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March 25, 1998

Gatekeeping: Good or Bad, but Never Indifferent

JAMA. 1998;279(12):908-910. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-12-jbk0325

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.

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