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Letters

Beyond Interns

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I enjoy reading Hopkins Medicine magazine during our stays and visits to the hospital, and I appreciate your coverage of such issues as “too many tests.”

I’m writing with regard to your story on “Bedside Manners” (Spring/Summer, p. 6) and wonder: Why did the study focus only on interns? They only follow the behavior they observe in their seniors. I’d like to suggest that a similar study be done that examines the bedside manners of the whole medical team, including senior faculty. You might have some surprising results.

Mina Doshi, M.S.

A Chance to Vent

Congratulations on your new format of Hopkins Medicine magazine. You have created a cross between The Economist and People magazine—and that is meant to be a compliment.

I’m writing because I’ve been entertained by a number of events occurring in the medical world lately. Several months ago, I was sitting with my friend, a retired orthopaedist, at the Johns Hopkins Medical and Surgical Association meeting. A speaker announced that he was excited, because Johns Hopkins had received a grant of $1 million to teach med students how to talk to patients. We almost fell off our chairs. They need a special grant to teach and do the obvious—some of which the students should have learned in childhood?

Then I read the letter [Spring/Summer] about “Put to the Test” [which appeared in the Winter 2014 issue], and I agree with the letter writer. Increasingly, I see patients who have had multiple tests, the results of which would not change much. Perhaps the docs ordering the tests were the same ones who didn’t know how to talk to their patients and get a history?

Then I read your piece on “Bedside Manners” [Spring/Summer, p. 6], and again I was entertained but not surprised. Having been in practice for some time—and not spending much time entering excess data into computers—I can’t imagine practicing without welcoming patients and introducing myself, shaking hands, and thanking them for coming. And I don’t let them leave without asking if they have any questions. 

While it is difficult and requires talented staff, we usually do stay on time and thank patients for being on time—if they are. You might add to the list: the doctor’s obligation to respect the patient’s time. The major complaint I hear from patients about other doctors is long waiting times.       

Again, much of this behavior should have been learned in childhood.

Thanks for letting me share my observations—and for your editing a fine magazine.

Allan D. Jensen, B.A. ’65, M.D. ’68

Associate Professor of Ophthalmology, Emeritus Johns Hopkins University School of Medicine

Prescription for Failure?

In “Managing Big Change in Maryland” [Spring/Summer, Post-Op], Dean/CEO Rothman carefully avoids commenting on whether the new payment system is good or bad, right up until the penultimate paragraph. If Johns Hopkins is actively seeking out-of-state and international patients to bring in extra revenue, then clearly his expectation is that the state will not allocate enough to Johns Hopkins. Johns Hopkins could be focusing those resources on improving the health of Maryland’s most needy but will instead, understandably, continue to act in a businesslike manner to protect its financial stability.

This state program will likely fail as those hospitals in Maryland that do not have the ability to generate external revenue and will find themselves squeezed to fiscal desperation. Rather than allowing hospitals to close, the state will inevitably prop up those institutions with “emergency funding,” which will negate any savings from the program. The reality is that all services have a price. That price can only be shaved so much. True cost savings will only come about with a reduction in services. Some of that reduction can be legitimately gained by comparative effectiveness research. The rest will be gained by reduced access to service, such as is seen in the British and Canadian systems, where long waiting times for elective procedures lead to patient attrition. Like it or not, rationing is coming if the American people are willing to accept it. If they won’t accept it, then programs like this are doomed to failure, and costs will continue to rise.

Richard S. Goldstein, B.A. ’74, M.D. ’77, FACS, FASCRS

Clinical Assistant Professor of Surgery Drexel University College of Medicine