To The Editor:
The new addition to The Journal, "The Orthopaedic
Forum," has raised my interest a great deal. However, it would appear
that the article on the application of game theory to physicians'
dealings with managed care, "Topics in Medical Economics: Lessons
of the Prisoner's Dilemma," (82-A: 595-598, April 2000), by Dr.
Bernstein, may indeed draw the wrong conclusions considering the
magnitude of managed care and different spheres of influence in this
country. I am from southern California, and believe me, managed
care is a dilemma - and a nightmare. Ergo, Darwinism.
I also read the wonderful and mellifluous speech by Dr. Canale,
entitled "Falling in Love Again" (82-A: 739-742, May 2000). What
a noble and beautiful sentiment from an individual on the verge
of retirement. Besides falling in love again with my patients, wife,
and children, I have also found it helpful to fall in love with
malpractice attorneys, HMO administrators, insurance-plan managers,
and hospital administrators. I have found it especially helpful
to fall in love again with all of my patients who only wish to have perfect
or unobtainable results in a totally imperfect world.
Furthermore, I think it was most wise of Dr. Canale, a self-described
"dysfunctional, egocentric, self-centered" character on the verge
of his retirement, to announce that he is falling in love again
with his wife. Lucky wife!
All venomous attacks aside, I believe that The Journal should
stick to the facts and stop the various vignettes and campfire stories
of isolated, fortified, and aloof individuals who have absolutely no
conception of what has happened and where medicine inevitably is
going.
T. Thomas Ackerson, II, M.D.
Huntington Pasadena Orthopedic Medical Group
10 Congress Street, Suite 103
Pasadena, California 91105
To The Editor:
I also congratulate the Editor's decision to offer "The Orthopaedic
Forum."
Concerning Dr. Canale's article (82-A: 739-742, May 2000), I
have found that we physicians share many concerns and feelings in
our global culture as a result of our new involvement in many managerial
and administrative issues. I agree with Dr. Canale's statement that
it is "quite difficult" to "keep up with [both] managed care and
the diagnosis and treatment of orthopaedic diseases." I also feel
that "my orthopaedic education has suffered."
In fact, we are very troubled by the changes in our old paradigms.
Nowadays, we receive the message that patients have become clients! There
is a new belief that medical practice and surgery are exact sciences
(and it seems that there will always be a lawyer to confirm it).
Also, patients' ideas about us are changing so fast that many are
looking for an almighty scientist who can solve everything.
Last, but not least, I also need to fall in love again with my
patients, and I accept Dr. Canale's invitation to join him in making
this the year of the patient in spite of new paradigms.
Jorge Luis Santodomingo, M.D.
Department of Orthopaedic Surgery
Hospital Regional
9400 Rio Gallegos, Santa Cruz
South Patagonia, Argentina