“No one should stand between you and your doctor!”

Really! let me see!

Politicians
Administrators
Insurance companies
Medical Boards
Malpractice lawyers
Economists
Efficiency experts
Rating agencies
Third party payers
Speciality Associations
Guidelines committees.
Utilization review  nurses
preauthorization  personnel
Receptionists
Nurses
nursing assistants
The janitor
The Parking attendant/Robot
Beers Criteria

"My small examination room, designed for quiet personal consultation,
is already crammed with unobserved “third parties” intruding on an ostensibly
very private relationship. Pharmaceutical representatives, those
well-dressed young men and women carrying pill samples and wearing
corporate logos, are there to persuade me to prescribe their newest
and most expensive products. Midlevel managers of health insurance
firms and HMOs are also “in the room,” containing costs by restricting
and rationing care through the ploy of prior approval. Medicare bureaucrats
are there as well, codifying care of the elderly, translating the art
of medicine into volumes of digitized diagnostic reference numbers and procedure codes. Soon the bureaucrats will also be scoring the clinical outcomes
of care in an arcane formula for physician reimbursement. Last, the
plaintiff’s medical malpractice attorney lurks in the corner, never out of
my mind for a moment, as I defend myself daily through ever-escalating
diagnostics and unceasing documentation, always producing a well buffed
chart, but not necessarily a healthier, happier patient. Seating is
indeed limited in the exam room; patients should be advised that there
may be standing room only.procedure codes. Soon the bureaucrats will also be scoring the clinical outcomes of care in an arcane formula for physician reimbursement. Last, the
plaintiff’s medical malpractice attorney lurks in the corner, never out of
my mind for a moment, as I defend myself daily through ever-escalating
diagnostics and unceasing documentation, always producing a well buffed
chart, but not necessarily a healthier, happier patient. Seating is
indeed limited in the exam room; patients should be advised that there
may be standing room only.

It is not sufficient, however, merely to offer a paean to primary care,
singing its praises without appreciating what it is or how it works. As with
the modern laptop computer, the iPhone, or the GPS direction finder, we
depend on good primary medical care without knowing what’s inside. We
stand to gain from a look under the hood.