Letter to the Times: Solo Medical Practitioners

The Times didn't publish this letter, so I'll put it here. I really wanted the patient I discuss to see my comments.

To the Editor:

I was sympathetic toward Dr. Ronald Sroka until I reached the account of his treatment of Alice Beall's plantar fasciitis. (http://www.nytimes.com/2011/04/23/health/23doctor.html?_r=1&hp, April 22, 2011). 

I've been a member of Kaiser Permanente since 1990. Here's what happened when I went to my primary care physician with pain in my foot. First, she referred me to a podiatry department class on heel pain. At the class, the podiatrist discussed stretches, shoes, orthotics, anti-inflammatories, and steroids, with a recommendation to try stretches and orthotics before steroids. My primary care physician also sent me to physical therapy, where the physical therapist determined that the plantar fasciitis was very likely secondary to multiple ankle sprains in my past. He prescribed a course of stretches and strengthening exercises. Additionally, I have off-the-shelf inserts for my shoes.

Dr. Sroka prescribed anti-inflammatories, to be followed by steroids, for Ms. Beall. She loves him, but his care for her didn't meet the current standard of care for plantar fasciitis. That's just one reason that large group practices are superior to solo practitioners.

Very truly yours,

Lisa Hirsch

Oakland, CA

I had some other issues with Dr. Sroka: he won't go to electronic records, he doesn't provide health insurance to his five part-time staff members, and he's opposed to joining a group practice because of their use of nurse practitioners for primary care. NPs and PAs provide high-quality primary care at a lower cost than MDs, and his view seems to be straight out of the hierarchical past rather than the team-oriented, collaborative present.