Response

I should begin by thanking everyone who offered their comments through e-mail and letters to the editor. In response to the 2 previous letters, I would like to clarify a number of issues.

The source of my data is from research in progress. I have had the opportunity to speak with a number of physicians and patients who shared their experiences with the “give-and-take” aspect of the patient audition process. Since the publication of the commentary, a number of physicians have discussed their use of screening mechanisms with me. These measures were motivated, for them, by a desire to facilitate the best possible doctor-patient relationships. There are justifiable reasons to not accept, or even terminate, relationships with patients, and there are unjustifiable reasons. In the process of doing this research, I’ve heard examples of both. Is a body mass index greater than 30 a reasonable basis upon which to accept or reject a potential patient?

I still struggle with the expansion of a patient “under-class.” If some physicians are concerned about accepting patients who constitute unreasonable professional burdens, then we must ask what happens to those patients. There is a tendency to see the problem in strictly selfish terms, but ultimately the question requires a collaborative debate that should include nonphysicians.

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