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Don't discount
these factors
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Regarding
"Does practice make perfect?" (SN: 7/17/99, p. 44), it
may be that treating larger numbers of patients has a
"volume-discount" aspect. This might lower the cost of
equipment and/or drugs, thus lowering hesitation to use those
items in treatment at the high-volume centers relative to the
lower-volume settings. This may be a dynamic that has an impact on
survival and yet is somewhat divorced from specialization.
Denny Miller
Columbus, Ohio
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It seems
that the story failed to take into account the major driving force
of health care: economics. High-volume hospitals would be best
able to afford the best resources, both people and equipment.
Highly skilled doctors, nurses, and technicians are certainly
going to gravitate to those facilities that do higher volume in
their specialties. Because of the dollar volume, these facilities
will be able to offer the best equipment, ample staff, and better
pay and benefits. Hospitals of any size will certainly channel
resources to higher-volume (read income) treatments. It's simply
good business.
J.H. Ericksen
Placitas, N.M.
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Your article
reiterates a truth that many of us have known informally for
years. Neither of us would consider having a serious operation by
a physician who does not do the procedure regularly in a hospital
that has a team to support patients undergoing that procedure.
Physicians are trained to react to the patient's illness, and it
is usually the nurses who create a humane therapeutic environment.
It is a well
established fact that a clinically competent nursing staff, which
is structured to practice primary nursing care, results in a
reduction of the number of malpractice suits. Knowledgeable
nurses, who are well acquainted with their patients and their
patients' families, usually pick up the inadvertent mistakes or
omissions that may be made even by the best-trained medical
specialists. The issue becomes a function of effective
colleagueship.
June Werner
Oswald Werner
Evanston, Ill. |
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