Physicians who once only grappled with learning the language of medicine must now also cope with a health care world that has turned hospitals into factories and reduced clinical encounters to economic transactions.

The Internet has had a profound effect on clinical practice by providing both physicians and patients with a wealth of information. But with those rewards come risks of incorrect or poorly interpreted information that require that a doctor "never be optional."

As President Obama and Congress weigh changes in the nation's health care system they must avoid creating a system where physicians are financially motivated to pressure patients into mandated treatments that conflict with their values and needs, two Beth Israel Deaconess Medical Center physicians warn.

The idea of containing health care costs by itemizing and assigning value to each task a physician does could reduce productivity, impair quality and perhaps even increase costs, according to some physicians.

By O'Hara, William P BOOK REVIEW How Doctors Thin