Letters to the Editor

When Practice is All In the Family

Editor's Note: The following two letters are responses to Dr. Larry Patterson's Viewpoint “Family Matters” in February 2012 in which he asked readers to share their insights about working with family members.

■ Congratulations to your son. Anyone attaining their dream will certainly enjoy a better life. The question is: Is medicine that dream?

Yes, I work in a clean environment and the enjoyment I receive from mental stimulation and challenges is rewarding, but at what cost? I gave up my 20s, was abused as a resident, and currently abused by the government, insurance companies, the legal system and patients.

Our own Academy condones pay for referrals to paraprofessionals while we are required to take ethics courses. When I'm 70, I'll be studying for my “boards” for the fifth time, so I can try to outwit the examiner trying to “catch” me on something.

With reimbursements less than a third of what they were when I started, I am going to be fined by the government if I don't buy a computer system out of my money. All this while the Centers for Medicare and Medicaid Services tells the public we're overpaid by as much as 50%.

My 11-year-old son said it the best one night to his brother who was complaining about me not reading to them in bed because I had some preparation for a case in the morning. ”Jack, daddy needs to study because if he does something and the patient isn't pleased they can come and take everything we have.”

I think that about sums up medicine.

— Jim Martuccio, MD, FACS
Warren, Ohio

■ I have been carrying around your “Family Matters” editorial for five months waiting for the right moment to reply about what it's like to work side-by-side with family. In the last four months, my oldest son graduated from an Ivy League college (and is now applying to medical school), my nephew finished his residency in ophthalmology and has begun practicing with his father and me, we opened an oculofacial plastic/skin care and laser rejuvenation office, and we just received our LenSx laser (Alcon). I am now taking a breath to respond.

First, let me say that every month I look forward to reading the editorials that you and Dr. Paul Koch write. We all need to laugh a little in this incredibly complex and dynamic profession of ours. Like you and Paul, I believe we are in a wonderful profession where rapidly changing technology makes a real difference in patients' lives every day. I thank God daily that my father, Henry, chose ophthalmology.

My father started our ophthalmology practice in 1961 in Stockton, Calif., after leaving the cold winters of Michigan with my mother, a nurse and native Michigander—true Blue! My first cousin, Joseph, joined him in 1981, and I started in 1992. My father and Joe opened one of the first freestanding ASCs in California, a 900-square-foot facility, in 1985. In 2008, we closed this ASC and built a larger, more contemporary, two-room ASC.

I have assumed the role of managing partner in our practice (from my father), which has grown to seven offices, seven ophthalmologists, seven optometrists, and two ASCs. Despite our size, we continue to operate as a small “family business” — at least that's the experience we want our patients to have.

Now to the “family” part: Although my father retired in 2002, he remains my adviser, confidant and sounding board. We talk every day, whether it's about the practice, the Detroit Tigers, the stock market or world problems. My cousin Joe and I also talk almost every day, although we are never in the same location. We have personalities and private lives that are polar opposite with really only one thing in common: We love our jobs, our employees and our patients.

Despite all the regulatory issues and decreasing reimbursements, we continually stimulate each other's sense of humor and work ethic with stories of the curveballs that come our way each day. In the 20 years I've been in the practice, the three of us have never argued about compensation, vacation, call schedules or surgical volume. We have always felt blessed with our profession, talents, and each other.

Some of the advantages that we have experienced having a family practice include: knowing each other for years prior to working together; knowing that somebody near you will always “watch your back;” always covering for each other for vacations and call schedules when asked; having someone there for second opinions or advice, or both; having someone you completely trust tell you when you're wrong (and we're all wrong from time to time); and finally, from my father's point of view (and my cousin's and soon your point of view) experiencing the pride of seeing your progeny follow in your footsteps and once again confirm that your choice of a career in medicine, and specifically ophthalmology, was a great one.

In my experience the advantages have far outweighed the disadvantages in most “family” practices. Most of us who are parents have advised our children to learn from the mistakes of others. By my observations, the problems that cause family businesses to fail almost always involve one or more of the following six capital (deadly) vices: pride, greed, anger, gluttony (alcohol), envy or sloth (not sure if lust comes into play here). If family members keep these vices to a minimum, then practicing medicine together can be one of the most rewarding experiences in life.

We all look forward to having Joe Jr. join our group; another Zeiter to carry the torch that my father lit and to lighten the load on his father's shoulders. Larry, you must be very proud of your son, and I can assure you that in four years (the blink of an eye) you will be as happy as you were in the delivery room when he came into this world. God willing, my oldest son will join me in nine years. In the meantime, I have a busy week of learning to use a laser to make my incisions and capsulorhexis.

— John H Zeiter, MD
Stockton, CA

Patient Characterization was Irrelevant, Inappropriate

■ I have a long-standing concern about the quality and style of writing in medical records, interoffice letters and medical journal articles. As an editor, I am sure that you have seen examples that generate my concern, and perhaps you can have a positive influence from that position.

Unfortunately, my comment herein puts you in the hot seat. I am referring to your Viewpoint column, “A Mission That Benefits Doctor and Patient Alike,” in the June 2012 issue in which you relate your gratifying experience of cataract surgery for a patient with a traumatic cataract. The patient is described as “an attractive 26-year old ...”

We commonly see the adjectives “pleasant” or “attractive” in medical histories. I am confident that, upon reflection, you would agree these adjectives are irrelevant and inappropriate.

— Norman Spencer, M.D.
Hadley MA

Dr. Patterson replies: I would normally completely agree with your sentiments. The point I was making, and it sometimes gets shortchanged in a 500-word editorial, is that we go into the jungle setting and primarily see old, rugged, wrinkled appearing Mayans who've had a hard life. It was just a shock to see an attractive young lady in for cataracts. I was trying to make a contrast and apparently did a poor job at that.

Does that put a different light on it? I'd rather have someone object to my comments and know that someone's actually reading them than to hear nothing at all! OM