by Bruce A. Hershfield, M.D.
[Spring/Summer 1998; Vol. 25 No. 1]
On May 14, 1998, at Jeannier's restaurant in Baltimore, Jeffrey Janofsky, M.D., talked to the MPS annual business meeting about some of his concerns about the fiduciary relationships that psychiatrists have. He said that managed care physicians are responsible for populations instead of patients and that the managed care organizations have responsibilities to their stockholders instead of to the individual. This has led to a change to a more economic definition of "medical necessity." The invasion of patient privacy is set up to improve the profitability of the managed care organization rather than to protect the patient.
Dr. Janofsky emphasized that the doctor-patient relationship is the core of medicine. We have to teach residents to care for patients so that we can all protect the most vulnerable patients. Psychiatrists should make efforts to get rid of ERISA, which prevents lawsuits against managed care organizations. He concluded by emphasizing that physicians cannot be truly physicians unless they respect patient confidentiality, and by stating his certainty that we will achieve our goals to help patients and our profession.