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Nonabandonment: Medical Ethics
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
Two interesting and provocative papers recently appeared in Annals. In the first, Quill and Cassel [1] describe the importance of continuity of care, a concept we all learned in medical school as a fundamental precept. Although the moral and ethical imperative shown in this first paper is strong, the second paper, an editorial [2], indicates that the imperative may be overdone. Dr. Pellegrino [2] indicates that Quill and Cassel may find ritual-based ethics too rigid. However, I agree that the physician–patient relationship is important and should not be interrupted casually.
In today's climate, in which managed care is so prevalent, the ease with which the physician–patient relationship is ruptured by nonphysicians is telling. Patients have begun to feel the anguish of being told that the cardiologist, the pulmonary physician, or the surgeon whom they have grown to know, especially in the context of chronic illness, can no longer see them tomorrow when they could see them yesterday. This interruption of service of care is treated lightly by the third-party payers as if it is an unimportant aspect of the care of the patients.
Medical care is becoming relegated to little more than an impersonal service such as that which a plumber or car mechanic may perform on an unfeeling, unseeing, unliving entity. Although medicine is an expensive venture, people wish that their illnesses could be dealt with on a personal level and, at the time of crises, that they will not be dissuaded by expense. Only in a state of good health do people seem to be less likely to consider the consequences of paying less for what they feel is of equal quality. The dissection of quality means not only appropriateness and timeliness of care but also the maintenance of the physician–patient relationship, which has been established over the years and should be continued. I applaud the Annals for bringing this to light, especially as a voice of medicine, which the new Editor has recently espoused.
I and many of my colleagues hope that the effect of these articles will be more broad and far ranging and effective than that of simply a disposable communication.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
