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Know it or not, like or not, we have gone through the gate of gatekeeper medicine.  This is Dr. Steven Andrew Davis, Speaking of Health.  The good news is the re-emergence of family doctors with their interest and personal guidance.  The bad news is not always getting to that skilled specialist who may hold the direct and eventual key to cure.  The pros and cons of the gatekeepers system, the heart of the managed care concept.

Medical and surgical specialists charge more, their incomes are higher.  Henced the cost saving incentives of the gatekeeper system where primary care physicians handle as many problems as they can.  There are other advantages too, like the ability and interest of a single physician to understand the whole patient;  to track medications and allergies;  to help the patients get to the right kind of specialist when they need one;  to coordinate overall care.  And in this day and age of multiplying technologies, guidance becomes even more valuable.

Critics of gatekeeperism point, however, to the inherent lack of direct access to specialists.  Talk about sophisticated equipment.  How about sophisticated patients who want to take their tennis elbows directly to an orthopedist, skin cancers to a dermatologist, or recurring sinus infections to an ENT?  And what about the financial incentive some managed care plans impose on the primary care physician not to send patients to a specialist?  In some if the gatekeeper doctor sends the patient to a specialist the cost of the specialty treatment comes out of the gatekeeper's pocket.

Pros and cons not withstanding, the gatekeeper system is here and growing.  For a copy of this script access our web site,  Speaking of Health, I'm Dr. Steven Andrew Davis for, CBS News.


Dr. Steve Davis
7810 Louis Pasteur #200
San Antonio, Texas 78229