In 4 years as a locum tenens physician, I've filled out at least 15 credentialing applications asking for the same information. Much of it, such as my high school transcripts from 30 years ago, is irrelevant. All of it is repetitive and done in a vacuum.
The people usually reviewing my information are not physicians, but I'm not sure physicians could do any better with the current process, since it still relies on paper and isn't centralized ("Better Physician Credentialing Needed," May 1, 2001, p. 41).
The process could be streamlined using a computer database, centralized credential verification, and a national license. Elements of all three exist separately: the National Practitioner Data Bank, the Greater Arizona Central Credentialing Program, and our Drug Enforcement Administration numbers. State medical boards would still exist for oversight, discipline, and extracting tribute (license fees).
I doubt we will see a change in the people admitted to medical school, since the profession is more comfortable with more of the same. No one has asked who let Michael Swango graduate from medical school in the first place.
David A. Rivera, M.D.
Group Adopts DVT Guidelines
My partners and I enjoyed Dr. Bryan S. Jick's guest editorial on deep vein thrombosis and, like him, wondered why it has never become a standard to use prophylaxis in this high-risk population, as we do with gynecology patients ("DVT Prophylaxis in Pregnancy," May 15, 2001. p. 4).
Up until now we have not been using prophylaxis in our obstetric patients. As of this day, however, we have decided to adopt the recommendations of the Royal College of Obstetricians and Gynaecologists regarding DVT prophylaxis in obstetric patients.
Ed Haile, M.D.
New Iberia, La.
Compression and Heparin
I use pneumatic compression on almost all of my postoperative cesarean patients. In fact, it is on the postop order sheet. The compression is discontinued when the patient is ambulatory Heparin is used in those patients with a history of DVT or pulmonary embolism or those who are positive for factor V Leiden mutation.
Myer S. Bornstein, M.D.
chief of ob.gyn.
Morton Hospital and Medical Center
Why Compression Boots Work
I started using pneumatic compression boots in obstetric patients about a year ago for the same reasons as Dr. Bryan S. Jick. Uniformly the patients hate wearing the boots, but they know they can avoid it by getting out of bed. This increase in activity may be what really is working.
Aileen Stiller, M.D.
La Porte, Ind.
Folic Acid and NTDs
Nearly a decade has passed since the Centers for Disease Control and Prevention recommended that all women of childbearing age who are capable of becoming pregnant consume 0.4 mg (400 [micro]g) of folic acid daily to prevent the occurrence of neural tube defects in their offspring. Still, it appears that the message is having a difficult time getting to the women who need to hear it.
Approximately 4,000 infants are born with neural tube defects (NTDs) each year in the United States. Many more fetuses are affected by NTDs and are either spontaneously or electively aborted.
March of Dimes surveys show that, on average, 13% of respondents knew that folic acid prevents birth defects and only 7% knew that folic acid should be taken before pregnancy.
Marked deficiencies in physician knowledge are also a concern. One survey demonstrated that only one-third of obstetricians knew the correct dose of folic acid to recommend.
I tend to NTD-affected pregnancies almost on a daily basis and have yet to encounter a patient who used folic acid, which may have prevented the NTD. A simple multivitamin with 0.4 mg of folic acid should cost no more that 1-2 cents per day and the benefits are immeasurable.
Please do your part to help spread this critical information. Free bilingual educational material is available for you distribute in your offices by contacting the March of Dimes' national office at 914-428-7100.
Jordan H. Perlow, M.D.
chairman, Folic Acid Education Project
March of Dimes, State of Arizona