Faculty Bibliography

While it is true that we still make a decent living, at the same time, we must hire more and more staff members to handle certifications, pre-certifications and referrals while also accepting lower payments. With the new fee reduction almost certain to filter down from Medicare to the HMOs the way such reductions have done in the past, it will become increasingly harder to stay level. Last year, an HMO penalized me and several other New York University physicians thousands of dollars each for what it deemed 'overcoding' -- that is, billing for longer or more comprehensive sessions than our documentation warranted. I called in a coding expert, who lectured me on the principle of better record-keeping being a sign of better doctoring and gave me an elaborate form on which to write patients' notes. Struggling with my professional identity, I try to find myself in the famed physicians' Hippocratic oath, which says, in part, 'In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction.'

Siegel discusses reaction to the numerous terrorist alerts that the government issues. Tips are offered on whether it would be wise to get vaccinated for smallpox and how one would know when it was safe to come out of a 'safe room' following a terrorist attack

Meanwhile, the drug salespeople brought free lunches as well as flashy product samples to my office, trying to entice me and my patients with the latest and greatest. It was tempting to believe that the new pill would work -- we both wanted it to. It was easy to forget last year's pill, which was probably just as good and, having gone generic, a whole lot cheaper. But Mr. B was growing more and more cynical, not believing any pill could help his hip pain. On the rare day when his symptoms eased and he felt well, he would claim that medications had nothing to do with it. Mr. B would not consider hip surgery -- he was afraid of complications -- though he finally did agree to see an arthritis specialist. This doctor prescribed a yellow pill, the latest once-a- day medicine that was supposed to be easier on the stomach than other drugs. Taking it for a two-week trial, Mr. B reported that his stomach was fine, but he still limped noticeably. At his request, I sent him to a second arthritis expert, who switched him to a green pill, which didn't work even as well as the yellow one. The second arthritis expert recommended surgery, but Mr. B still refused it. In my office, the yellow pill competed with the green one for space in my sample closet. Both manufacturers clearly thought that I would end up prescribing the drug. All the drug salespeople seemed to know how much of their product I prescribed. They brought clumps of samples for various conditions all at once, probably believing if I gave out their green pill for arthritis, I would also start prescribing their red pill for sinus infections

Over the past five years the drug companies have struggled to create name recognition using extensive television and magazine ads. The major effect of this has been to raise drug prices and overall costs as patients pressure doctors to prescribe drugs that often aren't needed. A report from UCLA last year concluded that doctor/patient roles may be damaged

In October, when the first anthrax-laden envelopes were received, the FBI froze the Centers for Disease Control and Prevention out of the high-profile investigation, according to CDC officials. The US safety net against bioterror was porous because of a turf battle initiated by FBI autocrats, and five people died.

The risk of smallpox appearing in the United States is still theoretical. But ever since Ken Alibek, the former deputy director of Biopreparat, the Soviet biological weapons apparatus, freely admitted to extensive amounts of smallpox existing in the Soviet Union, there is every reason to believe that some of the stockpiled virus may have found its way into the hands of rogue dictators or terrorists. And smallpox may be aerosolized -- if it is sprayed, it could infect hundreds of victims right off the bat. The fear associated with smallpox is much more contagious than the disease. Smallpox is one of our ancient scourges, and it captures the dark side of our imaginations. Schoolchildren learn of smallpox as the first bioweapon, distributed in blankets to Native American tribes by British troops during the French and Indian wars of the 1750s. Vague memories of our earliest immunizations against smallpox haunt many of us

Siegel discusses a recent experience having dinner at a restaurant sponsored by a drug company.

In part it is the sleepless nights that form a doctor's mettle. Essential skills learned under military-type rigor are not soon forgotten and are essential to good doctoring. And many specialties require emergency middle-of-the-night calls throughout a doctor's career--it is the on-call shift that prepares a young doctor for the later demands of practice. A greater concern than hours is supervision. Eighteen years ago in New York a young woman named Libby Zion was diagnosed and treated improperly because of inadequately supervised--not sleep-deprived-- residents. She died. The result of this case was New York's laws to limit residency hours, yet adequate supervision, the real problem, was not ensured. This year, an undertrained doctor at a New York teaching hospital was left in charge of a ward of sick liver transplant donors and recipients, and a liver donor died