Re: Article in Med Economics

[Guest guest]

WOW! Simply amazing. It reminds me of a few patients but not quite

as dramatic. I was on the edge of my seat, but sort of knew how

it would end. You really did the best you could in the circumstance.

What a society.

Pamela

>

> Group,

> My " doctor's writing contest " article came out in Med Economics Magazine

> today. The link is:

> http://www.memag.com/memag/article/articleDetail.jsp?id=426214

> <http://www.memag.com/memag/article/articleDetail.jsp?id=426214 & sk= & date

> = & & pageID=1> & sk= & date= & & pageID=1 if you want to read it. The story

> probably sounds familiar as I made reference to it months ago in a

> different post. It is more ethical than actual medical, but I think it

> is pretty universal. By the way, the title I wanted was " Falling through

> the Safety Net. "

>

>

[Guest guest]

-great article. I would have done as you did, even now. What a

society indeed, however we do have a democracy and if enough people

vote to make changes, things can happen. Unfortunately, I feel there

needs to be even more suffering before significant changes will occur.

> >

> > Group,

> > My " doctor's writing contest " article came out in Med Economics

Magazine

> > today. The link is:

> > http://www.memag.com/memag/article/articleDetail.jsp?id=426214

> >

<http://www.memag.com/memag/article/articleDetail.jsp?id=426214 & sk= & date

> > = & & pageID=1> & sk= & date= & & pageID=1 if you want to read it. The story

> > probably sounds familiar as I made reference to it months ago in a

> > different post. It is more ethical than actual medical, but I think it

> > is pretty universal. By the way, the title I wanted was " Falling

through

> > the Safety Net. "

> >

> >

>

[Guest guest]

A well-written story, . Very nicely done. I'm with you too. Bob Forester " Brady, MD" wrote: Group, My “doctor’s writing contest” article came out in Med Economics Magazine today. The link is: http://www.memag.com/memag/article/articleDetail.jsp?id=426214 & sk= & date= & & pageID=1 if you want to read it. The story probably sounds familiar as I made reference to it months ago in a different post. It is more ethical than actual medical, but I think it is pretty universal. By the way, the title I wanted was “Falling through the Safety Net.”

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[Guest guest]

Dr Brady, you did the right thing, and wrote a good article. The patient was of sound mind and knew before he met you what his health status and risk factors were. He wanted to die the way he was, rather than go on being chronically severely disabled (and soon impoverished), and was happy for your comforting touch. Patients have the legal right to autonomy, even when they choose to do it their way. We are only their advisors, not their parents or commanding officers.

Wes Bradford

From: [mailto: ] On Behalf Of ForesterSent: Friday, May 18, 2007 7:12 PMTo: Subject: Re: Article in Med Economics

A well-written story, . Very nicely done. I'm with you too.

Bob Forester " Brady, MD" wrote:

Group,

My “doctor’s writing contest” article came out in Med Economics Magazine today. The link is: http://www.memag.com/memag/article/articleDetail.jsp?id=426214 & sk= & date= & & pageID=1 if you want to read it. The story probably sounds familiar as I made reference to it months ago in a different post. It is more ethical than actual medical, but I think it is pretty universal. By the way, the title I wanted was “Falling through the Safety Net.”

[Guest guest]

--Great job. I loved how you added the comments about your thoughts --

they reflect the reality of our human side as docs and how not everything we do is

pleasant, even if we feel it is right.But what struck me is the

significant difference of the title you hoped for and what they used. It reflects a

profound difference in perspective regarding doctor-patient relationship, societal

support and patient empowerment. Personally, I connect more with your title

and am saddened that so many in our society who have worked to add something to our

world are stuck between suffering with health problems and going bankrupt where

they'd then be dependent on the state. A very imperfect system (I'm trying to

be kind with my wording).Congrats on the article and thanks for sharing

it.Tim On Fri, May 18, 2007

11:46 pm EDT, Wesley G. Bradford wrote:

Dr

Brady, you did the right thing, and wrote a good article. The patient was of sound mind and knew before he met you what his health status and risk factors were. He wanted to die the way he was, rather than go on being

chronically severely disabled (and soon impoverished), and was happy for your

comforting touch. Patients have the legal right to autonomy, even when they

choose to do it their way. We are only their advisors, not their parents or

commanding officers.

Wes Bradford

From:

[mailto: ] On Behalf Of

ForesterSent: Friday, May 18, 2007 7:12 PMTo: Subject: Re: Article in Med

Economics

A well-written story, . Very nicely done. I'm with you too.

Bob Forester " Brady, MD " wrote:

Group,

My “doctor’s writing contest” article

came out in Med Economics Magazine today. The link is: http://www.memag.com/memag/article/articleDetail.jsp?id=426214 & sk= & date= & & pageID=1

if you want to read it. The story probably sounds familiar as I made reference

to it months ago in a different post. It is more ethical than actual medical,

but I think it is pretty universal. By the way, the title I wanted was “Falling through the Safety Net.”

---------------------------------------- Malia, MD Malia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd. Perinton Square Mall Fairport, NY 14450 (phone /

fax) www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com -- Confidentiality Notice -- This email message, including all the

attachments, is for the sole use of the intended recipient(s) and contains

confidential information. Unauthorized use or disclosure is prohibited. If you are

not the intended recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the sender

immediately by reply email and destroy all copies of the original message, including

attachments. ----------------------------------------

---------------------------------------- Malia, MD Malia Family Medicine

& Skin Sense Laser 6720 Pittsford-Palmyra Rd. Perinton Square Mall Fairport, NY

14450 (phone / fax) www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com -- Confidentiality Notice -- This email message, including

all the attachments, is for the sole use of the intended recipient(s) and contains

confidential information. Unauthorized use or disclosure is prohibited. If you are

not the intended recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the sender

immediately by reply email and destroy all copies of the original message, including

attachments. ----------------------------------------

[Guest guest]

Tim,

Thanks for your kind comments. I was

shocked when the editors decided to put the focus on noncompliance, because to

me that was a minor theme. Yes, the patient was noncompliant, but it was only

because he was forced to be that way by a failing system. When I pointed that

out to the editor stating I did not perhaps express my feelings on this clearly

enough in the story, he said, “No I think I got that from the story, but

it is really about noncompliance.” I’m not sure if the editor of

medical economics really wants to think or believe the system is failing.

Perhaps it is simply in the eye of the beholder. By the way, the question at

the end of the article about “what would you do” is rather

offensive. Let’s see…no other docs around here do home visits and

the patient couldn’t pay. So the real choices are do I abandon a patient

with no hope of anyone else seeing him, do I call APS (destroying what little

life he has left), or do I continue to try and care for him in the best way I

can (realizing that it will fail). To me, the choice is obvious.

Re:

Article in Med Economics

A well-written story, . Very nicely done. I'm with

you too.

Bob Forester

"

Brady, MD "

wrote:

Group,

My “doctor’s writing

contest”

article came out in Med Economics Magazine today. The link is: http://www.memag.com/memag/article/articleDetail.jsp?id=426214 & sk= & date= & & pageID=1

if you want to read it. The story probably sounds familiar as I made reference

to it months ago in a different post. It is more ethical than actual medical,

but I think it is pretty universal. By the way, the title I wanted was

“Falling through the Safety Net.”

----------------------------------------

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of the

intended recipient(s) and contains confidential information. Unauthorized use

or disclosure is prohibited. If you are not the intended recipient, you may not

use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and

destroy all copies of the original message, including attachments.

----------------------------------------

---------------------------------------- Malia,

MD Malia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd.

Perinton Square Mall Fairport, NY 14450 (phone / fax)

www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com --

Confidentiality Notice -- This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended

recipient, you may not use, disclose, copy or disseminate this information. If

you are not the intended recipient, please contact the sender immediately by

reply email and destroy all copies of the original message, including

attachments. ----------------------------------------

[Guest guest]

RE Home visits.

The home visit trap is a problem one.

Pts with insurance usually won't cover doc visit if pt ambulatory.

I got "caught" in past following up a pt at home for about 2 years, finally left that job and pt ended up dying ultimately.

About 1.5 years ago, ended up with pt almost completely home bound. Saw 2x in office, then he fell and fx hip. Didn't think would make it home. Pt had about 3 visits scheduled over course of 6 months, missed every one. These were after VNA saw pt and discharged them.

Next time I get trapped in this, I'll send in VNA and bill for supervision -- think it pays for $60-75 every 2 months. Fee for VNA in these circumstances is about $60. This may have been an option here, but I wasn't there, nor would I criticize.

Dr Matt LevinFamily MedicinePittsburgh PaDr_Levin@... Office Fax.

More about me--Using SOAPware since 1997Solo Practice started Dec 1st 2004 in Greensburg PA, east of PittsburghPart-time practice management and technology consultant

RE: Article in Med Economics

Tim,

Thanks for your kind comments. I was shocked when the editors decided to put the focus on noncompliance, because to me that was a minor theme. Yes, the patient was noncompliant, but it was only because he was forced to be that way by a failing system. When I pointed that out to the editor stating I did not perhaps express my feelings on this clearly enough in the story, he said, “No I think I got that from the story, but it is really about noncompliance.” I’m not sure if the editor of medical economics really wants to think or believe the system is failing. Perhaps it is simply in the eye of the beholder. By the way, the question at the end of the article about “what would you do” is rather offensive. Let’s see…no other docs around here do home visits and the patient couldn’t pay. So the real choices are do I abandon a patient with no hope of anyone else seeing him, do I call APS (destroying what little life he has left), or do I continue to try and care for him in the best way I can (realizing that it will fail). To me, the choice is obvious.

-----Original Message-----From: [mailto: ] On Behalf Of Malia, MDSent: Saturday, May 19, 2007 8:50 AMTo: wgbraducla (DOT) edu; practiceimprovement1 Subject: RE: Article in Med Economics

--Great job. I loved how you added the comments about your thoughts -- they reflect the reality of our human side as docs and how not everything we do is pleasant, even if we feel it is right.But what struck me is the significant difference of the title you hoped for and what they used. It reflects a profound difference in perspective regarding doctor-patient relationship, societal support and patient empowerment. Personally, I connect more with your title and am saddened that so many in our society who have worked to add something to our world are stuck between suffering with health problems and going bankrupt where they'd then be dependent on the state. A very imperfect system (I'm trying to be kind with my wording).Congrats on the article and thanks for sharing it.Tim

Dr Brady, you did the right thing, and wrote a good article. The patient was of sound mind and knew before he met you what his health status and risk factors were. He wanted to die the way he was, rather than go on being chronically severely disabled (and soon impoverished), and was happy for your comforting touch. Patients have the legal right to autonomy, even when they choose to do it their way. We are only their advisors, not their parents or commanding officers.

Wes Bradford

From: [mailto: ] On Behalf Of ForesterSent: Friday, May 18, 2007 7:12 PMTo: Subject: Re: Article in Med Economics

A well-written story, . Very nicely done. I'm with you too.

Bob Forester " Brady, MD" wrote:

Group,

My “doctor’s writing contest” article came out in Med Economics Magazine today. The link is: http://www.memag.com/memag/article/articleDetail.jsp?id=426214 & sk= & date= & & pageID=1 if you want to read it. The story probably sounds familiar as I made reference to it months ago in a different post. It is more ethical than actual medical, but I think it is pretty universal. By the way, the title I wanted was “Falling through the Safety Net.”

---------------------------------------- Malia, MD Malia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd. Perinton Square Mall Fairport, NY 14450 (phone / fax) www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com -- Confidentiality Notice -- This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. ----------------------------------------

---------------------------------------- Malia, MD Malia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd. Perinton Square Mall Fairport, NY 14450 (phone / fax) www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com -- Confidentiality Notice -- This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. ----------------------------------------

[Guest guest]

Home visits pay about 120$ in Illinois (medicare). All my homebound patients are on medicare. They are in a wheelchair, walker or some severe CHF that makes them homebound. The turnover is high (as expected), since they are sick. The secret is to keep them close to your office (10 min max). I usually schedule during in my dead time (like one hour waiting in the office with no other patients), it is easy since these people are always at home. Some of them have VN, some do not. Some are basically like NH patients but in a more decent situation. I have maybe 10 such patients, they are a constant source of income, great professional (and human) satisfaction. I do not see NH patients.It is not a trap, if you do it carefully and have strict guidelines. You need to read medicare guidelines about being homebound.RE Home visits. The home visit trap is a problem one.Pts with insurance usually won't cover doc visit if pt ambulatory. I got "caught" in past following up a pt at home for about 2 years, finally left that job and pt ended up dying ultimately. About 1.5 years ago, ended up with pt almost completely home bound.  Saw 2x in office, then he fell and fx hip.  Didn't think would make it home.  Pt had about 3 visits scheduled over course of 6 months, missed every one.  These were after VNA saw pt and discharged them. Next time I get trapped in this, I'll send in VNA and bill for supervision -- think it pays for $60-75 every 2 months.  Fee for VNA in these circumstances is about $60.  This may have been an option here, but I wasn't there, nor would I criticize. Dr Matt LevinFamily MedicinePittsburgh PaDr_Levincomcast (DOT) net Office Fax.     More about me--Using SOAPware since 1997Solo Practice started Dec 1st 2004 in Greensburg PA, east of PittsburghPart-time practice management and technology consultant RE: Article in Med EconomicsTim,Thanks for your kind comments. I was shocked when the editors decided to put the focus on noncompliance, because to me that was a minor theme. Yes, the patient was noncompliant, but it was only because he was forced to be that way by a failing system. When I pointed that out to the editor stating I did not perhaps express my feelings on this clearly enough in the story, he said, “No I think I got that from the story, but it is really about noncompliance.” I’m not sure if the editor of medical economics really wants to think or believe the system is failing. Perhaps it is simply in the eye of the beholder. By the way, the question at the end of the article about “what would you do” is rather offensive. Let’s see…no other docs around here do home visits and the patient couldn’t pay. So the real choices are do I abandon a patient with no hope of anyone else seeing him, do I call APS (destroying what little life he has left), or do I continue to try and care for him in the best way I can (realizing that it will fail). To me, the choice is obvious.-----Original Message-----From: [mailto: ] On Behalf Of Malia, MDSent: Saturday, May 19, 2007 8:50 AMTo: wgbraducla (DOT) edu; practiceimprovement1 Subject: RE: Article in Med Economics --Great job. I loved how you added the comments about your thoughts -- they reflect the reality of our human side as docs and how not everything we do is pleasant, even if we feel it is right.But what struck me is the significant difference of the title you hoped for and what they used. It reflects a profound difference in perspective regarding doctor-patient relationship, societal support and patient empowerment.  Personally, I connect more with your title and am saddened that so many in our society who have worked to add something to our world are stuck between suffering with health problems and going bankrupt where they'd then be dependent on the state.  A very imperfect system (I'm trying to be kind with my wording).Congrats on the article and thanks for sharing it.Tim Dr Brady, you did the right thing, and wrote a good article. The patient was of sound mind and knew before he met you what his health status and risk factors were. He wanted to die the way he was, rather than go on being chronically severely disabled (and soon impoverished), and was happy for your comforting touch. Patients have the legal right to autonomy, even when they choose to do it their way. We are only their advisors, not their parents or commanding officers.Wes BradfordFrom: [mailto: ] On Behalf Of ForesterSent: Friday, May 18, 2007 7:12 PMTo: Subject: Re: Article in Med EconomicsA well-written story, . Very nicely done. I'm with you too.Bob Forester " Brady, MD" wrote:Group,My “doctor’s writing contest” article came out in Med Economics Magazine today. The link is:http://www.memag.com/memag/article/articleDetail.jsp?id=426214 & sk= & date= & & pageID=1 if you want to read it. The story probably sounds familiar as I made reference to it months ago in a different post. It is more ethical than actual medical, but I think it is pretty universal. By the way, the title I wanted was “Falling through the Safety Net.”---------------------------------------- Malia, MD Malia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd. Perinton Square Mall Fairport, NY 14450 (phone / fax) www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com -- Confidentiality Notice -- This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. ---------------------------------------- ---------------------------------------- Malia, MD Malia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd. Perinton Square Mall Fairport, NY 14450 (phone / fax) www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com -- Confidentiality Notice -- This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. ----------------------------------------

[Guest guest]

RE Home care trap

No, not a trap, unless it forces you to reschedule an afternoon of pts in office.

Each doc has to make their own decisions.

Dr Matt LevinFamily MedicinePittsburgh PaDr_Levin@... Office Fax.

More about me--Using SOAPware since 1997Solo Practice started Dec 1st 2004 in Greensburg PA, east of PittsburghPart-time practice management and technology consultant

RE: Article in Med Economics

Tim,

Thanks for your kind comments. I was shocked when the editors decided to put the focus on noncompliance, because to me that was a minor theme. Yes, the patient was noncompliant, but it was only because he was forced to be that way by a failing system. When I pointed that out to the editor stating I did not perhaps express my feelings on this clearly enough in the story, he said, “No I think I got that from the story, but it is really about noncompliance.” I’m not sure if the editor of medical economics really wants to think or believe the system is failing. Perhaps it is simply in the eye of the beholder. By the way, the question at the end of the article about “what would you do” is rather offensive. Let’s see…no other docs around here do home visits and the patient couldn’t pay. So the real choices are do I abandon a patient with no hope of anyone else seeing him, do I call APS (destroying what little life he has left), or do I continue to try and care for him in the best way I can (realizing that it will fail). To me, the choice is obvious.

-----Original Message-----From: [mailto: ] On Behalf Of Malia, MDSent: Saturday, May 19, 2007 8:50 AMTo: wgbraducla (DOT) edu; practiceimprovement1 Subject: RE: Article in Med Economics

--Great job. I loved how you added the comments about your thoughts -- they reflect the reality of our human side as docs and how not everything we do is pleasant, even if we feel it is right.But what struck me is the significant difference of the title you hoped for and what they used. It reflects a profound difference in perspective regarding doctor-patient relationship, societal support and patient empowerment. Personally, I connect more with your title and am saddened that so many in our society who have worked to add something to our world are stuck between suffering with health problems and going bankrupt where they'd then be dependent on the state. A very imperfect system (I'm trying to be kind with my wording).Congrats on the article and thanks for sharing it.Tim

Dr Brady, you did the right thing, and wrote a good article. The patient was of sound mind and knew before he met you what his health status and risk factors were. He wanted to die the way he was, rather than go on being chronically severely disabled (and soon impoverished), and was happy for your comforting touch. Patients have the legal right to autonomy, even when they choose to do it their way. We are only their advisors, not their parents or commanding officers.

Wes Bradford

From: [mailto: ] On Behalf Of ForesterSent: Friday, May 18, 2007 7:12 PMTo: Subject: Re: Article in Med Economics

A well-written story, . Very nicely done. I'm with you too.

Bob Forester " Brady, MD" wrote:

Group,

My “doctor’s writing contest” article came out in Med Economics Magazine today. The link is:http://www.memag.com/memag/article/articleDetail.jsp?id=426214 & sk= & date= & & pageID=1 if you want to read it. The story probably sounds familiar as I made reference to it months ago in a different post. It is more ethical than actual medical, but I think it is pretty universal. By the way, the title I wanted was “Falling through the Safety Net.”

---------------------------------------- Malia, MD Malia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd. Perinton Square Mall Fairport, NY 14450 (phone / fax) www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com -- Confidentiality Notice -- This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. ----------------------------------------

---------------------------------------- Malia, MD Malia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd. Perinton Square Mall Fairport, NY 14450 (phone / fax) www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com -- Confidentiality Notice -- This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. ----------------------------------------

[Guest guest]

RE Home care trap

No, not a trap, unless it forces you to reschedule an afternoon of pts in office.

Each doc has to make their own decisions.

Dr Matt LevinFamily MedicinePittsburgh PaDr_Levin@... Office Fax.

More about me--Using SOAPware since 1997Solo Practice started Dec 1st 2004 in Greensburg PA, east of PittsburghPart-time practice management and technology consultant

RE: Article in Med Economics

Tim,

Thanks for your kind comments. I was shocked when the editors decided to put the focus on noncompliance, because to me that was a minor theme. Yes, the patient was noncompliant, but it was only because he was forced to be that way by a failing system. When I pointed that out to the editor stating I did not perhaps express my feelings on this clearly enough in the story, he said, “No I think I got that from the story, but it is really about noncompliance.” I’m not sure if the editor of medical economics really wants to think or believe the system is failing. Perhaps it is simply in the eye of the beholder. By the way, the question at the end of the article about “what would you do” is rather offensive. Let’s see…no other docs around here do home visits and the patient couldn’t pay. So the real choices are do I abandon a patient with no hope of anyone else seeing him, do I call APS (destroying what little life he has left), or do I continue to try and care for him in the best way I can (realizing that it will fail). To me, the choice is obvious.

-----Original Message-----From: [mailto: ] On Behalf Of Malia, MDSent: Saturday, May 19, 2007 8:50 AMTo: wgbraducla (DOT) edu; practiceimprovement1 Subject: RE: Article in Med Economics

--Great job. I loved how you added the comments about your thoughts -- they reflect the reality of our human side as docs and how not everything we do is pleasant, even if we feel it is right.But what struck me is the significant difference of the title you hoped for and what they used. It reflects a profound difference in perspective regarding doctor-patient relationship, societal support and patient empowerment. Personally, I connect more with your title and am saddened that so many in our society who have worked to add something to our world are stuck between suffering with health problems and going bankrupt where they'd then be dependent on the state. A very imperfect system (I'm trying to be kind with my wording).Congrats on the article and thanks for sharing it.Tim

Dr Brady, you did the right thing, and wrote a good article. The patient was of sound mind and knew before he met you what his health status and risk factors were. He wanted to die the way he was, rather than go on being chronically severely disabled (and soon impoverished), and was happy for your comforting touch. Patients have the legal right to autonomy, even when they choose to do it their way. We are only their advisors, not their parents or commanding officers.

Wes Bradford

From: [mailto: ] On Behalf Of ForesterSent: Friday, May 18, 2007 7:12 PMTo: Subject: Re: Article in Med Economics

A well-written story, . Very nicely done. I'm with you too.

Bob Forester " Brady, MD" wrote:

Group,

My “doctor’s writing contest” article came out in Med Economics Magazine today. The link is:http://www.memag.com/memag/article/articleDetail.jsp?id=426214 & sk= & date= & & pageID=1 if you want to read it. The story probably sounds familiar as I made reference to it months ago in a different post. It is more ethical than actual medical, but I think it is pretty universal. By the way, the title I wanted was “Falling through the Safety Net.”

---------------------------------------- Malia, MD Malia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd. Perinton Square Mall Fairport, NY 14450 (phone / fax) www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com -- Confidentiality Notice -- This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. ----------------------------------------

---------------------------------------- Malia, MD Malia Family Medicine & Skin Sense Laser 6720 Pittsford-Palmyra Rd. Perinton Square Mall Fairport, NY 14450 (phone / fax) www.relayhealth.com/doc/DrMalia www.SkinSenseLaser.com -- Confidentiality Notice -- This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. ----------------------------------------