Dr. Davidoff's editorial on the amount of time physicians spend with their patients [1] merely skirts the issue of quality care that so many of us who have been practicing medicine in communities have been concerned about for some time.

Unfortunately, the trend of the late 1990s (generated by the government's cutback in spending for preventive programs and by the insurance companies), especially managed care companies' lack of interest in quality care, is driving physician-patient relationships into shorter and less preventive encounters.

Although everybody claims to be interested in preventive care, the facts of medical practice are not that some medication may be prescribed inappropriately but that major preventive techniques, such as mammography, prostate-specific antigen blood tests, and chest radiography cannot even be performed on a preventive, routine basis because the government and the insurance companies (especially health maintenance organizations) will not pay for preventive care. The emphasis, unfortunately, is on saving dollars in the short term, not better health in the long term.

It is a mystery to me that the groups that represent women's health, children's health, and the health of the elderly have not let loose a major outcry about the cutbacks in preventive care that are constantly occurring.