Last year I returned to southeastern Connecticut to practice where local legends - doctors such as McFarland, Stein, German, Ellison - provided my medical care and inspiration to become a physician. After 20 years teaching, researching, practicing and administering hospital patient safety, I'll offer a "fresh set of eyes" to complement Dr. George Sprecace's provocative letter (Feb. 4) to the medical staff at Lawrence + Memorial Hospital.

Is L+M in trouble? From a quality of medicine perspective, the answer is an unqualified, "no." Every hospital is struggling with the same challenges. L+M provides care at least as safe as any I've practiced and taught in - including the University of Connecticut, University of Chicago and Yale.

The progressive and quality-minded hospital leaders at L+M stand out. The hospitalists - professionals who direct much of the routine hospital care - are clinically excellent. I am particularly impressed by the nurses' care and commitment, from ICU to wards.

The hospital provides more rapid bedside testing, physical therapy and other vital services than any hospital I've seen. Overall, the medical care provided is impressive.

So, why does the admittedly poor morale exist? First, health care is undergoing a revolution and nobody likes change. For a variety of reasons (many of our own making), physician independence has been increasingly arrested by MBAs and policy-makers. Dr. Sprecace's letter is the capstone of frustration borne, in part, of our failure to lead.

Meanwhile, nurses and other allied professionals have realized their vital role and demanded overdue respect. They confront managers already buckling under the tough, new fiscal realities facing hospitals.

At this point, it's a perfect storm.

Each group - physicians, nurses, administrators - reside in bunkers of distrust, forgetting that ultimately patients' (and our own) welfare hinges on our ability to cooperate. Rather than coalesce around common cause for the community, we seem to be needlessly polarized.

Ultimately, member-leaders from each bunker need to show, through their actions, that they can transcend petty grievances and their discomfort with change in order to focus on what they should all share; a commitment to the patients of southeastern Connecticut.

Managers might consider visiting the hospital wards and doctors' offices regularly to ask a few common sense questions, recognizing that L+M clinicians are often better able to address them than are external, expensive consultants.

What can we do, together, to make patient care better and safer?

How can we make patients' experiences at L+M more hospitable?

And what needs to be done to create a better work environment?

In response to these questions, we must all follow through with concrete actions to demonstrate common purpose.

Physicians can and should assist or accompany managers in this work. We need to accept that, for better or worse, medicine has changed. As more physicians become employees, it is all the more important that we help our managers understand what is in the best interests of our patients.

In this détente, the board of directors can be an active participant by representing the community.

Unless we can cooperate with mutual respect and support, patients will be ill-served and we will remain alienated, frustrated and pessimistic, a situation in which nobody wins.

If my mom or dad becomes ill, I am comfortable with them going to L+M. But the culture, the prism through which we view our otherwise good work, would benefit from some tweaking.

After a year working with the excellent professionals at L+M, I'm confident that Dr. Sprecace's call to arms will provoke constructive change.

Dr. Constantine A. Manthus is an internist and critical care specialist. His office is in Niantic.