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In a message dated 7/24/98 11:28:55 PM Central Daylight Time, [log in to unmask] writes: << >belong to a PPO, which is not wonderful either, but at least I can go to >outside doctors if I want to pay a higher co-payment, and deductible. I wonder >how much pain, discomfort, and mental anguish is caused by these Horribly >Managed Organizations? Are there any lawyers who would care to get involved? >(Am I starting trouble here?...GOOD!) [log in to unmask] >> Ken, I do not understand how some of the abuses reported happen either. However, I do understand some of the dynamics of the system. These management reviews of doctors decisions are in part driven by very real problems. I will try to explain one example. It evolved through an unintentional collaboration of non-thinking physicians and the drug companies. For many years, the warnings have been out to avoid using up all of the new antibiotics through frivolous use. In other words, if plain penicillin works do not use the latest cephalosporen. However, at lest as late as the mid 80's, drug company representatives have visited doctors with gifts (some really nifty knick knacks) and easy to read literature touting their latest ""bug juice". Many of these doctors would then ordered that latest antibiotic for their next patient with an indication for an antibiotic. Only now are the long predicted 'totally drug resistant strains of bacteria emerging. It was a real problem -therapeutically and economically (the new stuff was -you guessed it) much more profitable to use. Armed with the conviction that some doctors cannot, will not, and shouldn't be required to make such decisions, a formulary of accepted drugs can be a Godsend. The general principle is that one should give the duly constituted authority power to do what it thinks best. A Jewish friend once said " There are only ten rules, the rest is all guidance." It cannot all be done by regulations. Good managed care, like most anything else good that involves human beings, depends on the intellect, the dedication and the caring - the quality of work of those administering it. Sometimes poor quality reflects a lack of experience. That usually works itself out. After all ignorance is fixable. However get a lazy or uncaring bureaucrat behind his /her fortress of regulation s and you have a recipe for abuse. That 's a good reason for multimillion-dollar lawsuits. It's sorta like believing that there is a time to "earmark funds". Usually it is a good idea to let the experts do their thing. To prevent abuses, some higher or equal authority must both listen to customer feedback and occasionally monitor/inspect that authority . Adjustment of the rules or maybe even firing and hiring replacements may be necessary to get desirable results. Results, WHH 54/18