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Dr Alpert¹ engages in hyperbole not befitting a medical journal in his commentary regarding the plight of health maintenance organization patients (HMO). To repeatedly compare the difficulties of some American patients receiving substandard medical care with victims of ethnic cleansing in Kosovo is an exaggeration that trivializes the refugees' profound suffering.

Of course, managed care is problematic and frustrating to patients and their physicians. I, too, see the shifting of patients from one physician to another as destructive, and I believe that dramatic reform is long overdue. However, when Dr Alpert paints a picture of "3000 hapless individuals whose only access to primary medical care will be through brief telephone encounters," he absurdly projects a few examples of poor medical care onto all of primary care medicine. This emotional diatribe does little to further the cause of improving health care in this country.

Michael J. Mininsohn, MD
Baltimore, Md

1. Alpert JS. Medical refugees in America [commentary]. Arch Intern Med. 2000;160:417-418. FREE FULL TEXT

Arch Intern Med. 2000;160:2680.

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