A larger criticism of UHS's primary care system is that it restricts access to specialists. This practice of erecting barriers to care, known as "gatekeeping," is used in many health maintenance organizations.

"The positive spin on gatekeepers is that the physician is watching out for you and directs you to the right person," says Dr. David Brooks, acting chief of surgery. "The pejorative--the one I tend to believe--is that the physician keeps you from the specialists you should see anyway."

Fred S. Soo '96, who had an eye problem, says the gatekeeping process kept him from seeing a specialist for over a month.

"I wanted an appointment with an ophthalmologist, but I still got a [primary care] practitioner," Soo says. "I didn't get anything out of it. He didn't tell me what was going on."

Many UHS specialists say they are flexible, especially in case of emergencies only they can handle. But many of these specialists work for UHS only part-time, and the wait for an appointment with them is usually more than a month.

"I think our wait for routine care runs 2-3 weeks," says Dr. Firmon E. Hardenbergh, chief of ophthalmology. "I'm willing to see patients in the early morning, during lunch, after hours."

The problems of reaching a specialist can be a serious deterrent to students with specific medical problems. Thanh A. Nguyen '94 says that immediately before the start of his first year, he was in a car accident. The accident left him with a neck injury and a lot of pain.

But when he called UHS, he was told he'd have to wait three weeks for an appointment.

"The people were nice and all, but there was just so much bureaucracy," says Nguyen. "So I went to see a doctor on the outside. UHS was basically useless."

Rosenthal and primary care providers, however, see no trouble with gatekeeping Dr. Kenneth Gold says primary care physicians like himself serve an important role as referee between different specialists.

"What most people have is six different doctors and no primary care doctor," says Gold. "The doctors don't know what the others are doing. There's no unified care, and the patient suffers."

Many students, particularly those with primary care physicians, praise UHS doctors. But these same students say the real problem with the health service is negotiating a maze of receptionists and nurses, many of whom are insensitive and at times openly belligerent towards students.

Stories like those of Smith, who had to wait six days to find out--over the phone--that she had a brain tumor, are indicative of the lack of sensitivity that accompany UHS's access problem. UHS officials say they would not discuss specific cases with the Crimson. Some doctors agree that sensitivity at the health service needs improvement.

"We're not always the best set-up for access to students," says Dr. Karen E. Victor '80. "Once you are known to a doctor, everything goes all right. But getting to a doctor is not always so easy."

"I do think the receptionists are in a difficult position because they don't have the options to offer the patients," says Victor. "I think that what some students may be experiencing is that their frustration is shared by the receptionist."