Dear Sir, I write as a Physician at KEMH to respond to recent comments in the media regarding the state of our hospital and health care system.

Firstly, a Royal Gazette editorial last week referred to the medical profession as "clubby''. This may have been true in the past, but the facts are that within the last four years Bermuda has welcomed a significant influx of new physicians.

These include two internists, an oncologist, a dermatologist, and an cardiologist. Two endocrinologists are due to start this summer and efforts are under way to recruit a nephrologist.

The Island is also served by visiting consultants from various overseas institutions. The point is, the facts show Bermuda is now extraordinarily well served by primary care and consultant services (an isolated community of 60,000 in North America should be so lucky).

In my recollection of the past four years, there were no objections from physicians to the arrival of non-Bermudian physicians with a notable paediatric exception, and in two cases where qualifications and licenses were called into question.

Bermudian physicians, like all Bermudians, are concerned about their job security but the situation, while not perfect, can no longer be described as "clubby,'' and I ask the Editor to acknowledge this.

Secondly, recent statements in the press have implied that the standard of care "is not as good as it could be'' ( The Royal Gazette Editorial last winter regarding HIV disease) or that the hospital (and by inference hospital care) is "horrendous'' ( The Royal Gazette , Dr. Ewart Brown last week).

In my opinion, responsible journalism and responsible statements to the press by members of the medical community dictate statements such as these be backed up by research and explanation of the facts, and I ask the Editor and Dr.

Brown to acknowledge this.

Otherwise such statements do nothing but to leave the public guessing as to what the nature of the "horrendous problems'' are, or as to what way care "is not as good as it should be''.

This guessing game undermines public confidence in the health care system and is particularly unfair to patients and their family members. When faced with the challenges of a serious illness, the last thing that one needs is uncertainty regarding the competency of one's physician -- who might not be "as good as (he or she) should be'' -- or fear of being treated in the "horrendous'' hospital.

Exploration of the facts shows past problems with HIV care were largely related to Government funding of the medications needed to treat this illness, rather than anything to do with physician competency or the hospital.

The point is, rather than leaving the public guessing as to the safety of our health care system, anyone making statements in the media should either be prepared to research and explain the facts, or not say anything at all.

It can be argued that the memo which was circulated by Dr. Brown was directed more at physician behaviour rather than at drawing attention to the hospital.

If physicians are not referring patients to Lahey Clinic Consultants for personal reasons, Dr. Brown is right in stating this is unprofessional, as personal squabbles should not take place at the level of the bedside.

Dr. Brown is also right when he implies that physicians should be working together to improve the health care system.

However, this group of physicians should also include himself! To this end, I do not see that the picture of the "horrendous'' hospital that was painted in the media is helpful to anyone -- with the exception of overseas institutions, such as the Lahey Clinic, which are competing for our patients.

With respect to "the horrendous problems'' at the hospital, yes, there are problems but they are being worked on, just as they are in any other health care system anywhere in the world.

To put things in perspective, I draw attention to the truly horrendous problem of the fact that in excess of 20 million people in the United States are without health insurance, or the fact that 14 million people in Africa are infected (and will die) with the HIV virus.

Our health care problems in Bermuda pale in comparison to these dreadful statistics. The keynote address to the meeting of the American College of Physicians this year by Dr. Donald Berwick draws attention to the fact that "The United States is in great trouble when it comes to health care'', yet there is often public pressure for Bermuda's health care system to emulate that of the United States! While there is still work to be done, I would like to draw attention to the many positive changes which have recently occurred within the realm of Internal Medicine and General Practice (which happens to be Dr. Brown's own hospital department!).

The medical wards are rarely without letters expressing gratitude for the excellent nursing care received; the Diabetes Centre has flourished; a first class Endoscopy suite has been developed; Cardiology care is first class; HIV care is flourishing in the new clinic; patients at Agape House receive compassionate end of life care; elderly care has improved; PALS deliver outstanding support for cancer patients while family practices are building on a solid foundation of good primary care.

Nurses, medical consultants and family practitioners are working hard to improve quality and cost effectiveness, with the development of care maps, clinical practice guidelines, continuing medical education programme, quality improvement initiatives, as well as addressing issues such as manpower, staffing and the growing problem of care for the uninsured.

Other departments are also flourishing, but I leave it to members of these departments to blow their own horn.

Mrs. Sheila Manderson has shown tremendous courage and vision as our Executive Director. Many of the changes within the Department of Medicine and elsewhere in the hospital are owed to her.

She is not perfect -- who is? -- but she has shown us the path towards achieving excellence through strong leadership and team work.

Massive restructuring -- which will include a shift to outpatient care and the loss of acute-care jobs -- is inevitable if health care is to be made affordable for all, and this entails great challenges for our Government and health care leaders, as well as the BPSA.

Such change inevitably entails public and private criticism. However, while many physicians express respect and admiration for Mrs. Manderson privately, the silence from physician leaders in response to negative comments in the media regarding the Hospital and/or Mrs. Manderson in the past has been deafening.

Physicians need to stand up and support the hospital (and vice versa) if we are going to build a health care system which is excellent for all.

So come on Dr. Brown and Mr. Editor -- support us in making it happen! STAND UP FOR KING EDWARD Devonshire