 |
 |
|
|
Dr. Charles Atkins of Waterbury, Conn., in his May 15 Viewpoints article, "Physician Reviewers Not the Answer," expressed his puzzlement and anguish in dealing with HMO physician reviewers who are given financial incentives for denying care. He asks, "So why would someone become a physician reviewer?"
One feature of the reviewer's motivation would seem to be the unconscious mechanism of "identification with the aggressor." In this state, a threatened individual handles his fear by becoming aligned with those who threaten him, and many become tyrannical toward his colleagues. This is seen in hostage crises where the captive becomes chummy toward his captors. The term "Stockholm syndrome" has been applied sometimes, following a bank robbery and hostage drama in that city some years ago. The World War II era saw many examples of this phenomenon, as fear of the invading Nazis prompted some to become junior Hitlers in their own countries. Pierre Laval of Vichy France and Quisling of occupied Norway thought of themselves as national patriots trying to get the best deal for their respective countries in the face of Hitler's overwhelming force.
Are they so different from today's physician reviewers who see themselves as trying to get the best deal for HMO-insured patients in the inevitable managed care era? In my view, once a physician sacrifices his primary allegiance to his patients and to the art of healing, he becomes merely a cost-containment Quisling for the insurance carrier.
Gerald W. Grumet, M.D.
Rochester, N.Y.