Groopman, ?Gatekeepers?

Discussion questions: Groopman, "Gatekeepers" (2008)

Note: this reading is one chapter from a book, and sometimes refers to points made in previous chapters, so don't worry if you aren't always sure what Groopman is talking about.

1. Groopman begins chapter four of his book by talking about time and money pressures on pediatricians and primary care physicians. He then talks about social context and sensitivity to language in patient care, physician competence, and prejudices encountered by doctors, before returning to the time pressures created by insurers. How does he relate the topics in the middle of his essay to his central thesis?

2. If you know any medical professionals, ask to what extent time pressures and cost control are a factor in their work. Do they have to care for a certain number of patients or do a certain amount of paperwork in order to be considered adequately productive? Do they ever feel rushed, and if so, how do they cope with that? If you know anyone who works for an insurer or HMOs, ask how their organization tries to balance cost control with good patient care.

3. Should primary care physicians make the same income as specialists? Their training takes fewer years than the specialists' training, meaning they can start earning sooner, and their knowledge in any one area is not as in-depth. Yet as the quotation from Eric Cassell on pp. 103-4 points out, they must have a wider range of knowledge than any specialist does, and they need to spend enough time with each patient to notice things a specialist isn't expected to notice, like the patient who can't read her medicine labels.