Merging medicine, managed care, and public health. Interview by Linda Walburn.

In an effort to enhance communications and cooperation among Pennsylvania leaders in medicine, managed care, and public health, The Foundation of the Pennsylvania Medical Society, and its coalition, Keystones of Public Health, sponsored a one-day symposium on September 8, 1999, at State Society headquarters. More than 70 key leaders gathered to identify and plan a project that will positively impact the health status of Pennsylvania. Nancy W. Dickey, MD, immediate past president, American Medical Association, delivered the keynote address. In this interview, Dr. Dickey shares her insights on the importance and impact of this statewide initiative.

Teaching professionalism: passing the torch.

Changes in medicine brought on by health care reform will increasingly pressure physicians and physicians-in-training to adopt business or trade strategies in the name of cost containment and of competition in the health care marketplace. These strategies run directly counter to the professional standards and are a potential threat to medicine's status as a profession. A challenge for this generation of students is not to let this emphasis on finances erode medicine's professionalism. Medical faculty must ensure that their students properly understand the nature of the relationships that permit medicine to enjoy the benefits of being a profession (rather than a trade) and that they learn the appropriate balance between financial and professional considerations. Faculty can and should place financial considerations in proper perspective. Students should learn the basic components of professionalism, how physicians in the past have not always met the full criteria for professionalism, how the current emphasis on cost containment could threaten medicine's status as a profession, appropriate goals for health care reform, the need to form new alliances to meet those goals, and criteria for forming appropriate alliances. Armed with this knowledge, the generation of physicians now in training can understand the delicate balance that must be maintained between financial exigencies and professional imperatives. They will then be prepared to participate in the reform process, embrace its positive aspects, and argue effectively against its negative ones.

Pain management at the end of life.

This article reviews the problems which lead to less than adequate treatment of pain for patients at the end of life. The public has demonstrated a tremendous increase in concern about dying, the possibility for uncontrolled pain during the terminal stages of life, and the desire to assure dignity and control at the time of death. The concerns, particularly about uncontrolled pain, have helped drive the assisted-suicide discussions. Review of the current status of pain treatment and discussion of barriers to improved treatment are the first steps to improving patient care and providing meaningful reassurance to patients. Assisting clinicians to provide the best possible care, particularly adequate pain relief, and to overcome the barriers whenever they can is in the patient's best interest.

Delegates approve protocol for third-party telephone review.

The Texas Medical Association Physician-Patient Advocacy Committee has conducted an extensive study of the telephone utilization review activities of private third-party payers and self-insured arrangements. Many of these organizations contract with private firms to conduct pre-certification and concurrent review of hospital admissions. These reviews often are accomplished by telephoning the attending physician's office. The procedures and criteria used by these firms and the qualifications of their review staff vary greatly. Physicians and their office staff are spending an increasing amount of time dealing with telephone utilization review. These review firms are not regulated or controlled by any agency. In response to the concerns expressed by physicians in dealing with telephone utilization review, Texas Medical Association's House of Delegates has approved the "Texas Medical Association Recommended Protocol for Physicians Responding to Private Third Party Telephone Review." The guidelines address concerns about confidentiality, physician documentation, patient advocacy, appeals, and cost and billing.