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December 15, 1989

The Doctor as Patient Advocate-Reply

Author Affiliations

Louisville, Ky

Louisville, Ky

JAMA. 1989;262(23):3269. doi:10.1001/jama.1989.03430230041012

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In Reply.—  I share Dr Lind's belief that all physicians should be patient advocates. However, most physicians today have conflicts of interest that can interfere in varying degrees with pure patient advocacy, such as allegiance to a group, hospital, health maintenance organization, or insurance plan. Patients know this. On occasion, some patients want and need a pure type of advocacy that only the senior community physicians who are about to retire, physicians with a wealth of experience and judgment, can provide. Patients need it on those few occasions when death-dealing disease suddenly threatens, when a barrage of strange diagnostic and treatment subspecialists take over, and when the prospect of an outlay of thousands and thousands of dollars presents itself. At this juncture, some patients need an added reassurance that the family physician is not providing. Why deny this simple service to patients in this situation? There is no compelling reason