Gatekeeping revisited - protecting patients from overtreatment

Article Abstract:

Primary care physicians often act as gatekeepers to more specialized medical care. Most patients of health maintenance organizations (HMO) must be referred by a primary care physician for specialized treatment or diagnostic tests. This type of system is designed to minimize costs associated with unnecessary treatment. In the US and other Western countries, primary care physicians who are not connected to HMOs also function as gatekeepers to medical care. In this role, the primary care physician is responsible for seeing that patients are not over-treated or under-treated. Certain risks are associated with both over-treatment and under-treatment. Patients treated by primary care physicians also have more continuity of care than those treated by specialists. Patients should be educated about the economic aspects of medical care, and should become involved in decisions about their own treatment.

Care and treatment, Column, Practice, Family medicine, Hospital patients

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Sex, access, and excess

Article Abstract:

More research may explain the possible link between the active approach that women take in seeking health care and why they receive fewer invasive procedures and yet have a longer life expectancy. Women are more likely to seek preventive care, primary health care, and follow-up care. Women also communicate better with their doctors and feel more involved with their health care than men. Men, however, are more likely to be referred to a specialist, hospitalized, and receive more invasive procedures. More procedures do not necessarily predict better treatment outcomes. For patients with heart disease, women outlive men even with fewer procedures. Researchers should concentrate on developing programs that encourage men to take an early and more active role in their health care delivery.

Health aspects, Editorial, Women, Medical care, Demographic aspects, Women's health, Men, Men's health

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Influence of Patient Education on Profiles of Physician Practices

Article Abstract:

Managed care organizations that use patients' physical and mental health to evaluate doctors need to take the patients' educational level into consideration. In a survey of 100 primary care doctors and 50 of their patients, doctors whose patients had less education on average had lower ratings. However, when the patients' educational level was considered, the same doctors had higher ratings than before this adjustment was made.

Analysis, Evaluation, Physicians, Medical professions, Social status

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