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Editor's Correspondence
July 12, 1999

Plunging Clinical Standards Under Managed Care

Arch Intern Med. 1999;159(13):1499. doi:

In reply

We agree that the notion that "fast" physicians are more likely to forget to implement preventive guidelines for care of patients with diabetes appeals to common sense. It had to be proven, however, because many hypotheses that make common sense have been shown to be invalid once examined.

Dr Steinsmith's letter is the lamentation of a dedicated physician, faithful to his Hippocratic Oath, facing the changes in the American health care system. He views these changes as the direct result of managed care, destined to produce hoards of employed, fast, sloppy physicians practicing depersonalized medicine. Unfortunately, in the community the problem is much more complex. Being fast depends mostly on the personal characteristics of the physician1: employed physicians are usually not fast,2 and fast physicians are more likely to own their own practice.3 Being fast has economic rewards under any health care delivery system, and it is conceivable that an appeal to the consciousness of the fast physicians will not reach its goal.