The Doctor with Two Heads -- The Patient versus the Costs

Abrams, Fredrick R.

doi:10.1056/nejm199304013281320

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Withholding and Withdrawing Life Support1

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1994

2007

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Cited by 19 publications

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“…Appropriate allocation of limited health care resources often is an unarticulated influence on these fateful decisions. Balancing the interests of society and patients can be a challenging experience for trauma surgeons [82]. The authors believe firmly that poor clinical decisions are made by surgeons acting as health economists at the bedside.…”

Section: Withholding and Withdrawing Life Supportmentioning

confidence: 98%

Injury in the Elderly and End-of-Life Decisions

Chang

Schecter

2007

Surgical Clinics of North America

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Section: Withholding and Withdrawing Life Supportmentioning

confidence: 98%

Injury in the Elderly and End-of-Life Decisions

Chang

Schecter

2007

Surgical Clinics of North America

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Primary Care in Transition

Alper¹

1994

JAMA

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It is generally agreed that too few physicians have chosen careers in primary care. The advent of managed care as a popular method of health care provision is now affecting primary care physicians in ways that may further discourage enthusiasm for the practice of primary care and have an unintended negative effect on the primary care physician supply. In addition, the early implementation of the resource-based relative value scale by Medicare and some insurance carriers has been less beneficial to primary care physicians than expected and may even have been harmful to general internists. Efforts to improve the position of primary care physicians in relation to payers and among peers are hindered by the fact that, as a group, primary care physicians are less affluent, less influential, and greatly outnumbered by their more specialized colleagues. Consequently, some of the support currently directed toward primary care may be more apparent than real. My proposals, which aim both to protect and to enhance primary care practice, are the creation of separate primary care fee schedules and separate primary care budgets within health plans, changes in consumer protection rules that intrude on primary care practice, and the development of statewide primary care associations for mutual support and greater bargaining power. Some aspects of contracting and gatekeeping require further study.

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