Night of the gatekeeper

BMJ 1997; 314 doi: (Published 03 May 1997) Cite this as: BMJ 1997;314:1355
  1. George Dunea, attending physician
  1. Cook County Hospital, Chicago, USA

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    The boy had kept nothing down for three days, ever since coming back from his vacation in Mexico. For the past six hours he had been vomiting continuously, and by now he was dehydrated and could no longer sit up. The mother was becoming hysterical, and at 11 pm the father, a professor at the medical school, now thoroughly alarmed, decided to call the health medical organisation (HMO). He had joined this some time earlier when the university had offered coverage at a lower rate than his private insurance. It was understood at the time that the children …

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