If verifiable, Ms. Bingham's conclusion [1] that her physician's misdiagnosis "Endangered my life ... and perhaps that of others" is well founded. However, two related issues are not addressed. The first, and least important, is the extent to which physicians "active in both teaching and administration in ... leading hospitals" can reasonably be expected to provide adequate availability and triage services to presumably small outpatient practices. Second, although this was not explicitly stated, one would infer from the author's ability and willingness to call her internist at home that there was some degree of friendship or at least a more than passing social acquaintance. It is my own impression and opinion that this type of relationship can deleteriously affect professional judgment. I believe that this largely has to do with one's formed conceptions about the coping styles and psychological makeup of friends and acquaintances. Such conceptions are not necessarily conductive to a professional relationship, the nature of which presumes a degree of detachment or separation from the personal and social lives of patients.

I am also concerned by the willingness of the Editor to publish this essay. Specifically, did the Editor obtain independent verification of the events described or obtain the perspective of the maligned internist? As department chair of a 15-provider internal medicine division of a multispecialty group, I am required to review patient complaints. Many of these are similar to Ms. Bingham's. Often, the physician's version is significantly at odds with the patient's. Ms. Bingham, as the spouse of a former representative to the U.S. Congress, has a high profile in her community. The section of the Bronx (known to most who live there as Riverdale) in which Ms. Bingham lives is disproportionately populated by physicians, many of whom are affiliated with academic centers in New York. It seems likely that the identity of the maligned physician would be known to many in the lay and professional communities. I would hope that the Editor performed the appropriate investigation and "fact checking" before allowing this physician's reputation to be denigrated in such a widely circulated professional forum.