIENT SATISFACTION WORKS I read Shelly K. Schwartz’s article “Recruiting for Patient Satisfaction” (The Administrator’s Desk) in the April issue with intense interest and could not agree more. I work as the “supporting staff” person at Integrated Psychiatry here at the InteWWW.PHYSICIANSPRACTICE.COM http://WWW.PHYSICIANSPRACTICE.COM
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