David Ignatius [“The new world of health care,” op-ed, April 1] wrote glowingly of the health-care system to come: care by ancillary practitioners, who will peer into their electronic record system for the next question to ask the patient. Having practiced primary care internal medicine for 40 years, I am confident that Mr. Ignatius’s enthusiasm is misplaced.

Impersonal medicine is not going to be good medicine, no matter how many data you accumulate. As my perceptive daughter said to her new doctor, who sat typing into a laptop instead of looking at her and listening to her, “Are you a doctor or a librarian?”

Emergency room treatment is getting to be very “cookbook,” due to doctors following electronic cues in the system and fear of lawsuits. A recent patient of mine went to a local ER with mild aching on the left side of his upper back and in his shoulder after helping to carry a couch into his condo. Though never touched by a physician, he had many expensive and useless tests, including a chest CT scan and an EKG, when all he needed was for a physical exam to reveal tenderness of the shoulder muscles and advice to use heat and some analgesics for a few days.

The most important dictum in medicine is to “listen to the patient.” That is the real path to good care and lower costs.

John A. Galotto, Bethesda


David Ignatius correctly noted that the delivery of health-care services by physicians is changing to an integrated system and will continue to change even if Obamacare is ruled unconstitutional.

He cited Toby Cosgrove, chief executive of the Cleveland Clinic, who stated that the integrated-delivery model of the Mayo and Cleveland clinics improves quality and lowers costs. This might be generally true, but it is not always.

What Mr. Cosgrove didn’t say, however, is that the Mayo and Cleveland clinics were developed years ago by physicians and are currently governed by physicians whose priority is patient care. Conversely, the majority of the new generation of integrated systems is controlled by organizationally sophisticated hospital administrations whose focus is on business first and patient care second. This administrative focus is highly problematic and needs revision with greater physician input. The realities are, however, that government regulations make it virtually impossible for physicians to duplicate multiple Mayo-type medical delivery models.

Robert P. Nirschl, Arlington

The writer, an orthopedic surgeon, completed his specialty training at the Mayo Clinic.