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June 1990

Somehow We Have to Stop the Train WreckPart 1

Arch Otolaryngol Head Neck Surg. 1990;116(6):669-670. doi:10.1001/archotol.1990.01870060027002

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


We practice medicine in a reality that is changing and challenging. Many external forces are reshaping medicine in ways that we do not like, and the bad news is that the changes will intensify before they are completed. As physicians, we feel like the targets and the victims of many of these changes, and we must try to understand the driving forces behind them. To understand, we will examine the beliefs of the major groups that are reshaping medicine through their interaction. These differing beliefs underlie the decisions that are affecting all of us each day.

Doctors believe that health care is worth what it costs. We believe that health care will continue to improve and that it will continue to cost more. We believe that patients, government, and corporations need to understand the primacy of quality and need to bite the bullet in terms of reasonable cost.

Patients believe

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