In the editorial, "Patient Privacy and Confidentiality --- Time to Draw the Line" (Medical Sentinel, Nov/Dec 1998), Dr. Faria discusses the severe problems that occur when patients lose their privacy. At the end, he warns of the consequences, "unless all citizens stand up and say no." Certainly, AAPS members wish that citizens would do this but under the current system, I doubt that they will. The reason is that we are under the control of central planners and central planners need data to do their planning. It is the gathering of this data that leads to our loss of privacy.
Central planners or top down planning does not happen with individually-based health care. With this, there is little need for central planners to gather the data that invades our privacy. Therefore the key to health care privacy is to change from a government-based (Medicare) and employer-based system to an individually-based health care delivery system.
Bert A. Loftman, MD
Medical Staff Bylaws in the Heartland
Thank you for your outstanding effort as editor of the Medical Sentinel, especially for your courage in tackling emotionally charged issues which our other "representative organizations" ignore. Unfortunately, our aversion to the feelings these issues engender, does not negate the need to deal with them. As new members of the AAPS, we have mixed emotions discovering that our unpleasant feelings are shared by so many colleagues.
We made the choice several years ago to move to "America's Heartland," hoping to practice medicine as it was taught. "Organized" medicine was a foreign concept where we settled. Unfortunately, the tyranny of "acquisition and central control" has discovered our enclave. Our rural independent hospital (with "help" from the administration) is now under siege by several "suitors."
Seeking to maintain physician independence from the various health care merchants, we turned to AAPS for assistance. With unbelievable promptness they responded. Through Andrew L. Schlafly (AAPS General Counsel) we were introduced to José Guerra, Jr., M.D. Dr. Guerra, Chief of Staff, Wood County Hospital, Bowling Green, Ohio, graciously shared his experience and insights in dealing with this challenging issue.
Facing these issues of physician autonomy and self-determination, we recognized the need for stronger Medical Staff Bylaws. These bylaws provide not only the professional structure for medical staff operations, but also the legal structure through which the medical staff relates with the Hospital Board. If worded correctly, bylaws assure that physicians control their own affairs! If carelessly constructed, they can become worthless if hospital ownership changes.
Dr. Guerra and Mr. Schlafly assisted our implementation of bylaw changes, from language through tactics. We expect that these bylaw changes will insure that some medical control remains in physicians' hands, whether our hospital is sold or not.
Many of us realize that major non-medical forces continually disrupt the efficient provision of patient care. Few of us realize the ease with which our professional worlds can crumble. Many inefficiencies are forced upon the physicians by regulatory agencies which control hospital certifications, reimbursement, and malpractice issues. Few efforts are as worthwhile as the proper preparation of hospital Medical Staff Bylaws.
Unfortunately, we are usually too busy caring for the sick to deal with these issues. Also, most of us have no idea what we should do to protect ourselves; our "education" typically comes from the school of hard knocks. The need for further education is clear. The first step, then, is to share with our colleagues the importance of AAPS membership; no other physician organization "tells it like it is," refusing capitulation.
Further, we endorse Dr. Guerra's idea of a forum, perhaps through a regular Medical Sentinel section, or a dedicated department on http://www.aapsonline.org to inform members (and non-members) of important medical and non-medical issues (such as bylaws development and construction) which physicians can influence locally.
Robert T. McQueeney, MD
Ralph D. Skowron, MD
AAPS is setting up forums on various subjects including medical staff bylaws at http://www.aapsonline.org. Interested physicians can e-mail Andrew L. Schlafly, Esq. at firstname.lastname@example.org. See also Dr. Guerra's report on pages 65-66. ---Ed.
Dr. Blaylock's history of the socialist movement in America filled in many gaps in my understanding ("Managed Truth: The Great Danger to Our Republic," Medical Sentinel Nov/Dec 1998). I would like to correspond with him and ask him a question concerning the article. You listed his "snail mail" address, but didn't give an e-mail address. Do you have his e-mail address and, if so, could you give it to me?
Enjoying your publication,
Dr. and Mrs. Stephen Weinberg
"It has been well said that the chief trouble with the contemporary generation is that it has not read the minutes of the last meeting." After this quotation from Richard Weaver, Dr. Russell L. Blaylock proceeds to blame the liberals, particularly the Fabian intellectuals for the distortion of the truth and the consequent state of disarray of the American society at present.
I suggest Dr. Blaylock should have assimilated Weaver's admonition before he went to place the blame on relatively harmless people. For instance, he could read the minutes of the Inquisition's activities in pursuit of the "heretics" in the 14th through 17th centuries. Malleus Maleficarum, "The Witches' Hammer," by Heinrich Kramer and James Sprenger could be a good start. This official legal/moral code of the church/state power of that period begins as follows: "Whether the belief that there are such beings as witches is so essential a part of the Catholic faith that obstinately to maintain the opposite opinion manifestly savours heresy." We all know the fate of heretics. Minutes of those days show the people lived in a state of terror. Even the great intellectuals, (liberals?) such as Descartes did not dare to confront the capricious dogmatism of the state power for fear of ending up on a pile of burning logs.
The "minutes" show there is such a thing as condition of terror in a population. Condition of terror can cause the people to pretend they do not know the truth, however obvious the truth may be, in order to save their lives.
We, in the U.S.A., are in a state of terror today. "Hate speech" is now what heresy was then. The power of the state is greater now than then (read Gore Vidal's "The War at Home," Vanity Fair, November 1998). The liberals versus conservatives argument is as evasive and futile now as it was then arguing how many angels could be placed on the tip of a pin. Or whether it was wrong for the Emperor to have foreign tailors.
"Perhaps the truth is that we need the enemy in order to define ourselves," Richard M. Weaver in his book The Ethics of Rhetoric.
Nelson Borelli, MD
Dr. Blaylock Responds
I thank Dr. Borelli for his letter, but I must conclude he has made a common error. He assumes any resistance to the left --- i.e., the collectivists --- constitutes tyranny from the right. First, he underestimates the enemy. As I pointed out in the article, the Fabians, and subsequent leftist elements, though small in number, were extremely influential in our society because of their power and social standing. It was by design that they placed themselves in positions to control the dominant rhetoric that was allowed to be heard by our society. I suggest he re-read the article carefully, and without his preconceived prejudices against Christian society and the necessary hierarchy of our culture.
I find it amusing he quotes Richard Weaver, a man I greatly admire and read often. Weaver was first a Southerner, then a conservative and a rhetorician. Like M.E. Bradford, he saw an intimate relationship between rhetoric (the art of persuasion) and culture. For Dr. Borelli to draw from my comments about the left's abuse of the public forum, a call for the power of the State or even the Church to police society, is incredible. It sound much like the left's mournful chant that any light shed on their nefarious exploits is "McCarthyism." Ironically, it is also the left that uses the analogy of the Inquisition, ad nauseum.
The idea of "hate crimes," "politically-correct speech," and the suffusing of our culture with extreme leftist (collectivist) rhetoric under the guise of "progress" or "compassion," emanates from the extreme left. I have read Compendium Maleficarum as well as Demonology and other classic works on the Inquisition. As you will recall, it was a union of the Church with the State that resulted in the terror and not the Church alone. The Church only controlled rhetoric at that time because of this union.
Today, the tyrannizing force is a leftist-liberal power that virtually controls rhetoric and engages in a massive exercise of propaganda. What I am calling for is truth in the public square. It is those who continue to deny the power of these forces who give them the cover of darkness that they require to exercise their evil will over society. If not exposed, our society can only deteriorate into the dictatorship of totalitarianism.
Russell L. Blaylock, MD
Free At Last!
Thank you for providing information on how to "opt out" of Medicare. I followed your instructions to the letter and proudly enclose notification by my local carrier that my affidavit meets all the required criteria to privately contract with my Medicare patients without interference by oppressive HCFA bureaucrats.
To celebrate my new independence, I have donated a one-year subscription to the Medical Sentinel to both the local public library and to our local AHEC (Area Health Education Center), neither of whom were aware of its publication.
I echo the immortal words of a great American spiritual leader: "Free at last, free at last, thank God Almighty, I'm free at last!" (Dr. Martin Luther King, Jr.)
David J. Pasek, MD
Starting on January 1, 1999, HCFA's new E&M guidelines will be imposed on practicing physicians. The new E&M guidelines request the physicians to practice medicine according to federal, descriptive, required, outlined, specific details. New federal requested guidelines will authorize "armed" auditing agents to enter doctors' offices, unannounced, to inspect and/or audit private patient charts (your chart) without your previous informed consent.
...After many hours, days, weeks, and months of reflection, deliberation, prayer, and consultation, the Lord has provided a solution:
° I will continue to see my patients who are insured under Medicare.
° I will not submit patients' bills to the Medicare intermediaries.
° I choose to honor freedom and reject unconstitutional constraints and tyrannical edicts so long as this country is still (partially) free.
° I will not submit any bill directly to my patients who are on Medicare.
° Patients who are on Medicare and who have received my medical services for free are encouraged, urged, and exhorted to make a free will offering to any of these three 501(c)(3) tax-exempt educational foundations: a. The Americanism Foundation; b. The Freedom in Medicine Patient-Physician Coalition Educational Foundation; c. The Born Again American Foundation, all located in Norwalk, OH 44857.
Gratefully and Faithfully your doctor,
Nino M. Camardese, MD
Open Letter to Congress
...The Clinton gang has made liberal use of polls and focus groups to determine just about every policy issue...Congressman, I want to remind you polls represent only a snapshot in time and results are inseparably tied to how the question is asked. For instance, when pollees are asked whether the president is doing a good job running the country, it may be like asking whether the pilot of the aircraft did an adequate job of flying the plane on your last trip. If the results were that you got to your destination safely, in the case of the pilot, one would expect high approval ratings. However, a president is something more. He is the inspirational leader, the commander around whom the populace may rally at times of national crisis. He is the political descendent of Madison and Jefferson and Lincoln, whose foundations were firm and based on principles and beliefs, codified in the Declaration of Independence and the Federalist Papers as well as the Emancipation Proclamation. In matters of trust, integrity and honor, we place our hopes and aspirations in our president. On questions of trustworthiness, integrity and honesty, Bill Clinton fails in the polls with ratings at a miserable 15 to 20 percent....
David A. Westbrock, MD
Correspondence originally published in the Medical Sentinel 1999;4(2);41-43. Copyright©1999 Association of American Physicians and Surgeons (AAPS).