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Since most of my practice is not managed care but fee for service, I still have the liberty of performing annual examinations for patients when indicated. I have found this beneficial to the doctor-patient relationship as well as for occasionally uncovering important medical disease before symptoms are bad enough for the patient to seek my attention.

Drs Gordon et al¹ discuss patient care from a monetary viewpoint. This seems to be a clear declaration that managed care promotes policies designed to collect funds while giving as little attention as legally feasible to the patient in our medical-legal society. I do not wish to sound overly altruistic, but I would like to see a return to the idea that even negative results of a physical examination build the relationship between a doctor and a patient, and this relationship cannot be measured in monetary terms.

Leroy T. Gerson, MD
Wynnewood, Pa

1. Gordon PR, Senf J, Campos-Outcalt D. Is the annual complete physical examination necessary? Arch Intern Med. 1999;159:909-910. FREE FULL TEXT

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