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Balint, M. (2002). The Crisis of Medical Practice. Am. J. Psychoanal., 62(1):7-15.

(2002). American Journal of Psychoanalysis, 62(1):7-15

The Crisis of Medical Practice

Michael Balint, Ph.D.

There are two categories of medical journals. The first one essentially publishes scientific papers, and the second one focuses on social, economic, and organizational problems in the field of medicine. However, three topics are thoroughly discussed in both categories. These three, representing the most burning issues in today's medicine, are healers, health insurance plans, and the collapse of private practice. At first sight, the narrow connection between these three points is hardly obvious, and most authors don't even mention it. However, whatever problem is tackled at the start, every article eventually reaches the same conclusions: the degradation of economic conditions. One section of the middle class, which used to call on private doctors up until recently, is now impoverished and has joined a state health insurance plan. Another category has done the same because the coverage of the insurance was raised substantially. Even the few patients who do not fall into these categories find it difficult to pay their doctors: they would rather go to a clinic, to the hospital, or to charity medical facility. As for the well to do, they would only consider a doctor who is at least a docent at the university. In any case, the general practitioner without fancy titles finds himself excluded. This situation is not beneficial to the patients either. Neither the medical care offered by hospitals and clinics, nor the one offered by health plans, proves satisfactory because mass processing does not allow the doctor to devote enough attention to everyone's unique sensitivity.

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