LETTER
Honing Clinical Skills
Robert A. Gutman
15 May 1993 | Volume 118 Issue 10 | Page 828
TO THE EDITOR:
I was surprised that in the last paragraph of your well-written editorial on physical examination skills that you did not cite the missing element in the "collective will to use simpler methods of diagnosis," namely, the lack of patient participation in the cost of expensive tests. I know that we are living in a time when it is popular to believe that "health care is a right". A variable copayment based on individual income might lead patients to care how much money is being spent. A high-level administrator in our local insurance company says that it is technically possible to require, for example, a 30% co-payment from a vice president of a company and a 5% co-payment from his company's janitor. We have to abandon the notion that everything should be financially painless to the patients before doctors will begin to seriously care about the use of expensive technology.
1. Fletcher RH, Fletcher SW. Has medicine outgrown physical diagnosis? (Editorial). Ann Intern Med. 1992; 117:786-7.
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