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July 20, 1984

Unacceptable Pressures on the Physician

Author Affiliations

Dean's Office School of Medicine UCLA

JAMA. 1984;252(3):351-352. doi:10.1001/jama.1984.03350030021015

The same society that demands the best of physicians is now creating the conditions that make it difficult for them to offer their best. By "society" I refer to all those forces beyond the physician's office that have a substantial effect on patient care. More particularly, I have in mind those actions or policies of group insurance plans and of government—whether national, state, or local—that regulate compensation of physicians and hospitals for medical services.

I doubt that any aspect of medical care payment policies, whether public or private, is less enlightened or more misguided than the refusal to compensate physicians for talking to patients. Payment is made for procedures, tests, and treatments. For some reason, laying the foundation for careful diagnosis and treatment, which is what the painstaking interview is supposed to do, is apparently not considered important enough to be included in a schedule of payments.

Why shouldn't doctors