STAT now publishes chosen Letters to the Editor acquired in response to First Opinion essays to encourage strong, good-faith dialogue about tough points. Submit a Letter to the Editor right here, or discover the submission type on the finish of any First Opinion essay.
“The infectious illness physician scarcity threatens future pandemic preparedness,” by Raul Ruiz
It’s crucial to consider the working circumstances of infectious illness (“ID”) specialists if we’re critical about sustaining a pipeline. ID docs are famend within the medical schooling world for his or her meticulous history-taking and complete overview of medical data. Given their pivotal function in antibiotic stewardship, an infection management, and numerous diagnostic challenges, it isn’t unusual to witness ID pvractitioners tirelessly working lengthy hours, even on weekends and holidays. Though this isn’t universally relevant to all ID physicians, the publicity of the sector to trainees, together with me, considerably shapes our notion of ID specialists — typically depicted as overworked, burdened with bureaucratic duties, and inadequately compensated.
And whereas there’s a urgent want for ID physicians in rural America, these areas additionally exhibit increased ranges of mistrust towards public well being and ID specialists. Political polarization has, sadly, led practitioners to endure hostile acts of vandalism, threats, and harassment through the Covid-19 pandemic. It’s no marvel that ID docs are among the most burnt-out in our career, and these are the concerns that weigh on my thoughts when considering the kind of work I aspire to pursue and maintain.
Throughout my fourth 12 months of medical faculty, I rotated within the ID hospital session service, encountering fascinating instances involving monkeypox, rabies, and problems stemming from HIV, syphilis, and tuberculosis. The ID school that I discovered and labored with had been ardently dedicated to serving marginalized communities together with refugees, folks experiencing homelessness, and people with a historical past of incarceration. ID specialists are really on the frontlines with these communities and confronting the well being challenges which can be exacerbated by a mess of systemic elements. Neglecting to deal with the scarcity of infectious illness specialists represents a step backward in addressing the deficiencies inside our public well being and well being care methods. And whereas monetary concerns are essential, focusing solely on financial elements could fall wanting addressing the deeper systemic points related to the shortage of infectious illness consultants.— Daniel Pham (Observe: On Wednesday, Dec. 6, Rep. Ruiz will reply to this letter on the “First Opinion Podcast.”)
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Public well being and well being care are completely different. It is extremely regarding to see Rep. Ruiz apparently misconstrue this fundamental reality. If we would like a stronger public well being system, then we have to distinguish public well being from well being care. Conflating these phrases, which was executed quite a few instances by means of the pandemic, will solely additional subordinate public well being to well being care and never tackle root issues within the system.— Eric M. Coles, Tule River Indian Well being Middle
“Filling 12-month prescriptions is one sensible method to assist the pharmacist disaster,” by Stephen Buck
Twelve months is a good suggestion, however for these with house issues, and secure storage points, the administration of medicine is usually a ache. Sizing the containers by no means appears to be a priority for pharmacists, however for outdated folks with 10 drugs, group and dosing could be very tough. Sufferers generally want smaller containers, or further small containers as a result of drawers are too shallow, or deep and medication cupboards are nonexistent or overflowing. Each pharmacist ought to go to a number of houses periodically to see how it’s executed, as a result of it may be a large number. Labels are unimaginable to learn with out glasses or a magnifier. Actually, go large, but additionally go smarter.— Steve Bunting
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I labored retail for over 40 years and it has been a continuing battle for extra staffing to make sure affected person security. After I first began, there have been solely money fills or Medicaid. With persistently decrease reimbursements, this was a battle that the retail pharmacist would by no means win. There really was once a revenue (bear in mind meting out charges, and so on.) in pharmacy. Now it’s a loss chief. In the event you implement 12-month prescription fills, administration will simply cut back staffing accordingly, don’t be fooled in any other case. I additionally doubt insurers will enable it since there may be nonetheless the query of adjusting dosage if altering medicine fully with the next waste of insurer’s premiums. It’s all the time been a no-win scenario for the retail pharmacist.— Richard Reginelli
“The subsequent Census might undercount the variety of disabled People by 20 million,” by Bonnielin Swenor and Scott Landes
This essay misses the purpose that the Washington Group (WG) questions gather a variety of difficulties due to the response classes aren’t sure/no. If the “some issue” cutoff is used, it really identifies extra folks with disabilities. We don’t have to make use of the “lot of issue” cutoff. Plus, the WG questions are extra helpful when it comes to coverage as a result of they present the vary of exclusion. The American Neighborhood Survey (ACS) questions, as a result of they’re sure/no, mix folks with completely different stage of purposeful difficulties. Utilizing them to disaggregate end result indicators due to this fact masks the excessive diploma of exclusion that some folks face since you are combining many individuals with average limitations with a fewer variety of folks with extra important limitations.
So the WG questions can determine extra folks with disabilities, with higher nuance which is beneficial for policymakers. For instance, folks with a whole lot of issue based on the WG questions have a 14% employment price. These with some issue have a 40% employment price. The ACS doesn’t enable us to see that, and since there are lots of extra folks with some issue, the ACS questions don’t enable us to see the excessive charges of exclusion confronted by folks with important difficulties.— Daniel Mont, Middle for Inclusive Coverage
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I’m curious why the Washington Group questions can be used after they ask the respondent to self-describe the extent of incapacity they’ve. Particularly amongst Hispanics, it extra possible that the diploma of issue can be understated as an alternative of being appropriately reported, whether or not as a consequence of issue with language or an unwillingness to look needful. As famous within the article, the incapacity neighborhood is missing help, and this counting utilizing the Washington Group questions will end in even much less assist to make them as unbiased as doable.— Jose L. Loera