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Do the Right Thing

In “Ask the Ethicist: Hospital Privileges and Call Coverage” (Notebook, April), Dr. Charles Zacks, chair of the Academy’s Ethics Committee, presented his position that relinquishing one’s hospital privileges to avoid emergency department call coverage did not violate ethical principles. I read this with concern.

As an educator of resident ophthalmologists, I am expected to help them develop a commitment to carrying out professional responsibilities and an adherence to ethical principles. According to the common program requirements from the Accreditation Council for Graduate Medical Education, this includes a “responsiveness to patient needs that supersedes self-interest” and “accountability to patients, society and the profession.”

In another era, physicians in a community banded together to provide coverage for citizens. I argue that this is an ethical imperative for physicians.

Nowadays, when specialists leave the hospital setting in favor of surgeon-owned ambulatory surgery centers, inpatients find themselves without the benefit of necessary consultation. Is it any wonder why some of our colleagues in medicine look upon ophthalmology with distaste when hospitals lack basic ophthalmologic consultative services but airwaves are filled with advertisements for “high-def” vision? Although most of us can practice without ever setting foot in a hospital, it doesn’t mean we should.

It is understandable why a physician would not want to take call or be on a hospital medical staff. Not only is the care provided inefficient compared with that provided in the office, but patients are often sicker and cases more complex while reimbursement rarely adequately rewards the ophthalmologist for the time and effort involved. I would hope our specialty’s leadership at both the local and national levels would work to change the reimbursement. In addition, the time required to be on call cuts into time with family and friends. This, however, is part of the social contract of being a physician.

To those who have dropped their hospital privileges: Do not be lulled into a false sense of self-righteousness that you haven’t broken any ethical boundaries. You have abdicated your commitment to serve your fellow man in time of need. Look to the most basic ethical code, the Golden Rule. How do you want to be treated when you or a loved one presents to the emergency room with an acute sight-threatening condition on a Saturday night? Do you really want to be told that an ophthalmologist is not available?

Preston H. Blomquist, MD   
Dallas   

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Outdated Technology?

Your status update “IOLs for Presbyopia Move Ahead” (Feature, April) was a misnomer with regards to Abbott Medical Optics’ ReZoom IOL. While the other three presbyopia-correcting IOLs have made incremental improvements in their technology, you state “the ReZoom is essentially unchanged.” I believe that the ReZoom IOL is old technology and should be withdrawn from the market altogether. The manufacturer has new technology in the Tecnis presbyopia-correcting IOL.

Optical bench studies have shown that the ReZoom IOL demonstrates the poorest overall optic quality compared with five other accommodating, multifocal, spheric or aspheric IOLs.1 Clinical studies based on the two eye care forums sponsored by the Academy have shown that the currently marketed ReZoom IOL has more dysphotopsia and fewer happy patients than older model Crystalens and ReStor IOLs that are no longer marketed.2

Ophthalmologists and manufacturers need to recognize when “new” technology morphs into obsolete technology that should be removed from the market.

John C. Hagan III, MD,   
FACS, FAAO   
Kansas City, Mo.   
Financial disclosure: None   

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1 Maxwell, W. A. et al. J Cat Refract Surg 2009;35:166–171.
2 Hagan III, J. C. and M. J. Kutryb. Review of Ophthalmology 2009;16(4):52–55.
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