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To the Editor: The Commentary by Drs Emanuel and Fuchs¹ listed 7 factors working synergistically to cause overutilization of the health care system in the United States. I believe that a crucial aspect behind many of these factors is the loss of quality in the patient-physician relationship. When the authors stated that "US patients prefer high technology over high touch," this raised a question of why US patients would behave differently from their counterparts in other countries.

"Etiquette-based medicine" may be difficult to find in the United States.² Young physicians need to be taught that 78.1% of patients want the physician to shake their hands.³ It appears that a disconnection between physicians and patients has caused a progressive loss of trust between both parties. This may be a root cause of overutilization of health care in the United States, driving a need for excessively thorough investigations as well as the . . . [Full Text of this Article]

Eduardo F. Motti, MD
emotti@uol.com.br
São Paulo, Brazil

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