To the Editor:

I'm a bit perturbed by Dr. Sanford Brown's recent advice in Practice Diary.

In the June issue, he describes an ER patient with blunt flank trauma and hematuria. While I agree that Dr. Brown (or I) could have provided more efficient service to this patient in the office, I'm not sure I would have omitted the abdominal CT, as he seems to suggest. Passing off the hematuria in this setting could be foolhardy.

In the May issue, Dr. Brown's comments about nutrition seem to reflect a disdain for basic, up-to-date nutritional concepts. I believe our patients deserve better than that.

Author's response:

The patient referred to in the June issue had occult hematuria following minor trauma and did not, I believe, require a CT scan.

The point of the piece was that emergency departments run up big bills on workers' compensation cases, and more employers are now turning to family physicians to see their workers with minor injuries. My advice is that this represents a revenue stream that we should not ignore.

Regarding diets, mea culpa! I like cheeseburgers and doughnuts in moderation, but I don't guilt-trip anyone for eating oatmeal — even my friend who insists on having it with skim milk and dry toast!

Practice Diary is meant for the pure enjoyment of FPM readers. So take it with a grain of salt — unless, of course, you're hypertensive.