Gatekeeping

To the Editor: The Sounding Board by Franks et al. (Aug. 6 issue)* was timely. As a general internist for the past 18 years, I have an additional observation regarding strategies to minimize overtreatment. There has been a deterioration in communication and medical etiquette between generalists and specialists. Too commonly, patients are referred to specialists and diagnostic and therapeutic plans are made without a timely discussion with the referring physician. Our patients would be better served if we discussed their consultation with them after the consultant had had an opportunity to communicate with us. Over the past two decades, with . . .