Pity the poor gatekeeper: a transatlantic perspective on cost containment in clinical practice.

This paper summarizes the key findings of a U.S. study of 48 primary care physicians acting as gatekeepers in a large health maintenance organization to determine the effects of their cost containment role on the doctor patient relationship. Taylor highlights some of the findings and conclusions that he believes are relevant to the current and projected problems concerned with controlling costs in Britain's National Health Service. Individual interviews, group discussions, and reviews of patient records with physicians yielded a series of decisions or clinical problems that the interviewees believed exemplified the gatekeeper role. These decisions and problems entailed overt conflict between doctor and patient. Study participants described how they coped with the conflicts associated with gatekeeping decisions, and what they perceived as the gatekeeper role's effect on their relations with patients.