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March 7, 1977

The Growth of Bureaucratic Medicine: An Inquiry Into the Dynamics of Patient Behavior and the Organization of Medical Care

JAMA. 1977;237(10):1009-1010. doi:10.1001/jama.1977.03270370081036

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This is one of the more difficult books to read on this topic. It is clear that the author and his colleagues have perused the literature extensively. It is not quite so clear that they have reached either consistent or understandable conclusions from the perusal. In addition to being a tedious book to read, there are a number of internally inconsistent themes in the book; the same test for success is not placed against the advantages of bureaucratic medicine when operated by government as is placed against bureaucratic medicine in the fee-forservice general environment. The author starts and concludes with a heavy bias in the direction of governmentally directed medicine, but at no time in the course of the book does he present an adequate rationale for that bias. In light of his seeming allergy to large bureaucracies, it is particularly intriguing to see his bent to take medicine from