September 2002
Volume 66 |
Number 9
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| Letters
to the Editor |
Physician/Poet: The Next Subspecialty?
The following poem was dedicated to University of Texas Medical
Branch faculty and was read at the graduation dinner on June 8,
2002:
Seems like only yesterday when everything was new, A Macintosh
was an apple; a Miller was a brew. Since the day I started, I've
learned so much from you About ventilators, ABGs and mixed SVO2.
One night on call as a CA-1, I became a CA-3 'cause a AAA rolled
on back, and there was only you and me!
Should I aspirate a second time when I place a spinal block?
Are you OK with an 18-gauge and only one stopcock? Which I.V.
induction agent would you like to use? I have a nice selection
here; which syringe will you choose?
Propofol, pentothal, ketamine or etomidate, My job is not to
direct, but only to accommodate. Vapor pressures and intubating
doses dance inside my brain.
There really is so much to know, it's driving me insane. Sorry
about all those pre-op calls while you were home eating dinner,
But I knew if I didn't make them, you'd treat me like a sinner!
Besides, knowing too much is always much better than knowing
nothing at all,
But it doesn't matter when your first case is some disaster leftover
from call!
With your help, I've learned to keep the anesthetic goals in
focus.
Maintaining normal hemodynamics is not just hocus pocus.
You showed me how to relieve the pain from a chronic lower back,
And how to save a patient or two from a scalpel-wielding hack.
I learned to place a labor epidural under your direction, And
I got to see the smiling face as I won my patient's affection.
But then I had to drop it all, not a dereliction, Instead, it
was to intubate another crash c-section! I've learned so many
things from you and shared so many cases,
UTMB is a special place, I'll never forget your faces. As we
move on in our professional lives, our paths will cross again,
And I will always refer to you as my teacher, colleague and friend.
Jeffrey S. Richards, M.D. Galveston, Texas
Guardians of Sleep Have No Time to Rest
Dr. Lema's "Where Would You Rather Be But Right Here, Right
Now?" in the April 2002 ASA NEWSLETTER literally brought
tears to my eyes. I was afraid that I was alone in my feelings;
now I know that I am not.
Despite all of the obstacles that have been placed before us
in patient care, we still are granted that unique privilege of
treating those who need us most. To have strangers quite literally
place their lives in our hands, to guide them through the psychological
and physiological stresses of the perioperative period and to
do it in a fashion that preserves their dignity and soothes their
psyche is indeed a gift and privilege. I feel bad for our colleagues
who have forgotten this, or worse, have never felt this way. They
have a job; we have a profession.
Production pressures, financial pressures and the decrement in
the quality of life that modern-day anesthetic practice is subject
to are all undeniable. I expect that those of us fortunate enough
to have practiced in the 1970s and 1980s, when these were not
issues, are suffering the worst from having known the "good
times." For those who have known nothing else, this is "business
as usual." This realization came to me several years ago
when interacting with a senior medical student who reminded me
that he had nothing to compare American medicine with!
Despite this, whenever I lecture to students or residents or
precept them clinically, I remind them of how remarkable it is,
the trust that our patients have in us. I remind them that it
is more precious because it is so acutely earned. More often than
not, we meet our patients minutes before surgery (not the day
before) where we must establish rapport and earn their trust so
that they can comfortably and confidently lay their lives in our
hands. They must know that we will not "drop them" by
doing anything other than providing 100 percent of our effort
and attention in their behalf. We cannot breach that trust.
Thank you for your wonderful editorial.
Shepard B. Stone, PA
Branford, Connecticut
No Choice But to Retire
I read the June ASA NEWSLETTER on professional liability.
I thought the subject was very important. Each article was well
done.
I retired on June 30, 2002. I've planned this action for several
years, so the malpractice premiums were not a deciding factor.
Last November my net premium increase was over 34 percent. This
was on top of a similar increase the year before. I was glad that
I had decided to retire!
Recently two surgeons asked me to consider working in a surgical
center one or two days a week. I looked at the numbers, the types
of cases (mostly Medicaid and Medicare) and pointed out to them
that my income would barely cover expenses (including malpractice
insurance premiums). It just is not worth the risks involved.
Besides, my mind was made up, and I was ready to move on. Thanks
for the well done job you do as editor.
James R. Moyes, M.D.
Lubbock, Texas
Tort Reform for the Common Good
Dr. Lema's June's editorial, "America the Suable,"
focuses on the problems with our legal system. While doctors have
always complained about medical malpractice insurance, the situation
has never been as bad as this. A true crisis exists that will
eventually involve the entire country. Those of us practicing
in the Philadelphia area can attest firsthand to your observations.
Neurosurgeons, orthopedic surgeons and obstetricians really are
moving out of the area, limiting their practices or retiring early.
As you pointed out, the problem goes beyond medical malpractice
to involve the entire tort system.
There is a ray of hope. This unsustainable situation has been
recognized by many prominent individuals with political backgrounds.
I would like to call everyone's attention to a bipartisan organization
knows as "Common Good." Common Good is allocated to
a radical overhaul of America's tort system. The Board of Directors
include many prominent individuals from both sides of the political
spectrum, including: George McGovern, Newt Gingrich, Alan Simpson,
Paul Simon, Richard Thornburgh, Tom Kean and many others. Anyone
interested in this subject should visit the very informative Web
site: < www.ourcommongood.com
>.
While change will certainly be slow, there may be a light at
the end of the tunnel.
Joseph L. Seltzer, M.D.
Malvern, Pennsylvania
The views and opinions expressed in the "Letters to the Editor"
are those of the authors and do not necessarily reflect the views
of ASA or the NEWSLETTER Editorial Board. Letters submitted
for consideration should not exceed 300 words in length. The Editor
has the authority to accept or reject any letter submitted for publication.
Personal correspondence to the Editor by letter or e-mail must be
clearly indicated as "Not for Publication" by the sender.
Letters must be signed (although name may be withheld on request)
and are subject to editing and abridgment.
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