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More on Finding a Cure for the Ailing Medical Profession

August 01, 2004

Rarely does an expose that tackles technical and political medical issues contain such clarity and insight as Janet Wells' piece did on the ever-present struggle faced by emergency personnel ("Medical Alert," July 11). For 13 years I have specialized in emergency medicine in Los Angeles and Orange counties. A thick, hindering fog surrounds emergency departments, one that obliges us to spend countless hours haggling to get uninsured and even "covered" patients admitted or transferred; trying to find on-call specialists to aid us; struggling to get authorizations from the myriad HMOs--in other words, non-clinical issues--all while we attempt to care for people and hope to avoid a malpractice reproach. There is no refuge; the system spins more wildly out of control on a daily basis, and fewer and fewer resources are available to us to provide a remedy.

Dr. Lawrence Stock lives, on a part-time basis, the fantasy that we all dream about in this field: to care for ill humans without fear of criticism, political influence or insurance considerations, and to feel appreciated by those whom we treat. Isn't it ironic that it seems easier in many ways to practice medicine in harm's way in the jungle of a Third World country than here in Los Angeles?

Scott Jacobs

Los Angeles

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Although working in the jungle is admirable, it can't solve our problems back home. I have done several short-term stints overseas. But to compare and contrast medical mission work there to private practice here is not instructive. First, these are not interchangeable career options for most doctors. Second, it might be fairer to compare private practice in L.A. to private practice in Bangkok, say, or refugee work there to work with free clinics here. The contrasts might not be as sharp.

Also, surgery and emergency medicine are by nature episodic, intense patient interactions, ideally suited to short-term work. The long-term management of chronic illness, however, is much more difficult to support in rural areas with thin supplies of medicine and where patients' understanding and cooperation are required. Although it might give prompt, temporary relief to physicians who suffer from burnout, practicing overseas is not the antidote to issues of access, price and quality that bedevil the health-care system today.

Jonathan B. Blitzer

Long Beach

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