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Patients, Primary Care Physicians, and Payments for Hospital Visits

Bernadine Z. Paulshock, MD
JAMA. 1997;277(3):213. doi:10.1001/jama.1997.03540270039023.
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Published online

To the Editor.  —I liked the A Piece of My Mind article1 in which Dr Brown described how his hospitalized patient still considered him to be her physician even though her actual medical management was by her hematologist.Many general internists have the same urges and feelings as Brown and want to provide their patients the attentive care desired, care that requires an intimate knowledge of the patient's personality and life history. This is knowledge not possible for the consultant of the day or the week to acquire. This type of care is enabled only by previous experiences that have engendered trust and confidence between patient and physician. But what insurance carrier will pay for hospital visits of this type?If patients are enrolled in a managed care plan such as a health maintenance organization (HMO), perhaps their physicians will feel that such ongoing visits are part of their contract;


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