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Gerald W. Grumet, M.D. is a psychiatrist in Rochester, NY who found himself increasingly ensnarled in paperwork as the era of Managed Care began to take hold in the 1980s. Minor bookkeeping chores which had previously taken minutes began to consume hours. While most physicians use professional billing clerks to interact with health insurers, Grumet put himself on the front lines, doing his own clerical chores in search for answers. His research led him to conclude that the central problem of bureaucracy is the rigid or obsessional personalities that form the functional core of advanced societies.