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Thursday, January 22, 2004Just thought you like to know that Chris Matthews was just on the air beating up on Howard Dean's campaign manager about Dr. Steinberg's abscence from the campaign in Iowa, and implying it cost him the caucus. Mr. Trippi was stating that Dr. Steinberg was running a "family practice", "taking care of a seven-year old daughter of someone she has taken care of for twenty-five years" Ain't politics grand? I'd say Joe Trippi doesn't know much about either his candidate or his candidate's wife. Another reader comments on Dr. Steinburg's specialty and questions whether it really should be a factor in her decision to stay away from his campaign: I can identify here. I have a serious, potentially fatal blood disorder, and I see one of the top hematologists in the country for it. If he were a she, and her husband was running for the presidency, I wouldn't be inconvenienced one bit. (In fact it would be kind of a kick to see him/her on TV all the time.) My top expert is a very busy man. He sees patients only one day a week, does research, travels the world to go to various conferences, publishes frequently, etc. So he often delegates day-to-day care to associates. This is not unusual, I would think. He attracts a large cadre of young, very talented docs who are interested in cutting-edge medicine. These guys often see patients and learn from the master. A friend of mine who also sees the same heme doc recently had a bone marrow transplant. The procedure is fraught with danger, but obviously the work is not done by my top hem doc, it is done by hospital staff docs, nurses, etc. There is a routine for even these procedures, procedures which are being fine-tuned constantly. I suspect that Dr. Steinburg is more like my local hem doc. She works with the top hem doc in deciding on treatments and administering them. If my local heme doc left town for 12 months, I'd do just fine. She's good, but she's not one of the top experts in the country. You may recall the saying, 'the cemeteries are full of irreplaceable people'. Dr. Steinburg's distance from her husband must give people pause; is he so unbearable she can't stand being with him? (It's probably moot now since it looks as though Dr. Dean is dead meat, or will be soon.) Well, after that Monday night scream you've got to think his personality might have something to do with her decision, but it's still not such an easy thing to abandon a medical practice - at least not one that you own. The difference between Dr. Steinburg and the academic is that the academic's salary is paid by the university. If he chooses to practice part time, he doesn't have to worry about covering the cost of over-head, the university will. A doctor in private practice has to keep earning the money to pay for her rent, malpractice, staff, utilities, etc. The profit margin in medicine is very small. Cutting down by one or two days a week can erase a doctor's income. It also means two days when you're not available to your patients. And that means that a certain percentage of patients will leave and go to someone who is more accessible. As far as patient attachment to doctors, that varies with the patient. Some people couldn't care less who treats them. But others become very disconcerted if there's a change in doctors. I know a significant proportion of my cancer patients are very devoted to their oncologists. And community hematologists/oncologists do much more than just follow the advice of tertiary care center specialists. They decide the appropriate therapy for all but the rarest of cases, and manage the consequences of that therapy. If Dr. Steinburg signed her patients over to her partners for a couple of days a week, she'd risk losing some of those patients, or taxing her partners beyond their limits by increasing their work load. Her decision is a reasonable one, and one that the media should respect. posted by Sydney on 1/22/2004 08:20:00 AM 0 comments 0 Comments: |
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