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August 23, 1995

Managed Care: Ethical Issues

Author Affiliations

The University of Chicago Chicago, Ill

JAMA. 1995;274(8):610. doi:10.1001/jama.1995.03530080025027

To the Editor.  —The recent exploration of the ideal physician-patient relationship is puzzling.1 Physicians and patients are already in actual relationships, and practical help is needed to turn those relationships into partnerships within managed care.The modern physician-patient relationship without managed care now focuses on the individual patient, not a patient population. It recognizes patient autonomy as the key ethical principle, not proportionality. It values trust (and competence and compassion) more than accountability. It appreciates the subjectivity of patients' signs and symptoms and finds them difficult to quantify. It embodies a clinical approach to patient care, not an administrative one.2The most important anticipated change in the physician-patient relationship, however, is that more patients are likely to have one, even if the relationship under managed care is different and not ideal.3 Managed care plans are more affordable than fee-for-service plans, and many people who enroll will have

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