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Having Same Doctor Vital to Patients

May 23, 1993

* Of the millions of words printed and spoken about health care reform, everyone seems to agree that, next to cost, most people cherish the right to choose their own doctor and hospital.

For many, free choice of physician ranks even higher than cost. Despite the confusion and contradictions, the Clinton Administration does seem to be promising that choice. But nowhere have I seen or heard mentioned that the choice may be limited to one year.

If the managed competition plan is selected, everyone in Orange County will be placed in a vast buyer pool. Huge groups of hundreds of doctors and hospital conglomerates managed by an insurance company will bid to provide service to that group.

In the tradition of corporate America, the low bidder will get the contract, and if your doctor and your favorite hospital are low bidders, you will get the doctor and hospital of your choice.

But suppose that next year or the year after, when the first contract expires, another low bidder with a different group of hospitals and doctors wins the new contract. Thousands of patients and hundreds of doctors will have to get quickly acquainted.

If all you have is a sore throat, no problem. If you are otherwise healthy and break your arm, perhaps you will be OK. But suppose you have high blood pressure, heart failure with diabetes or that you are in the midst of treatment for cancer and you lose the doctor who has treated you for five years or 10 years? Suppose you have had a hip or a heart valve replaced, and after the third year, you have trouble. Wouldn't you like to go back to the surgeon who did the job? I would. You won't be able to if his group is not the current low bidder.

Medicine is not an assembly line and people are not cars. Every patient I have ever met is unique and reacts to treatment differently, even though he or she has the same disease.

There is simply no good substitute for an ongoing relationship between a caring physician and a patient who likes his doctor.

Managed competition arguably may save some money but doesn't appear to offer any opportunity for long-term continuity of care, which is so necessary for the critically ill.

ARTHUR D. SILK, M.D.

Member, Board of Directors

Orange County Medical Assn.

Garden Grove

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