To the Editor:

Almost every issue of every medical journal has an article about what I'm supposed to do differently so that managed care companies can make more money and patients won't suffer (see “Decrease Hassles and Costs by Integrating Your Plans' Formularies,” November/December 1998). I'm all for helping patients, but primary care has done too much already to make life easy for insurers.

Although the effects of managed care formularies on office staff and physicians are hard to measure, my instinct tells me they are significant and adverse to patient care. It's time for primary care physicians to draw a line in the sand and say, “Enough, already!”

The fix is not for doctors to do more, but for the system to be more supportive of professionals who are trying to do a good job.