To the Editor.—The widely used term gatekeeper (which many physicians find insulting) suggests
that the role of the physician in a managed care setting is to limit care,
rather than provide it—a serious deviation from the physician's fundamental
obligation to do the best for his or her patients. Two articles in JAMA
highlight the nature of this moral crisis within medicine.
The article by Dr Halm and colleagues1
explores physicians' attitudes regarding gatekeeping. However, this article
confuses the gatekeeping role and the role of primary physicians in providing,
coordinating, and expediting needed health care—a role originally articulated
in the 1966 AMA Report of the Citizens Commission on Graduate Medical Education.2 Most managed care organizations use primary care
physicians in this latter role. It seems that the article by Halm et al is
really asking physicians about their role as primary physicians in a managed
care system, which is not, I trust, primarily a role of gatekeeping.
Beasley JW. Gatekeeping: Good or Bad, but Never Indifferent. JAMA. 1998;279(12):908-910. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-12-jbk0325