DATE: Sunday, May 18, 1997                  TAG: 9705160055

SECTION: DAILY BREAK             PAGE: E7   EDITION: FINAL 

COLUMN: IMPERFECT NAVIGATOR

SOURCE: ALEXANDRIA BERGER

                                            LENGTH:   69 lines

COLUMN ON DOCTORS WHO ARE EGOMANIACS RINGS TRUE FOR SOME

MAIL BAG: To the primary care doctor for Virginia Beach, Virginia, who wrote to let me know how angry he was at my column on, `the physician disability of egomania:'

I seem to have struck a nerve. I appreciate your advertisement for primary care physicians, since my husband is one. Also qualified in geriatrics and director of a family medicine residency program, we don't always agree on what I write. But, on this column, sorry, he agrees with me.

Prior to becoming a columnist, I possessed several decades of professional experience in medical arena positions. Then, there is my mail. Lots of it with ``doctor'' stories.

Now, to the heart of the matter. Reread my column. I never said good doctors were bad. I never said all doctors are bad. But, whether you like it or not, patients have the right to a second opinion, which means physicians cannot deny this request.

So, one more time. a good physician will welcome a second opinion, when it is requested, will suggest a second opinion, when stumped or unsure. A physician who denies a patient or family's request for such an opinion deviates from the standard of care, and suffers `physician disability due to egomania.'

While primary care physicians may have specialty training aside from generalist medicine, they can't always provide answers or solutions to all complex specialty problems. Neither can some specialists. Additionally, good practitioners in any area understand that a parent unable to communicate or comprehend would not want their family kept in the dark about their medical condition, especially if terminal.

Not letting family members know a parent's condition, when there is no legal or competent patient request to the contrary, rejects the family's need for closure with loved ones. Ignoring family involvement in planning appropriate nursing home or comfort care ``dumps'' the patient. Next to the responsibility to the patient, the physician has a responsibility to the family. When a doctor's ego interferes with the best interest and legal rights of a patient, sound logic and ethics go out the window.

In many cases, insurance policies have made providing patients with optimum treatment a nightmare for physicians. This is where physicians should direct their anger and voice, not at self-promotion and denial of patient rights. They have no place in competent medicine.

I believe in the defense of the thousands of good physicians practicing conscientious medicines in the patient's interest. However, it doesn't solve the problem for that patient caught in the trap of an egomaniacal physician. I am sure you are one of the good doctors. The point is patients have choices in obtaining one, and need to know how to do it.

I received many letters from people who thanked me for telling it like it is. You mentioned you had also been a ``sometime patient.'' Yet, as a patient, you did not mention physicians and their families are a select category. With greater knowledge you possess special access and receive preferential care for yourself and your family. More specifically, you would not accept your physician denying you or a family member a second opinion should it be desired, nor would you tolerate arrogant physician behavior.

Regarding a patient's right to fire a doctor. . . The week after my column appeared, an article in Parade Magazine documented this same patient right. I stand by what I wrote.

To the emergency room physician, who hated this column's headline, referring to ``ER doctors,'' but liked the copy.'' You're absolutely right. I'm with you. I don't write the headlines, just the column. The headlines are written by the newspapers in which my columns appear. Sometimes they miss the mark.

To all of the folks who've requested information on the brain and sent SASE's: We've been swamped with requests. Information is on the way. Watch for it coming soon to a mailbox near you.

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