Letters to the Editor

The Permanente Journal,

Thank you so much for printing the moving letters "Dear Doctor" and "Dreams From Childhood" in your Winter (2002) edition. I must say, though, that I strongly disagree with your decision not to include the authors' names.

The simple fact that neither author requested to be anonymous is a powerful statement to us as health care professionals and to society in general. Through tremendously courageous efforts, the two authors have jumped into the dark pool of emotional pain and have emerged with the insight that being an abuse survivor is nothing to be ashamed about. Secrets breed shame, and the more we, individually and as a society, talk about abuse, the less its targets will feel shame.

Equally important, and I'm sure the authors would agree, is that those who abused them were probably abused themselves. Ignoring or "protecting" this fact shows no compassion for their own pain and deep emotional wounds. Are we to have compassion only for the courageous authors who have walked the long path to forgiveness and to sweep under the rug (so they will go away) those who remain too afraid to begin the painful journey themselves?

I am not the survivor of abuse, but I do believe that physical ailments are a reflection of unhealed emotional wounds. I have experienced and been witness to the incredible power of forgiveness. It can't be done anonymously.

Terry Woodard MD
Internal Medicine, Santa Rosa, CA

-- Reply
As the prefatory comment to "Dear Doctor" reported, the Editorial Board spent much time debating the anonymity issue. A unanimous verdict was never reached, and all felt sadly constrained by our imperfect, litigious world. Not the least of the problems was our feeling that--in the court of public opinion--innocence is not always presumed. Despite the wish to see their names published, the authors readily agreed to remain anonymous.

Editor

Dr Klatsky,

I have just finished reading "Dear Doctor" (Winter 2002). Thank you for printing this moving story. Although not a victim of such abuse myself, my mother unfortunately was such a victim. This account greatly helps in understanding not only her issues but also those of my patients. I am so proud to be a member of the Kaiser family where, even with our warts, we can still be unabashed humanists. Indeed, I feel fortunate to be alive!

Thanks,

Gary G Huffaker, MD
Ophthalmology, Riverside, CA

Dr Felitti,

I think your research and recent article are invaluable. After reading your article in The Permanente Journal, I feel my treatment approach with patients has been validated. For years I've believed that the self-destructive habits of adults (smoking, alcohol abuse, street drug use, overeating, etc) must somehow be related to a need to self-medicate or self-soothe for some conscious or unconscious childhood trauma. When I talk to my patients about these issues (the habits), I usually point out that the habit is often the manifestation of an emotional issue. I frequently don't direct the patient toward education (usually, they don't need to be "educated" about healthy behaviors); nor do I lecture them about self-control and proper behavior. Instead, I mention that if they ever seriously want to tackle the issue of their unhealthy habit, they should consider counseling. My patients will initially react with surprise, asking, "Why are you saying this to me?!" But I must say that, almost universally, they end up agreeing with me and leave my office with what is perhaps a more appropriate tool/approach to use to improve their health.

Susan Twining, NP
Occupational Medicine, Sacramento, CA

Dear Dr Janisse,

Thank you for a superb Winter 2002 edition of The Permanente Journal! It is an outstanding work of journalism covering the depth, breadth, and scope of the art and science of medicine with some truly fine pieces. There are some very thought-provoking, informative, and useful articles--the content of which I find to be highly relevant. In addition, I appreciate that The Permanente Journal provides a format which showcases the many and varied artistic talents of our physicians and providers. I feel very proud to be part of an organization of people with such a high level of skill, knowledge, talent, and integrity--but most of all, of commitment to the highest quality of care for our patients!

Sincerely,

Carol Ball, PA-C
Dept of Preventive Medicine, San Diego, CA

The Permanente Journal,

Several years ago, I proposed to Plastic and Reconstructive Surgery a new section called "Three-Year Follow Up."¹ My idea was that each author who has an article published would write a one- to three-paragraph follow-up statement on his or her subsequent experience that would be published three years after the original article had appeared. If the author refused, that would be reported. This alleviates the problem readers have with techniques that may have, months or years after article publication, developed problems or been superceded by better techniques.

I am now proposing that The Permanente Journal adopt a similar program of follow-up. I'm certain that TPJ readers would appreciate this extra step in keeping them up to date. I thought it was a good suggestion for that journal then, and I think it's a good suggestion for TPJ now.

John H Cochran, Jr, MD
Executive Medical Director, Denver, CO

1. Cochran JH Jr. Proposed 3-year follow up [letter]. Plast Reconstr Surg 1992 Feb;89(2):386.

--Reply
We agree with Dr Cochran and are implementing a process to periodically contact authors of past articles and request follow-up. The first of these follow-ups, on Fibromyalgia, appears in this issue. At our Web site, original articles will be cross-linked with their follow-up articles and can be accessed online at www.kp.org/permanentejournal.

Editor