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September 8, 1978

Fiduciary Responsibility

Author Affiliations

The University Hospital and Clinics Oklahoma City

JAMA. 1978;240(11):1140. doi:10.1001/jama.1978.03290110038011

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To the Editor.—  "We Physicians Are Fiduciary Failures" (239:1629, 1978) points up a most valuable concern, but fails to take into account many other equally important aspects of the problem. Indeed, if we are to discharge our fiduciary relationship to the patient honorably, we should consider only that individual's physical, mental, and financial well-being rather than that of some third party. Obviously the latter is inappropriate, but if we are going to play a perfectly open game with the patient in terms of cost, should we not also explain to the patient the cost-effectiveness ratio of each given test or procedure, the role of the sequence in which these are done, including delays that may be introduced as a result of sequence (eg, a small-bowel contrast study can be done almost immediately after intravenous pyelography but not vice versa)? Furthermore, the patients would have to assume some liability for consequences