Home >> ALL ISSUES >> 2017 Issues >> Letters, 9/17

Letters, 9/17

image_pdfCreate PDF

Joint specimen exams

I write this after reading “Total joints in view: to tilt at or to toss” (July 2017). I just completed my 42nd year as a general pathologist in an acute care community hospital that had 100 beds in 1971 and now has close to 500. From about 1980 (before we went to “separate billing”) through 2014, I fought relentlessly to have and keep the policy that all tissue get a pathology exam. These exams are needed:

  • as patient protection from missed occult, significant diagnoses,
  • to guard practitioners from failure-to-diagnose lawsuits,
  • to be a source for defense against the erroneous particularities of some medical malpractice lawsuits,
  • to stave off fraud and abuse claims against the surgeon and the institution about sham surgery or unfulfilled DRG and other such services,
  • to provide potential data for institutional organized medical staff efforts in Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FFPE),
  • for facility accreditation reasons,
  • to provide more accurate data for public health tracking of true incidence and prevalence of disease, and
  • to be a source for possible subsequent DNA identification of an unknown deceased person who is thought to be someone who had surgery at that institution.

All of these needs have to do with what is best for the patient and society and nothing to do with cost-effectiveness (which defies accurate analysis) or the pathologist earning more by performing these tedious duties.

The only way to convince organized medicine in the United States that pathology exams must be performed on all removed tissue would be to establish a secure, online, de-identified registry of cases. I suspect no pathology organization has the will to tackle this.

Ervin B. Shaw, MD, Lexington Medical Center, West Columbia, SC

Transgender medicine

I read your article “Making it personal: transgender medicine” by Karen Titus (August 2017). It was fantastic and I can hardly wait until the next installment. I am a graduate student at Rutgers University in the Department of Clinical Laboratory Sciences and this is the topic I have been researching for my final paper. It is very interesting to me, and most of the physicians I encounter in my day-to-day life have no answers to my questions. So thank you for your article. It has made me realize that I am not crazy to wonder about my questions on the diagnosis, lab results, and treatment plans for transgender patients. I have also now been enlightened on billing and laboratory information system issues I hadn’t thought about until now.

Meg Harlin, BSMT(ASCP), CLS(NCA), Clinical Laboratory Scientist, Atlantic General Hospital, Berlin, Md.

Your article is by far the best, most straightforward article I have ever seen on health care for transgender people. So many of the issues I have faced as a transgender woman are discussed and many I never considered but still may face. Thank you for publishing this work. Karen Titus should be commended for such unbiased, direct, factual reporting. I hope your article gets wide circulation.

Jaye S., Naperville, Ill.

CAP TODAY
X