Lategola-Rahn Got There Before
Swan-Ganz
The
letter by Colin F. MacKenzie,
M.B., in the February 2003 NEWSLETTER,
correctly disputes the priority credit given to W. Ganz,
M.D. and H.J.C. Swan, M.D., for the flow-directed, balloon-tipped
catheter named after them. However, he then goes ahead
and credits R.D. Bradley, M.D. (1964), B.S. Jenkins,
M.D., and M.A. Branthwaite, M.D. (1970) with having
published this technique first.
In reality, the self-guiding catheter for cardiac and
pulmonary artery catheterization was developed 10 years
earlier by two pulmonary physiologists, Michael Lategola,
M.D., and Hermann Rahn, M.D., in 1953 at the University
of Rochester, New York.1
Walter H. Massion, M.D.
Oklahoma City, Oklahoma
Reference:
1. Lategola M, Rahn H. A self-guiding catheter for cardiac
and pulmonary arterial catheterization and occlusion.
Proc Soc Exp Biol Med. 1953; 84:667-668.
Europe Says No, Nein, Non
and Nao to Frivolous Lawsuits
This is an additional response to the letter
by Vibeke Moen, M.D., “Patient
Insurance,” which appeared in the March 2003
NEWSLETTER. Contingency fees are unethical.
As far as I know, in Europe, patients can sue, but
lawyers get paid only their usual fees. They cannot
make a fortune with a single lawsuit and retire on
it. There is no incentive to take up frivolous suits.
Evamarie Malsch, M.D.
Narberth, Pennsylvania
Axe Is Falling on Medicare Issue
I agree with Ross J. Musumeci, M.D.,
(“Medicare and the
Anesthesia Shortage, Part 3: Making a Stand” in
the March 2003 NEWSLETTER)
it’s time to declare independence from Medicare,
Medicaid and all the HMOs. Anesthesiologists as a group
“go along to get along.” We fear pressure
from the hospital, egged on by the surgeons. (The perceived
inequity of our fees being higher as nonpar than those
of surgeons who do par plus pressure from insurers to
reign us in.) Uncompensated insecurity causes glomming
onto plans fearing competitors will get patients they
don’t; referring internists will restrict cases
if they avoid those from bad payers.
Fortunately for insurers and government, this mentality
is pervasive among surgeons. There’s no patient
loyalty to internists either; patients want cheap care.
Clever internists with a reputation suggest surgeons
they feel are best qualified; should patients want somebody
based on price, let them search their book. For poor
outcomes, they answer, “You picked him, not I.”
The more low-end plans accepted, more patients come
through, the more rapidly the surgeon works. At some
point, the surgeon must bring in another to contribute.
Soon the same problem faces the new associate. The surgical
practice becomes a “Jobs Program” —
working at breakneck pace, no contact with their patients
= malpractice litigation. Doing two cases for their
usual fee = 10 cases for the discount = 20 percent legal
exposure. Hospital administrators negotiate with no
thought to us.
There’s a manpower shortage in anesthesiology,
so wouldn’t now be the time to act? Who else could
they get? There is nobody. If the government forces
us to practice for their price, wouldn’t we have
cause for legal action? Make us feel guilty about not
caring for elderly patients? Then feel guilty about
caring for them for next to nothing and being bitter
about it. It’s time to put an end to this insanity.
We should make the break; see what happens. It could
not get much worse than waiting for the next axe to
fall.
Zvi J. Herschman, M.D.
West Hempstead, New York
Is ASA Leading or Lagging on
Reimbursement Issue?
I’ve enjoyed your articles for some time now.
I am frequently inclined to respond but rarely make
the time to do so. I am writing today in response to
your “Editor’s
Note” at the end of the article
“Medicare and the Anesthesia Shortage, Part 3:
Making a Stand,” written by Ross J. Musumeci,
M.D., in the March 2003 NEWSLETTER.
I think it is ludicrous to suggest that an inner-city
exodus of anesthesia personnel offers any hope of a
solution to the tremendous inequity and unfair Medicare
reimbursement scheme. If a construction contractor can
charge the government and get paid some insane amount
for a hammer while a physician accepts only 39 percent
of the commercial rate for his or her service, clearly
the doc lost the game long ago. The doc is just plain
stupid when it comes to business — he plays the
game by deciding what is right rather than what makes
economic sense.
Market forces will not prevail when there is compulsory
price-fixing by a government that has already demonstrated
it will take advantage of this fact, no matter how the
shrinking workforce migrates around. A strong and united
stand, lots of screaming from the rooftops (i.e., extensive
media coverage) and pursuing Dr. Musumeci’s suggestions
will be a good start.
More to the point of my ire, however, is your disclaimer
that Dr. Musumeci’s views and proposals should
not be viewed as an endorsement by ASA. They should
be. While I recognize that because of antitrust laws
you needed to attach the disclaimer, I do not fully
understand the legal reasons why. The majority of us
are certainly very dissatisfied with the status quo.
We need someone to provide leadership, and I believe
it should be the function of my professional society
to advance this agenda — aggressively. If not
ASA, then who and how?
Glad you’re at the helm.
Name withheld upon request
Editor’s Note: All who are
frustrated with the Medicare system and feel that ASA
should organize a boycott must read the “Washington
Report” in the December 2002 ASA NEWSLETTER.
It can be accessed at: <www.ASAhq.org/Newsletters/2002/12_02/washReport12_02
.html>.
I am not suggesting that those who work in urban hospitals
should flee. I am merely suggesting that this phenomenon,
which is already occurring, may ironically be more effective
on Capitol Hill than a planned (and illegal) boycott.
— M.J.L.
Creating Well-Rounded Residents
I was intrigued to read in the article
by resident Maneesh Sharma, M.D.,
(April 2003 ASA NEWSLETTER) that there is
consideration by the Residency Review Committee to
incorporate the PGY-1 year into a four-year anesthesiology
residency. The transitional year would include medicine,
surgery, pulmonary medicine, pediatrics, cardiology
and intensive care.
Just add in obstetrics/gynecology and you have the
rotating internship that those of us of a certain
age were most likely to have done in the past! I still
believe that all graduating medical students benefited
greatly from that last opportunity to experience different
aspects of medical training. There was such a huge
difference between the senior student who still had
to have orders and workups checked by the senior resident
and the intern who had independent decision-making
and responsibilities. Plus, one was not forced to
make residency choices in the early months of senior
year.
Mary C. O’Keeffe, M.D.
Orinda, California
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