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There Is a Conflict of Interest in Treating Medicare Patients

Thomas J. Romano, MD, PhD
Arch Intern Med. 1993;153(21):2505-2506. doi:10.1001/archinte.1993.00410210133017.
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I read with interest and extreme concern an article by Gordon and Reiser that appeared in the March 8, 1993, issue of the Archives.1 On the surface, the authors appear to give arguments both for and against seeing Medicare patients, and in the end, they come to the conclusion that physicians have a "responsibility of caring for the senior citizens of this nation." However, if one critically reads the article, one realizes that a balanced view is not given and, therefore, their conclusions are flawed. Please allow me to explain.

The doctor-patient relationship is a very special one. However, under the Medicare program, it cannot exist between the physician and the person being treated. Unfortunately, the senior citizen on Medicare does not know that this is the case. He thinks that when he goes to the doctor he is being treated by his doctor. He does not realize that he


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