November 27, 2008

Let physicians provide counsel patients need

While the article "Dispensing advice" (Nov 17) is accurate in reporting that many Marylanders have complex medical issues that require drug use and interaction counseling, the solution to the problem is not to add another counselor to the treatment equation.

Further fragmentation of health care serves nobody. To borrow a tried and true phrase, "Too many cooks will ruin the broth."

Primary-care physicians always have and always will see counseling as part of their responsibility to patients. For instance, for diabetics, counseling is an important part of the treatment plan. Many physicians allocate time and money to counseling diabetics. Adding another counselor could undermine the course of treatment prescribed by the physician.

Many health care policy experts see the development of a medical home - a medical care delivery system in which each patient has an ongoing relationship with a personal physician - as the most satisfactory way for patients to be treated. And a big part of the role of that medical home is to provide advice and counseling to patients. Inserting another party into the process without clearly delineating its role could create confusion and defeat one of the advantages of the medical home.

The correct solution to the problem is to find a way to let primary-care physicians continue to provide the counseling.

Right now, primary-care physicians in Maryland have to pack their days with medical procedures just to keep their practices open.

The reason is simple: The payments by Medicare and private insurers for the cognitive services provided by physicians are too low.

Dr. Ronald C. Sroka, Baltimore

The writer is president of MedChi, the Maryland State Medical Society.

Disparities damage death penalty law

Maryland Attorney General Douglas F. Gansler is incorrect in believing that the state has a race-neutral and fair death penalty system ("Panel's death penalty backers still in the minority," Nov. 21).

There is evidence to the contrary in the report of the Maryland Commission on Capital Punishment. The commission concluded that our system is fraught with racial disparities, risks executing innocent people and is hard on the survivors of murder victims.

In addition, the death penalty costs more than other sentences and does not act as a deterrent to murder, the report concluded.

The commission found that the system should be abolished.

I urge Mr. Gansler to respect the efforts of the members of the commission, who approached their work with great seriousness and issued a thorough and reasonable recommendation.

Mark Breaux, Columbia

The writer is a volunteer for Maryland Citizens Against State Executions.

Leopold's pragmatism offers GOP new path

In his column "Ehrlich's stock tumbles, along with his party's" (Commentary, Nov. 23), C. Fraser Smith stated that the "GOP's best recent electoral performance may have been the losing U.S. Senate race run by former Lt. Gov. Michael S. Steele in 2006."

But the best electoral performance in 2006 for the GOP was not a losing race but the winning race of then-Del. John R. Leopold, who defied the odds and a strong Democratic tide and won a tough countywide race for Anne Arundel County executive, even though he was outspent 3-to-1 by his general election opponent.

By governing as a pragmatic, problem-solving conservative, Mr. Leopold offers hope for a beleaguered Grand Old Party.

Stephen-Clark Reigle, Severn

Will deer devastate the 'seeds of change'?

It was wonderful to read about the city school system's plan to establish an organic farm in Baltimore County to produce healthy fruit and produce for the school cafeteria program ("Seeds of Change," Nov. 24).

But the managers of the facility had better be prepared to put in a 10-foot high electric fence around their entire 32-acre property. As any gardener who lives within a mile of Patapsco Park can attest, the rampaging deer herd from the park will surely find the farm's delicate greens and sweet apples irresistible.

Battling the deer, insect pests and numerous plant diseases will give our urban youth some real perspective on the uncertainties farmers face in trying to make a living.

I wish them the very best of luck.

William Richkus, Catonsville

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