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Letters


laptops and HMOs and how many patients you can fit into a day are not what is really important.

I miss him.

Cheryl Taylor
Canaan, N.H.

A great narrative
I enjoyed the wonderful article by Deborah Lee Luskin about Tim Shafer in the Fall issue of Dartmouth Medicine. I empathize with them, recalling with fondness the nice relationship I had with patients but cringing about the unpleasant administrative and financial burdens. I, too, became an employed physician in 1991, but my health forced me to retire in May 2007. The patients were what made it all worthwhile.

I note with awe the retirement at age 55 to 60 of college classmates who went into business and finance. Theymay have homes and toys I can only dream about, but I get to live where they like to visit—not too bad.

I commend Tim on his impressive career and Deborah on writing a great narrative and supporting the office for so long.

Warner Jones, M.D.
North Springfield, Vt.

A way to go it alone
I was terribly saddened by the commentary within "Care Package," as it sends the message to our younger physicians that solo private practices are no longer possible.

The truth is anything but that. Speaking as a solo physician whose office is much like the one described in the Editor's Note in the same issue, "Revisiting Vinyl" I have avoided HIPAA entirely by remaining small and by not having any electronic transfers of information. And I've avoided billing problems by simply collecting payment at the time of service, by not accepting any insurance or joining any managed care panels, and by keeping my fees reasonable.

My patients know what day I'll be at the office and simply show up. I stay until I'm finished and the waiting room is empty. Patients are thrilled with the ease of access, I'm happy because I'm not

Readers were moved by our Fall cover story—about what happened when fam- ily physician Tim Shafer found himself doing too much paperwork late at night.

wasting anyone's time (my own included), and satisfaction on both sides is high.

The American Medical Association offers all member physicians a catastrophic insurance coverage program that serves me well and is inexpensive.

Placing a professional into an employment situation means that professional decision-making becomes biased by the needs or desires of the employer. Just as an example, the decision of DHMC to have a policy that applies to all employees regarding pharmaceutical company freebies means that the professionals employed there no longer get to use their own professional judgment regarding that domain.

Not wanting anyone else to make professional decisions for me, whether I happen to agree or not, I choose to keep my medical practice in my own hands.

Stuart Gitlow, M.D.,
M.P.H., M.B.A.
Woonsocket, R.I.

Gitlow holds an appointment as an adjunct instructor in psychiatry at Dartmouth Medical School.

Heart-wrenching portrayal
"Care Package" by Deborah Lee Luskin was a heart-wrenching story in its portrayal of the devastating effects of federal legislation on a rural medical practice. Reeling from one blow after another—managed care, HIPAA, CLIA, EMTALA—the "mom and pop doc shop" that she and her husband ran was finally forced to close.

It was not a happy story, but it was a true

story; the details of the struggles she described speak volumes about health-care delivery in the U.S. today. What we value most when we are ill—a focus on the treatment plan and on the healing process, and personalized and empathetic care—is undermined today by the proliferation of paperwork and the limits placed on providers.

This story both moved and frightened me. Thank you for publishing it.

Mary Buchinger Bodwell
Boston, Mass.

Bodwell is an assistant professor of English atMassachusetts College of Pharmacy and Health Sciences.

Insidious effects
As a friend of Dr. Bob Rufsvold's, I was glad to read the article about his time in Ethiopia [see "Being Present" in the Fall 2007 issue of Dartmouth Medicine]. I'm pleased to know that through his article, many people are being educated about the practice of medicine in the Third World. And about the insidiousness of the way the dam is threatening the grazing lands of the indigenous people of Ethiopia's Afar region. Dr. Paul Farmer's work in Haiti with Partners in Health offers similar insight into medical caregiving in this sort of situation.

I was glad to read recently that Médecins Sans Frontières, the organization with which Bob worked in Ethiopia, has developed a peanut paste that is better at helping nourish starving people than the milk products that have been commonly used in the past—for they depend on a clean water supply. There is no substitute for water. In fact, it may represent the limit of sustainable development, since 80% of disease and death in the developing world is due to the absence of a safe water supply. Ground water depletion and contamination are perils that we must make strong laws to prevent.

Yet little by little, headway is being made. I believe this is a time in which cross-cultural experiences and these sorts of reflections have never been more needed. Each hand that touches another makes a difference. To know that what we do matters is essential. I loved the thought


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