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    « Do You Know What Your Doctor Is Talking About? | Main | The Surgeon and the Torture Memos »

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    Dr. Marco Benavides

    Dear Dr. PAULINE W. CHEN, M.D.:

    I'm mexican, a kidney transplant surgeon and practice in Chihuahua city.

    My comment is about what two of your articles are about:

    In the first place, being capable of communicating with the patient is everything in Medicine. A physician can not even assume he/she can know the degree of suffering that a person has until the practitioner is able to fully understand what that person say and feel about the illness. And if a physician can't understand that patient's pain, it is impossible for that doctor to treat that human being in a farly humane way. The doctor may be a genius technically, but that is a completely different matter.

    The other comment, about the lack of primary care physicians, specially in medically underserved areas, comes with the fact that the current system is awfully restrictive regarding the opportunities for foreign physicians, who are in the position to work for the benefit of that usually unprivileged people.

    I can tell you that because I'm looking for an opportunity to go to work to the United States, and I've been exploring options as a doctor, to work in transplantation, surgery and primary care. This is motivated for the increasing violence here in Mexico, specially in Chihuahua. I'm sure you've read about it in the press.

    I've served since 1991 as a physician for the mexican health system. But now it is simply too dangerous to live, work and raise a family in a place where street shootouts and kidnappings are just the normal everyday's events.

    I fully agree that training programs, specially surgical ones, have to be strict enough to make sure that professional is a completely skilled practitioner. And I can't agree more with a complete licensing system.

    But, surrendering that many foreign colleagues have been successful, it is almost an administrative Mission Impossible to go to the United States and work as physician.

    All the paperwork is almost a science in itself. And the worst of it is that more articles, more often, get published regarding the increasing lack of multilingual physicians and primary care practitioners for medically underserved areas.

    The american people just need them and don't have them because the system makes it too difficult for them to go to work there.

    I think an important part of the planned US health reform should regard about that. Don't you think?

    Congratulations for your work, I just had the opportunity to read about it and I think it's wonderful.

    Respectfully

    Dr. Marco Benavides
    General/Kidney Transplantation Surgery

    James Patrick Lawrence, MD MBA

    Dear Dr. Chen,
    I recently read your September 3, 2009 piece in the New York Time. I must say, although I share your concern about this common problem, I find that this is a terribly irresponsible way in which you present it in the newspaper. Your account may represent a recollection of the events that occurred during that episode, but places in the public's mind a very skewed view of this very real challenge in patient care. As a surgeon, I have never handed off a case in the middle of an operation, and I would venture that passing a case off in this way happens very rarely, especially one involving such delicacy in a child. If that is the manner in which that occurred, so be it. However, you understand very well the complexity of medical and surgical practice and the dangers of public perception. One would take from the article that the behavior exhibited by the surgeons you describe is common, when it is in fact not. In addition, there may have been additional communication between the two professionals outside of the operating room, which is common practice. In any case, while the problem of patient hand-offs is very real, it is very rarely in that setting and I don't think your piece accomplishes the goals of improving public awareness of the issue. The issue lies, for the most part, in clinical patient care when physicians are changing shift and discussing in abbreviated fashion the care pathway and the tasks to be accomplished. This is much more common in internal medicine, pediatrics, neurology, and the other medical fields because of their large patient loads and the voluminous patient information that must be passed quickly.
    Thank you,
    James Patrick Lawrence, MD MBA
    Orthopaedic and Spinal Surgery

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