Primary care physicians' relationships with patients and specialists are repeatedly disrupted. Physicians dealing with armies of corporate utilization managers spend millions of hours chasing approvals, correcting inappropriate denials and dealing with conflicting formularies, all of which leads to skyrocketing administrative costs. As each plan develops its own electronic medical records, billions of dollars are wasted on incompatible information systems. It is more akin to an illegal kickback arrangement. Giving financial rewards to physicians who order or deny tests and referrals allows bribes to influence their decision making.
Primary care needs to be structured to preserve the physician's role as a trusted patient advocate.
Turning patients and physicians into adversaries generates intense antagonisms that undermine the trust needed for health care to work. Disgruntled patients, harassed doctors. Because most patients and providers have been forced into managed care arrangements under duress, exam rooms are increasingly filled with angry patients and stressed physicians. Knowing that they lose money every time a patient walks into their office makes physicians loathe sick patients. When you combine this with doctors' frustrations over inability to choose treatments and make clinical judgments, a decline in compassion and communication is inevitable.