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May 26, 1989

The Practice of Medicine-Reply

JAMA. 1989;261(20):2951-2952. doi:10.1001/jama.1989.03420200041014

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In Reply.—  Apparently Drs Lusk and Rose believe that one of the criteria for practicing medicine is getting up in the middle of the night and that another is being frustrated and suffering "wear and tear on the nervous system." I have not delivered a baby since I was an intern, but I spent a sleepless night last week trying to decide how to respond to a late evening call about a critically ill patient who needed Medicaid coverage for a liver transplant. To decide at 4 AM whether it is better to spend $100 000 for a liver transplant for one patient or for dental care for 1000 elderly people (since my "pot" of money is finite) causes just as much stress as a problem delivery or a critically ill patient in the emergency department. It is, in fact, a life or death decision. The primary care physician knows