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Will It Be 'Rational Care' or 'Rationed Care'?

September 05, 1993

Regarding James Flanigan's column "Industrialization of Medicine Has Already Started" (July 18): Flanigan treats "industrialization" of medicine as though it's something good. Medicine has always been a cottage industry because it's a confidential relationship between doctor and patient.

As a family practitioner in Van Nuys for the last 32 years, I've always seen patients face to face, one at a time. Most medical problems aren't complex and are best handled that way. When necessary, the patient can be referred to a specialist for more complex diagnosis and treatment beyond the skills of the primary physician.

Good primary physicians know their limitations. The bond of mutual trust that develops between the patient and the primary physician makes referral easy when necessary. This country has had the best medical care in the world. The problem has not been the quality of care--it's been access, cost and over-utilization of technology.

Industrialization of medicine will not make quality care better or less expensive. Flanigan writes about "rationalizing" the delivery of care. This is an insurance industry euphemism for rationing the delivery of care. You cannot get more for less, especially when so much of the medical premium dollar goes to insurance company marketing, operation and profits.

Every time I see medical insurance TV spots, newspaper ads or direct mail, I see medical insurance premiums being wasted in "managed competition" instead of buying patient care. It's already here, President Clinton, and it isn't working very well!

The motto of a small hospital in the San Fernando Valley was "Bigger isn't better; better is better." Certain human endeavors are best served by industrialization. Medical care is not one of them. The patient and quality care too often get lost when the size of the system gets too large. Already, the managed care insurance industry has breached its promise that patients will be able to choose their doctors. Ask the Los Angeles schoolteachers how many of them got to keep their old doctors or choose new ones they wanted!

Recently, one of the large insurance companies suddenly moved 175 of my patients to another primary care physician, another panel of specialists and another hospital, thus uprooting many of them in the midst of their care. The anger and frustration of the patients was ignored by the insurance company. When asked why, the answer by the insurance company was that it was a "business decision."

Businesses serve their profit margin; doctors serve their patients. The "industrialization" of medicine will serve patients much less than it will serve insurance company corporate profits. Medicine was, is and should continue to be a cottage industry.

MELVIN H. KIRSCHNER

Van Nuys

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