Doctors versus health insurance companies: "Economic oversight of doctors performed by heath insurers carries an inherent flaw that cannot help but undermine doctors’ integrity and their bonds with patients. That flaw is the inextricable relationship that insurers have with shareholders. Having to generate profits will always present a dangerous temptation for insurers to rationalize that good guidelines are good medicine. How can it be otherwise when CEOs and top executives have to present their strategies to boards of directors whose main responsibility is fiscal not medical?
The ascendancy of guidelines began when managed care began to exert their new-found power to control the way that doctors practice and the tests that they order. Since then, most doctors’ impressions of them is that they are a pretense for improving care. Although guidelines seem clear intellectually, they don’t easily translate into practice because they cannot reflect the real-time concerns and pressures that doctors deal."