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August 23, 1995

Managed Care: Ethical Issues

Author Affiliations

Sebastian, Fla

JAMA. 1995;274(8):609. doi:10.1001/jama.1995.03530080025025

To the Editor.  —The conclusion of Drs Emanuel and Dubler,1 "The physician-patient relationship is the cornerstone for achieving, maintaining, and improving health," is obvious to physicians and patients but largely ignored by the managed health care industry. Essential to an accurate diagnosis is the physician's knowing over time, both cognitively and intuitively, the medical history, the multidimensional aspects of that unique person's life, and the secrets that only a trusting patient reveals. Effective treatment requires an educational approach, a wise presentation of choices, and sometimes a little friendly coercion that again is based on knowledge of the patient over time. It is hoped that some health plans will realize the cost-effective competitive edge that this knowledge provides and will encourage continuity, choice, and adequate patient encounter time.There is an essential aspect of the physician-patient relationship, however, that was largely ignored by the article—that the relationship itself has therapeutic

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