Document Znwj1wKXddgo7yreVKG0E1YwY

July 3rd, 1963 Dr. Carl Weihl Dr. Lillis F. Altshuller University of Cincinnati Department of Pediatrics Cincinnati General Hospital Cincinnati 29, Ohio Dear Doctors Weihl and Altshuller: Your letter of July first presents a request which is so reasonable that I an almost at the point of embarrassment in recognizing that you were called upon to write to me about it. I think it necessary to explain why it is that we have felt it wise to set up the barrier of authorization. It is against my lnclincatlon to do so, for this is our common medical community and X like to feel that I and my associates as well in this Laboratory are actively participating members of it, and are prepared to give all the help we can. First, however, before enter ing upon on explanation let me say that your request is granted, we shall accept samples of blood for analyses for lead from the three clinics mentioned, for the next thirty days (and longer if it works out satisfactorily), without prior authorization. There must be a proviso in this, however. The samples will be received in the Laboratory and the accompanying request sheet will be looked at from the aspect of the adequacy of the information which enables us to Interpret it. If this information is inadequate, the sample will not be analysed. That is to say that we need at least the minimum of information which is requested on the sheet, and if the physician Involved does not care enough about his patient to give us the necessary information, we will set the sample aside and hold it for further information. This is not merely a question of labeling, and it is not a matter of just an analytical service. We do not provide analytical service. We do provide consultation, and if we are to consult we have to know the facts that enter into the formulation of our opinion. For example, the results are likely to be grossly distorted by chelation therapy. We need to know whether such therapy has been instituted, and how it relates in time to the collection of the sample. If the information is inadequate we have to moke a telephone call to find out what, in all reasonable courtesy, should have been provided as the very condition of the request. This is a part of the professional relations in medicine in which doctors, Interns and even residents have to be instructed. The manner in which expert Investigators are ordered about for the performance of various physiological and clinical microscopic pro cedures by junior physicians who have not learned the basic courtesies and necessities of professional life, is one of the fundamental weak ness of modern medical education, and X, for one, will not be a party 00546 Or. Ctrl Weihl Dr. Ullis F. Altshuller - a- July 3, 1963 to It. Our present procedure m m about because in attempting to render a satisfactory service to patients, we were finding it necessary to run to earth members of the house staff to find out the simple facts which we needed to know in order to render such a service. It is not that I have to find the money to pay for the services of this type which we render to the Medical Center (which run up to several thousand dollars per year). This is not unim portant, for we have no source of public or endowment funds, and no gifts of funds for such purposes, but it is not the main point at all. We have been doing this for years and we expect to continue to do so. It is rather the lack on the part of some of the physicians, of any understanding of what is represented in ordering, at random, often at the wrong time and for the wrong reason, analytical work of an exacting and expensive type. This is not a service Laboratory for physlclans/from which doctors can order what they nay choose for any reason that occurs to them, at a price. It is made up, for the most part, of a group of highly trained persons engaged in specific Investigations, who, because of certain facilities and skills, are willing, as physicians, to help their colleagues to help their patients to the extent that this is not incompatible with their primary duties. We expect those who seek our help to provide at least the minimum amount of information that enables us to perform a useful and intelligent service. 1 ask for your patience in considering what I have said in good faith. If you can advise, Instruct or coerce the members of your house staff, including the new ones, to the point of having them make a decent response to our request for information, we shall be delighted to render you and them and their patients, prompt and informative service. I, myself, am a busy man. Over the weeks, months and years, I have wasted many hours of my time in trying to find out wbat I have needed to know to give an Intelligent opinion for the guidance of physicians of the General Hospital in the c u j u of patients suspected of having lead poisoning. I have delegated this part of our work, of necessity, to certain of my associates from time to time and, recently, in Its entirety. Not all of my associates have the time or the patience that is required to do as I did, and all of us cams to the conclusion, some time ago, that such patience could not be J ustified. Hence the establishment of a system which, admittedly, put burdens upon your people but lightened our load considerably. It may be that you could use this letter or some part of it In bringing this matter to the attention of the incoming house staff. You have my full consent to do so, if you wish, and such is the reason I have gone to some trouble to explain the situation. Our working relations with the experienced members of the staff of the Hospital have been most satisfactory, and I should hesitate to write such a letter as this to you, were it not for the fact that there is a teaching Job to be done in this matter, as It relates to the various 0 0C47 Dr.C&rl Weihl Dr. Lillis F. Altshuller -3 - July 3, 1963 laboratory procedures which constitute diagnostic aids. Sincerely yours. Robert A. Kehoe, M. D. RAX:ss ADD RESS i department or pediatrics CINCINNATI GENERAL HOSPITAL CINCINNATI 29. OHIO UNIVERSITY O F CINCINNATI C O L L E G E O F M ED ICIN E 1 July 1963 Robert A. Kehoe, M.D. Department of Preventive Medicine Kettering Laboratory University of Cincinnati Dear Doctor Kehoe: First, we all want to thank Kettering for their prompt and reliable blood lead determinations which are of such inestimatable value in the management of our pediatric patients. Secondly, we realize that accurate analytical chemistry is always time consuming and expensive. We would not want to burden your laboratory with unnecessary determinations. Further, we will make every effort to instruct our new interns in the proper collection of lead levels. But, keeping this in mind, we would like to be able to send blood for lead analysis from the Cincinnati General Hospital Pediatric Clinic and the two clinics immediately under our supervision, Findlay and Christ Church, without a phone call first. If you like, we could have a one month trial period, and if the load was too excessive or the specimens incorrectly labeled during this period, you could re-institute the old system. Further if the phone call was eliminated, there would be a net saving of time 'Doth for the Kettering and the General Hospital since your men would not be taken from their work to answer our calls. Sincerely yours, CarX^Weihl, M.D CW/LFA/ca Lillis F. Altshuller, M.D