PATIENTS' VIEWS OF MEDICAL PRACTICE

Abstract

This book examines patients' assessments of three kinds of medical practice in the Bronx: entrepreneurial or practice, group practice in HIP, and that in the Montefiore Group Family Health Maintenance Demonstration. Families chosen for participation in the demonstration were drawn at random from the Montefiore medical group and were cared for by teams composed of a physician, a public health nurse, and a social worker. The small caseload of professionals working in the demonstration encouraged patients to make maximum use of medical care facilities, and gave the professionals involved sufficient time so that they could provide more thorough care to the families assigned to them than is usual. Freidson finds that patients view physicians practicing in solo fashion as being much more interested in their welfare and concerned about their interpretations of illness, therapy, and the like. On the other hand, physicians practicing in groups, while showing less interest in the patient, are viewed by the patient as being more competent, in part, because they have more equipment for diagnosis and therapy easily available to them. As might be expected, the patients in this study reacted more favorably to the demonstration than to the other two forms of practice studied. The demonstration approach, although impossible to apply on any but a small scale, seemed to combine the best features of both group and solo practice. In the concluding chapter, the author suggests that group practice is increasing in one form or another throughout the country. He is somewhat alarmed at this, because of the lack of interest in patients that is shown by physicians in group practice. Freidson feels that the physician in group practice is more likely to make his patients wait in the waiting room, to use the impersonal appointment system, and to give patients short shrift in rotating examining rooms, he is less likely to make night calls, he discourages home visits, and he has so much practice and is so controlled by his peers that he caters little to patients' expectations. Freidson finds that among the highly competitive conditions facing solo practitioners in the Bronx, these characteristics of practice are present in much smaller degree than in group practice. It would not surprise me, however, if many a reader of this book might recognize the above characteristics attributed to group practice as traits exhibited by many solo practitioners of his own acquaintance. It is possible that solo practice in the Bronx is just as aberrant from that in the rest of the country as is HIP practice and the Family Health Maintenance Demonstration. SAXON GRAHAM