I was deeply disturbed by Bloche's editorial "Cutting Waste and Keeping Faith" [1].

The author states that "physicians risk running afoul of these statutes primarily through careless documentation and trying to be too clever." He goes on to say "rather than railing against these confusing laws or, even worse, campaigning to broaden their exceptions, physicians should heed the sobering message the laws send-that Americans have lost faith in their physicians' ability to restrain themselves when tempted by money."

What nonsense! Why shouldn't physicians attempt to alter these unreasonable and capricious laws? Where does the author get the idea that the public has lost faith in physicians? How does the author deduce that we are guilty of "upcoding" or "careless documentation"?

We in the trenches of private practice are attempting to receive fair compensations for our services on the basis of vague criteria for coding. Has the author ever tried to treat a patient and then attempt to Figure out what level of care and what documentation are warranted?

Now the Health Care Financing Administration (HCFA) is attempting to use "fraud and abuse" statutes to intimidate us to downcode when it is not warranted. Unfortunately, the American Medical Association has cooperated with HCFA in promulgating these attempts to intimidate physicians. I have the distinct impression that the author's antiphysician bias is also shared by the editors of Annals and the American College of Physicians-American Society of Internal Medicine.

We physicians should reject these attacks on our honesty and do all in our power to alter the present "fraud and abuse" threats. We should also fight to eliminate HCFA's attempts to require extensive, unnecessary, and time-wasting documentation. Finally, we practicing physicians should work to educate or replace editorial boards of journals that seek to impugn our dedication or honesty.