To the Editor:

In “Seven Ways to Help Your Hospital Stay in Business”[May 2003, page 27], Dr. Kathryn Stewart describes what I’ve been trying to tell other physicians for years. Unfortunately, physicians still have no incentive to change their approaches to hospital care and, as Robert Edsall points out in his editorial [“Perverse Incentives, Perverted System,” May 2003, page 11], we have a long way to go before incentives actually align.

Another problem is patients’ dependency on hospital care. Most of us run a service-oriented business with our patients as “clients.” We are focused on serving these people because we care about them and because our livelihoods depend on it. If we delay tests, send patients home earlier and make better use of outpatient care, many of our patients feel our care is poor and move on to competing physicians. I’ve seen many patients cling to their normal saline IV as if it’s their lifeline, and they’re upset when switched to oral pills and prepared for discharge. As much as I try to use my best bedside manner to explain these things, I still feel my “clients” are not happy with me.

To change this mind-set, we need to educate the American public as much as or more than we do physicians. Patients need to get over the idea that every headache needs an MRI, every bad cold needs an antibiotic and that bypass surgery is a panacea. What a refreshing change to have patients who are motivated to leave acute care, willing to receive certain services as outpatients and who do not want every test available just because their insurance covers it.