How government killed the Medical Profession.

• Author: Tsambassis, Nicholas A.
• Position: Letters - Letter to the editor

Dr. Jeffrey A. Singer ("How Government Killed the Medical Profession," May) is spot on with his recent article. His assessment of the degree to which the medical billing code systems contribute to cost escalation dovetails closely with a similar point made by Steven Brill in a recent issue of Time, where he described in detail the chargemasters used by hospitals to determine fees and how intimately associated they are with procedure and diagnostic codes. In addition, many of the evidence-based protocols drive this system as well, along with sets of "core measures" applied to an ever-expanding list of diseases and conditions.

My colleagues and I are constantly reminded of these metrics at our hospital staff meetings, with never any mention of how core measure compliance actually improves patient care. I have also noted completely superfluous extra interventions ordered or recommended for some of my patients, appearing only to increase reimbursement for that particular Medicare code. God forbid that we should object to any of these measures, lest we be labeled "disruptive physicians" and referred to physician health organizations or, worse, to the state board of medical examiners.

Lamentably, we as physicians have enabled this sequence of events, mainly through reliance on professional organizations that we had entrusted to look out for our best interests while they were actually working in concert with regulatory entities. It is high time that we come together to preserve the practice of medicine and reduce third-party intrusions.

Nicholas A. Tsambassis, M.D.

Clarksville, TN

I want to thank Jeffrey Singer for his article. I spent 41 years as a teacher. Put the word "teaching" in the title, and "teacher" for "doctor" and "student" for "patient" throughout the article, and Singer has accurately described the demise of education as well as of his own profession.

The description later of the proliferation of "fee-maximizing advisers and seminars" fits education. In our case most are subsidized with tax dollars. Education also has its "evidence based, cookie cutter" mandates. They're known as "standards and benchmarks, state mandated core curriculum, standardized testing." Teachers also face hours of adapting to computer-based record keeping and tracking "data" that we suspect is mostly used by no one. Decisions about what it means to be educated are made by those as far away from the individual student as possible. It's madness.

I worry that the...