To the Editor: In the August Taking Issue column, Dr. Christensen (1) emphasized the ethical problem of sacrificing patient care to cost issues. In his example, such a sacrifice meant the apparent inappropriateness of referring a seriously ill inpatient to a primary care clinic for psychiatric follow-up.

Few would disagree with his point. However, the ethical considerations seem much more complex than presented, and several questions arise: Why was the patient referred to the primary care clinic? Was the patient doing quite well, even with a complicated medication profile? If not, the ethical question for the primary care clinic is: Why accept this patient? A call to the referring psychiatrist could have helped.

Why did the physician assistant make a drastic change in the medication, and who was supervising this sort of decision? Was this individual functioning beyond his or her capability? What did Dr. Christensen do to address the perceived ethical problem?

Perhaps Dr. Christensen could not fully describe the situation because of space limitations. If so, that leaves the reader with an inadequate presentation of and conclusion for an ethically complex scenario.

Dr. Moffic is with the department of psychiatry at the Medical College of Wisconsin in Milwaukee.