‘HMO Horror Story’ Perspective Challenged

The perspective offered by the article on health maintenance organizations, “HMO Horror Story” (Jan. 2) was biased and leads the reader to inaccurate conclusions about the appropriate treatment of low back pain and the quality of care delivered by HMOs.

About 95% of cases of sciatica will resolve with conservative treatment delivered by a primary-care physician. Rushing into sub-specialty referrals, costly diagnostic tests and surgical procedures does not improve the quality of care; it merely increases the costs of medical care while exposing more patients to the risk of postoperative complications. As your article shows, surgery is not without its hazards.

The article faults the physician for ordering a less-expensive test that failed to make the definitive diagnosis. Unfortunately, no test is perfect, and the results may be non-diagnostic. A less-expensive test with a reasonable chance of success should be ordered first, reserving costly tests for those cases in which the initial test fails.

Your article questions the competence of the HMO physician because the patient had a surgical complication. All operations carry risk regardless of the insurance system under which they are performed.

It is possible that the quality of care in a staff model HMO (such as Kaiser Permanente) is superior to that in other settings, as incompetent physicians can be disciplined speedily by the HMO without resorting to the slow disciplining procedures of hospital staffs and the state medical board.

JAMES MORGENSTERN

Fontana

The writer is an MD with Kaiser Permanente.