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Article
October 3, 1986

Patient Advocate or Secret Agent?

Author Affiliations

From The Center for Applied Biomedical Ethics at Rose Medical Center, Denver.

JAMA. 1986;256(13):1784-1785. doi:10.1001/jama.1986.03380130112038
Abstract

IF THE physician fails to maintain the primacy of patient advocacy, he has failed his profession and his patient. The "negative" incentives to save money for prospective payment systems, a health maintenance organization, or a governmental socialized medical system are as bad as the "positive" incentives of a fee-for-service system to overtest or overtreat for physician aggrandizement. Physicians must practice on behalf of their patients. They cannot divide their loyalty, and I am concerned that this basic role is seriously threatened.

In view of rapid changes in the provision of medical care in our country, a recent case in England1 (the differences in jurisprudence and health care access) may be a distant early warning to us in the United States. I believe it illustrates a standard of consent adopted in England that differs substantially from the more complete disclosure in the United States. The English

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