The Doctor as Gatekeeper

Steven Swiryn, MD
Arch Intern Med. 1986;146(9):1789. doi:10.1001/archinte.1986.00360210177025.
Text Size: A A A
Published online

Cerberus was the gatekeeper.1,2 For those who missed this mythical dog in high school, or have since forgotten him, Cerberus was the three-headed, scaly-tailed keeper of the gate to Hades. His job was not, however, to keep evildoers out, but to keep them in. It took Hercules (his 12th labor) to remove Cerberus from the gate.

Patients are not evil-doers. Oh, some smoke cigarettes, or eat marbled beef, or forget their blood pressure pills. And I scold or cajole or predict dire consequence. But to the old man with lung cancer I do not say "look what resources you have stolen from us with your addiction." He is no thief from whom I must keep costly care. I do not emphasize to the 40-year-old executive with his second heart attack that his company's health insurance costs will rise because of the marbled beef he ate. He is not wasting


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 3

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.