I appreciate Dr Wright's interest in my recent article1 and wish to respond to some of his comments. First, I never intended to imply that as physicians we "should be allowed to practice our trade with no interference from outsiders. . . ." Who among us has truly practiced medicine without any interference from "outsiders" in recent years? When our hospitalized patients no longer meet the criteria for acute care under third-party payer rules or Medicare, we often oblige, and they are transferred to nursing homes or discharged home. When Medicare refuses to pay for home intravenous antibiotics, we oblige, and our patients are usually transferred to nursing homes (even though often they could be treated at home at lower cost). When third-party payers refuse to pay for certain drugs because of cost, we often scramble to get free samples for our patients. In fact, I would argue that those of us who are still practicing medicine have adapted well to this "first wave" of change.
Manian FA. Shame on Who?—Reply. Arch Intern Med. 2001;161(18):2269-2270. doi: