Collusion of Anonymity

The need for a primary physician who accepts continuing responsibility for patient care was emphasized by Michael Balint (1965) in his concept of collusion of anonymity. In this situation the patient is seen by a variety of physicians, not one of whom is willing to accept total management of the problem. Important decisions are made—some good, some poor—but without anyone feeling fully responsible for them.

Francis Peabody (1930) examined the futility of a patient's making the rounds from one specialist to another without finding relief because the patient:

. . . lacked the guidance of a sound general practitioner who understood his physical condition, his nervous temperament and knew the details of his daily life. And many a patient who on his own initiative has sought out specialists, has had minor defects accentuated so that they assume a needless importance, and has even undergone operations that might well have been avoided. Those who are particularly blessed with this world's goods, who want the best regardless of the cost and imagine that they are getting it because they can afford to consult as many renowned specialists as they wish, are often pathetically tragic figures as they veer from one course of treatment to another. Like ships that lack a guiding hand upon the helm, they swing from tack to tack with each new gust of wind but get no nearer to the Port of Health because there is no pilot to set the general direction of their course (pp. 21-22).

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