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outcomes research in your Winter 2007 issue—every word of it. If only the folks in Washington, D.C., would do the same, and then pick up on the work from DMS and run with it.
Needs in our own backyard
As a strong believer in Jack Wennberg and his campaign to improve medical care, I liked your last issue.
The biggest problem in medicine is rural medicine. Doctors, too often, are attracted to urban practices, perhaps for monetary gain, silly social ideas, or whatever. It's fine to supply aid to needy countries, but there is a great need at home, too. Rural medicine is badly in need of some help.
Rowland French, M.D.
A valid observation
For a number of years I have been sent Dartmouth Medicine, free of charge. Please accept my thanks for the subscription. Your publication has added greatly to my reading pleasure. It is my favorite periodical. On the day that Dartmouth Medicine arrives, I cannot attend to other tasks until I have read the magazine from cover to cover. I have gained so much new information from the various articles.
In the Winter 2007 issue, I was particularly interested in the well-written story by Maggie Mahar concerning the life and contributions of Dr. Jack Wennberg. I am so glad his hard work and insights have been validated. Often those with great talent and brilliant ideas are not acknowledged during their lifetimes.
I am pleased to have the opportunity to read about all the people, places, and programs that make up DMS and DHMC. It makes me feel a firsthand connection to your great medical center and medical school.
Painter's point of view
The Winter issue of DM was, as always, fascinating. I think the staff has long since achieved the right balance between serious subjects and a dash of humor. Honestly, I can't imagine a more
informative, well-edited magazine; the magazine's talented editors and writers richly deserve every award they get.
There's one element of the issue that calls for particular comment. I can't think when I've seen a more marvelous portrait than the one of Jack Wennberg. It's a rendering that, as a longago pastel painter of children, I find incredibly well done. And it's in perhaps the trickiest medium—watercolor. I hope the original is someplace where it will be widely appreciated.
That portrait (reproduced above) was the work of noted artist Bert Dodson, whose work first appeared in these pages 20 years ago—in our Spring 1988 issue. Happily, his watercolor of Jack Wennberg will indeed be hung in a spot where it can be appreciated, as it's been acquired by the Dartmouth Institute for Health Policy and Clinical Practice, which Wennberg founded.
I just finished "Braveheart," about Dr. Wennberg. What an excellent piece—hats off!
My colleague and I have spent over 30 years combined in health-care outcomes management, asking these same questions. For example, we have seen physician after physician continue (even today) to order wet-todry dressings for chronic wounds, a practice that results in delayed healing, increased pain, increased costs, and poorer outcomes. Yet physicians still order these dressings ad nauseam.
When we ask nurses to collaborate with
physicians to improve wound care, many simply say, "We just follow the physicians's orders."
I once got up the courage to ask a physician in Houston why these dressings are still ordered—even though the Agency for Healthcare Research and Quality has been sending out the message since 1994 that they do not yield better outcomes (except, of course, in cases of short-term debridement, when the practice is "appropriate medical care"). He looked at me with a thoughtful expression and said, "Well, Melinda, I guess it's just a habit"!
We who are responsible for developing programs to improve health outcomes certainly do have our work cut out for us to get folks on board with something other than "habits." I only wish that most physicians felt the same enthusiasm.
Melinda Huffman, M.S.N.
Huffman is a disease management/ outcomes specialist with Miller and Huffman Outcome Architects, L.L.C. She is not related to the writer of the next letter.
Calling Norman Rockwell
I very much enjoyed the description in the Fall 2007 issue by Editor Dana Cook Grossman of her childhood doctor's office. She could just as well have been describing my dad's office in Ravenna, Ohio. He, too, took no appointments, just calling "Next." He charged only $2.00 to $5.00 per visit (often including medications) and when he began in practice had office hours every day, including Saturday and Sunday!
We may never again see the likes of a doctor working with the same office assistant and in the same office, and living in the same home (with the same wife), for well over 50 years. I was a very fortunate lad. My dad finally closed down his office in his 85th year!
I wish now that we had taken photographs of that Norman Rockwell-like setting—including the hard, white exam table and the "pill room." Fortunately, I do still have his big rolltop desk and some of the pictures from the walls of his office.
Thomas A. Huffman, M.D.
DC '48 and DMS '50