Skip to Navigation
University of Pittsburgh
Print This Page Print this pages

October 12, 2000


Why a chair in patient care?

To the editor:

I don't mean to be irreverent toward medical education or oblivious to the immeasurable contributions physicians make to society, but I confess nevertheless how nonplussed I was by the strange headline in the Sept. 14 issue of the University Times, "Med school prof named to nation's first chair focusing on patient care" (page 4). A special chair, I wondered? A chair? Focusing on patient care? My old-fashioned view of medicine is that all physicians should focus on patient care, that medical students across the board, in all medical specialties, are indoctrinated in patient care. Why, then, did Arthur S. Levine, senior vice chancellor for Health Sciences and medical school dean, in an adjoining story, gush and bust his britches over this chair, describing it as "a national milestone in bringing long overdue attention to the doctor-patient relationship as the very soul of the medical profession"?

First of all, is not the "doctor-patient relationship" at the very core, conventionally speaking, and never mind a vaunted chair, of a physician's medical practice? Next, since when is medicine characterized with the word soul? I thought that medicine was about bodies, not about souls, the soul being the province of theology, the clergy, or of pastoral psychology. But leave that be, a digression I could not resist including in this letter, my main purpose being to ask why the doctor-patient relationship is such a special alliance as to warrant its elevation, pedagogically speaking, to the level of chair.

If a chair in patient care is merited, then why not in arts and sciences a chair in teaching, or in engineering a chair in building safe highways, or in physics a chair in matter that matters, or in biology a chair in life, or in mathematics a chair in numbers that add up, or in business education a chair in achieving profitability, or in theology a chair in faith?

Robert Perloff

Professor Emeritus

Katz Graduate School of Business

Arthur S. Levine, senior vice chancellor for Health Sciences and dean of the School of Medicine, responds:

Professor Perloff is quite correct that the doctor-patient relationship is what medicine is about. However, there are a number of significant aspects of this relationship that have not been illuminated, brought into focus, and studied analytically. For example, young physicians dealing with patients who are dying not uncommonly react with anxiety, denial, depression, identification and even anger. The psychological transactions between the patient, the patient's family and the doctor that provoke these unproductive feelings in the physician are as much a substrate for scholarship as any subject in medicine, and perhaps more so — given Professor Perloff's statement that the doctor-patient relationship is "at the very core of a physician's medical practice."

With the emergence of managed care, and the constraints on a physician's time arising in the wake of this dramatic evolution in health care financing, it becomes increasingly important to explore the doctor-patient relationship in a social, cultural, political, psychological and economic context. Professor Perloff has trivialized a scholarly topic of great seriousness and importance which, fortunately, the family of Dr. Leo Criep, which endowed this unique chair, was able to view with greater perspective and profundity.


A benefits puzzle

To the editor:

I have been generally satisfied with my UPMC health insurance, especially since the recently approved arrangement allows me to use my long-time Premier (Highmark) physicians (University Times, Sept. 14 and 28).

However, I am puzzled by the Sept. 28 University Times report that 3 percent of participating employees enrolled in the UPMC Health Plan chose the comprehensive (deductible) plan. The comprehensive plan provides coverage that could be duplicated under the point-of-service (POS) plan but has premiums $336/year (individual coverage) to $974 (family coverage) higher.

When the UPMC comprehensive plan was announced its similarities to UPMC POS plan were apparent. In fact, if an employee enrolled in the POS plan and self-referred (did not use a primary care physician) the two plans provided identical coverage. During orientation sessions held this spring, UPMC officials freely admitted that there was no difference in coverage. Apparently the comprehensive coverage was offered because of a University requirement that a fee-for-service health plan be offered.

If the POS plan offers coverage identical to comprehensive but at a lower cost, why did 170+ employees choose the more expensive coverage? In early spring I phoned Human Resources to express my concern that unknowledgeable employees would select comprehensive coverage and in effect overpay for health insurance. I was assured that all employees selecting comprehensive would be contacted and dissuaded from that selection. If all employees were contacted, why did over 170 choose to overpay? I asked one colleague who selected comprehensive about contacts from Human Resources regarding that choice. He does not recall any contact. I estimate that these 170+ University employees will overpay for health insurance by more than $100,000. Doesn't the Office of Human Resources have an obligation to minimize health-care costs for University employees? How hard did HR try to explain the problem to employees? A detailed explanation seems called for.

Joel Falk

Professor and Chairman

Department of Electrical Engineering


Ronald W. Frisch, associate vice chancellor for Human Resources, responds:

I want to alleviate any confusion that may arise as a result of Professor Falk's letter to the University Times, and I trust the following will do just that. Let me first say that with over 12,000 University of Pittsburgh subscribers to the UPMC Health Plan, thousands have been served and are very satisfied.

It is correct that the comprehensive plan offered by UPMC Health Plan is the same as the self-referred/out-of-network option of the point-of-service plan. One of the primary objectives of the University's faculty and staff medical advisory committee was to offer "choice" to eligible faculty and staff. Professor Falk may recall that both the Faculty Assembly and Senate Council strongly recommended that the University administration should always offer an "indemnity" plan. (The comprehensive plan is an indemnity plan.)

Why Professor Falk is challenging the method in which the University communicated information to faculty and staff members about the two plans concerns me. The enrollment material, mailed to all eligible faculty and staff, definitively outlined the design of the two health plans. We took particular care this year to design information charts that clearly explained the available coverage within each plan as well as the associated employee premiums — the self-referred/out-of-network/point-of-service coverage and the comprehensive coverage were shown side by side to allow for easy comparison. Throughout the months of April and May, the staff of the Benefits department as well the UPMC Health Plan conducted numerous educational sessions where these two plans were discussed.

Furthermore, at the recommendation of the benefits and welfare committee of the University Senate, the Benefits office designed a question-and-answer brochure, including a clear explanation of the two levels of coverage within the point-of-service plan. That brochure, with an accompanying memo, was sent to all medical plan-eligible faculty and staff on March 3, 2000. Upon receipt of enrollment forms, during the open enrollment period, the staff of the Benefits office attempted to call those subscribers who chose the comprehensive plan to verify the selection before processing. Although they attempted to speak directly to the faculty or staff member, they were not successful in reaching all subscribers. Frankly, I think we have a success on our hands. Last year, over 700 subscribers elected the Highmark comprehensive plan. Even at that time, Highmark's comprehensive and self-referred/out-of-network/point-of-service plans were very similar. With the University's aggressive education campaign, there are only, as Professor Falk has indicated, less than 3 percent (just over 140 subscribers) who have opted for the higher cost comprehensive plan. At the same time, choice among different plans prevails. Annually, eligible faculty and staff have the option, during the open enrollment period, to change their health care plan if they wish.


Highmark: We weren't the cause of delay

To the editor:

On behalf of the 120 doctors in Premier Medical and Alliance Medical practice groups, and the approximately 1,000 Pitt employees and their dependents who receive care from these doctors, I want to express my appreciation to Nathan Hershey and several Pitt faculty members who championed continued access to these doctors. Continuity of treatment from doctors in whom these patients have great confidence is very important.

I do want to take exception, however, to one point in Jerome Cochran's letter in your Sept. 28 issue. In it, he states that "the major impediment to pro-gress…was Highmark," and that "negotiations" were required over the summer months to bring the matter to a successful conclusion in early September.

The fact of the matter is that Premier Medical and Alliance Medical, at the request of the UPMC Health Plan (UPMC), agreed on June 16, 2000, to provide continuity of care for patients who were University employees and dependents. We provided UPMC listings of patients who according to our records might be affected. On June 28, 2000, we provided UPMC recommended amendments to our contracts to meet the University's needs.

Since we agreed to UPMC's request in June, it is difficult for us to understand why the issue lingered until September — thereby disrupting a thousand physician-patient relationships, creating family trauma, and requiring intervention by concerned faculty.

Lee H. Bowser

Chief Operating Officer

Alliance Ventures/Premier Medical and Alliance Medical

(Alliance Ventures is a subsidiary of Highmark.)


Letters Policy

Letters should be submitted at least one week prior to publication. Persons criticized in a letter will receive a copy of the letter so that they may prepare a response. If no response is received the letter will be published alone.

Letters can be sent to 308 Bellefield Hall (include hard copy and a disk when possible) or can be sent by e-mail to

The University Times reserves the right to edit letters for clarity or length. Individuals are limited to two published letters per academic term. Unsigned letters will not be accepted for publication.


Leave a Reply