I read with interest the article "Effects of Managed Care on Physician-Patient Relationships, Quality of Care, and the Ethical Practice of Medicine" in the August 1998 issue of the ARCHIVES. Feldman and colleagues1 provided an excellent introduction on the effects of managed care on physician-patient relationships, with a special emphasis on ethical concerns.
I would like to make several observations. The referenced article clearly indicates that primary care physicians face a conflict of interest when choosing referral services for patients. This conflict is primarily due to the large financial incentives offered by the managed care industry, which are tied to restricting particular care.
Erwin K. Proactive Measures Needed for Health Care Reform. Arch Intern Med. 1999;159(12):1370–1371. doi: