Further Consequences of Managed Care

The relentless progress of managed care across the landscape of American medicine has affected hospital physician, and patient reimbursement, patient and physician freedom to choose health care facilities and treatments, and many other parameters. Much has been written in the Archives in the last year about the effects of managed care on critical pathways and practice guidelines,¹ economic dynamics,² neurology residencies,³ and stroke care⁴ after Lundberg's invitation⁵ to do so. Less attention has been paid to the effect of managed care on 2 physician behaviors—conversation and humor.

Throughout the 1970s and 1980s, as I served as a young physician in a community and academic teaching hospital, it was common to talk about patients, pertinent medical literature, or new laboratory tests in the physicians' lounge or cafeteria. This is now distinctly uncommon. Conversation usually relates to managed care, health care economics, which new health maintenance organization