Anticipated changes in the doctor-patient relationship in the managed care and managed competition of the Health Security Act of 1993
J. La Puma
Department of Medicine, Lutheran General Hospital, Park Ridge, Ill.
The doctor-patient relationship is the cornerstone of medical ethics, yet
the relationship will change significantly under the Health Security Act of
1993. In a way, managed care and managed competition are a return to the
old medical ethics: doing everything reasonable and probably beneficial for
all, instead of going all out for each. Five central questions may help
physicians and policy makers anticipate a paradigm shift in ethics. An
analysis of these questions suggests that managed care and managed
competition challenge physicians' roles as trustworthy patient advocates.
Fortifying doctor-patient relationships in managed care would be prudent
and wise and would help to achieve the ethical allocation of limited
resources. By protecting patients' personal medical interests and
empowering patients to do the same, doctors can attempt to safeguard trust.
Both doctors and patients want to have strong, personal, values-oriented
relationships. Whether such relationships are possible under the Health
Security Act remains to be seen.
