Patient acceptance was our biggest concern, and we monitored this carefully. One hundred ninety-eight patients discharged between 1 September 1993 and 30 November 1993 (before the implementation of the hospital system) were surveyed with a mailed questionnaire and a reminder postcard. We also sent a subsequent additional mailing to nonrespondents. These persons made up the baseline inpatient group. The identical questionnaire was mailed to 214 patients discharged between 9 January 1994 and 1 March 1994 (just after the start of the hospital service). Finally, 368 patients discharged 18 months after the inception of the hospital service were surveyed in an identical fashion.

Response rates were 68% to 76%. There was no difference in the groups with regard to age, sex, whether they belonged to a capitated health plan, or length of time they had been patients at Park Nicollet. Most were not in a capitated system and were established patients of the clinic. Similarly, there was no difference in their response to 11 additional measures of satisfaction. After getting the same answer on two separate surveys after implementation, we stopped asking the question.

Dr. Dawson also wonders about the economics. Our data indicate the decrease of hospital bill generated, which is independent of the billed charges of consultants and attending physicians. It is undoubtedly true that the physician-patient relationship continues to be important to some patients, particularly those with severe and life-threatening diseases. We must also acknowledge that a significant and growing part of the population would sacrifice that relationship for service, cost, and rapid knowledge.