judged by the "sum of its parts" and concern management of the drug da¬ "some of those parts" are in need of tabase. Processing of various data repair. I cannot stand by without com¬ about drugs may be obtained, eg, add¬ To the Editor.\p=m-\Asan otolaryngologist ment while the minority among us ing a new drug, deleting an old one, in my third year of medical practice, shoot themselves in the foot, then the retrieving the information about a I am stunned by what I see going on impact ricochets and hits the rest of us drug, and, finally, modifying any data around me. My sense of profession- squarely between the eyes. on any drug. A drug can be accessed LINDSAY I. GOLDEN, MD alism is offended by some of the billby its code number or name. Addi¬ Silver Spring, Md ing and coding procedures that are tionally, a list of all drugs included may appear. Sorting is possible in ev¬ occurring in my area. The actions of a few are affecting all of us. ery field of information, but searching I can understand that the setting of is the area where this program, and fees for medical and surgical services Computerized most modern PCs, displays its real is not a simple task. On one hand, we Prescription Writing strength. To obtain versatility, the pro¬ all see the inadequacies that stem from in gram was designed to be able to search Otolaryngology

A Few Bad

Apples. . .

the Resource Based Relative Value Scale that is being used in formulating Medicare fees. Clearly, the expertise, practice and malpractice costs, and cognitive effort used in performing an endoscopic anterior ethmoidectomy is worth more than the $382 that Medicare is allowing. On the other hand, a 2-hour "sinus operation," no matter how complex, cannot be worth the $12 000 that some are requesting. This discrepancy can only serve to raise the eyebrows of third-party pay-

To the

Editor.\p=m-\Pioneeringefforts

to

computerize prescription writing have been hindered by hardware limits. Most hospitals and institutions used time-sharing systems, and the first computers were expensive, inflexible, and cumbersome. Personal computers (PCs) have developed greatly dur-

ing recent years as regards memory, speed, and computing ability, minimizing the above problems. Taking most and, ors, legislators, importantly, advantage of this progress we have our patients. designed a PC-based prescription\x=req-\ Most disturbing is the "creativity" writing program for use by otolarynthat I have seen in the entitlement and gologists. The program is currently running coding of surgical procedures. I have had the opportunity to see several pa¬ in an IBM PC with a 20-megabyte fixed tients in consultation, with the benefit of operative reports and insurance forms. Some of the practices that I have seen include billing for partial inferior turbinectomy and electrocau¬ tery of the inferior turbinâtes, descrip¬ tions (and full billing for endoscopie ethmoidectomy and antrostomy) of endoscopie visualization of the max¬ illary sinus and frontal recess without mention of uncinectomy or ethmoid dissection, and billing for intraoper¬ ative diagnostic nasal endoscopy si¬ multaneously with other endoscopie sinus surgery. I am sure most of us go to bed at night satisfied that he or she has ren¬ dered quality care at a reasonable fee and that we have represented this care fairly. Our specialty as a whole is

disk, 640 kilobytes of random access memory (RAM), and a video graphics adaptor monitor. However, the program will operate on any IBM-compatible PC, needing only 64 kilobytes

of RAM. Prescriptions are printed on continuous fanfolded narrow paper by a dot-matrix printer. The program was written using random files of BASIC, the most friendly and widespread programming language. Three files have been created: the drug database, the main program, and a small file with ready prescriptions. The drug database includes infor¬ mation about the common drugs that are

currently in use by otolaryngolo¬

according to relevant medical literature.1-2 Most functions of the main program gists,

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for data with any combination of search parameters. A most interesting feature of the search option is the pos¬ sibility to type only a few characters of the desired data, making it possible for every user to establish his or her own codes for all the drug data, avoid¬ ing excessive typing, and making the program work even faster. One function of the main program concerns

prescription writing. During

this process, the screen is divided in two halves: the upper half is available for the composition of prescriptions, and the lower half contains helpful information. The name of the hospital and the clinic appear on top, and the user is asked to enter the patient's name and the date. Drugs are inserted by the code number they possess in the database. By entering the appro¬ priate number, the respective drug ap¬ pears on the screen, together with its usual formulation, dosage, and in¬ structions. Entering a new number makes the respective drug appear, and so on. Finally, the prescription is printed, if so desired. On the lower half of the screen, through a series of keys (Fl to F8), a list of the drugs with their code num¬ bers as well as various lists of formu¬ lations, doses, quantities, and com¬ mon instructions may appear. Every item from these lists may be inserted into the basic prescription by just one keystroke, helping to modify the pre¬

scription easily and thereby saving time and typing. Additionally, a list