And the Wait Goes On

Ho-hum. What's new, Doc? And what's new about Victor Cohn's article, "Those L-O-N-G Waits for the Doctor" {The Patient's Advocate, Oct. 27}? Every so often, the story turns up. And patients still wait. In the January 1975 issue of Prism, an American Medical Association publication, there was a story, "Check Your Waiting Room," about an AMA study on patient waiting time, to help "show you {physicians} how your office compares with others." The information was furnished by 4,000 physicians. An accompanying chart showed eight specialties. General family practice had the longest waiting time -- an average 29.9 minutes. Psychiatry the least, 5.3 minutes. Average of the eight specialties was 22.6 minutes.

At the time, I checked with Group Health Association and its statistics for one of the centers indicated an average waiting time of 16 minutes. I was told that a national survey (presumably different from the AMA one) indicated an average waiting time of 30 minutes with an appointment, 45 minutes without an appointment. Time of day was also a factor.

Certainly Mr. Cohn has pointed out in the article steps physicians can take to help cut down on excessive (and habitual) waiting times. Realistically, patients have alternatives that they do, and should, take: continue putting up with the waiting time if they feel the physician is worth the wait, change physicians, take along a good book (don't depend on the cast-off mags in the physician's office), come late or see a psychiatrist.Bernard S. Katz Reston

Stereotypes of Haiti

It was with great disappointment that I read your article "Crisis in Haiti: An Improvished Nation Confronts the Spread of AIDS" {Cover Story, Sept. 29}. Although titled provocatively, it leads the reader once again through the tired litany of fashionable plaints and titillating exotica that seem to appeal to simplistic American stereotypes about this troubled neighbor.

Haiti's crisis in confronting the AIDS threat is not a simple story of distracted bureaucrats, clumsy international organizations, errant research projects, disinterested political leaders and mystical folk healers. It is rather the story of a beleaguered lesser developed country trying responsibly to stand up to a pending global health disaster that brings weak knees also to its most developed neighbors. The backdrop for the drama is all the seedy trappings of any developing country, but the story line, I am sorry you missed, is how determined and courageous people are moving ahead in spite of these constraints.

Dr. Bernard Liautaud is not just the first person to diagnose AIDS in Haiti, he is among the first to see and report AIDS in the developing world. He and Dr. Pape are also members of the first national research group outside the United States dedicated entirely to AIDS research, which has contributed an outstanding amount of clinical and epidemiological information in international scientific forums on manifestations of AIDS in a tropical environment. It was precisely this body of knowledge that has allowed Haiti to dispute successfully the U.S. Centers for Disease Control's initial and erroneous categorization of Haitians, as a nationality, as persons at high risk for the disease. The lingering stigma of this initial error, however, continues to handicap the Americans' understanding of the Haitian experience with AIDS.

Characterizing "the WHO {World Healh Organization} grant" as another "miscue" or "stillborn" effort to confront AIDS, while cute journalistic rhetoric denigrates what has been a historic mobilization of Haiti's leadership in designing and launching one of the first national AIDS prevention and control programs in the American region. A prestigous 12-member National AIDS Commission has been working extremely hard in the last month to guide the initial WHO-supported program through all the scientific, operational and ethical problems that confront such efforts everywhere. All is not right in Haiti, but all is not wrong either.

Robert D. Fischer, MD Panamerican Health Organization/ World Health Organization representative in Haiti

When Doctors Don't Know

I read with considerable interest the recent article by Sandy Rovner about interstitial cystitis.

How true it is what the article says about doctors becoming frustrated in not being able to diagnose a problem, and so take the position that the patient has a psychosomatic illness. Behavioral psychologist David P. Schwartz is quoted in the article as having said "the history of medicine is full of examples of problems that were called psychological because there was no physical explanation." It's sickening the way doctors wave away problems by saying, "It's all in your head." Alice Vaeth Bethesda

Letters intended for publication must be signed and include the writer's home address and home and business telephone numbers. Letters may be edited. Although we are unable to acknowledge all letters, we appreciate the time and value the viewpoints of those who write. Send letters to Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071.