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August 14/28, 2000

Is the Therapeutic Nature of the Patient-Physician Relationship Being Undermined?A Primary Care Physician's Perspective

Arch Intern Med. 2000;160(15):2257-2260. doi:10.1001/archinte.160.15.2257

By far the most frequently used drug in general practice was the doctor himself. No pharmacology of this important drug exists. No guidance is contained in any textbook as to the dosage the doctor should prescribe himself. The usual answer is that experience and common sense will help the doctor to acquire the necessary skill.—Michael Balint1

SINCE THE advent of managed care, the practice of medicine has changed rapidly in just a few years. From the perspective of a generalist physician, such as myself, major changes include the loss of flexibility in controlling one's practice, the often wholesale transfers of patients from one physician to another as employers switch health plans, the impersonal selection of physicians from a list rather than by personal referral, and the existence of a large percentage of young physicians who are entering practice today as salaried employees of organizations. Just a few years ago, I controlled my own schedule in practice, and could spend as much or as little time as necessary to provide good care. My patients chose me to be their physician and maintained long-term relationships with me. My chief incentive was to satisfy them. I never felt that a third party was involved in this interaction.