October 8, 1997

Contempo 1997: Economics-Reply

Author Affiliations

Princeton University Princeton, NJ

JAMA. 1997;278(14):1150. doi:10.1001/jama.1997.03550140042029

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In Reply.  —Dr Yaes properly reminds us that, because of their superior technical knowledge in medical matters, physicians necessarily act as their patients' agents when they formulate the treatment plan for a given illness. I do not disagree with that characterization, nor with the proposition that this relationship imposes special fiduciary obligations on physicians. Many other professionals perform a similar agency function and bear similar moral obligations.It is the case that suppliers in the normal course of commerce do not play this fiduciary role. Nevertheless, as I always point out to my students, the surest way for capitalists to amass wealth is to please their customers. For that reason, it is not self-evident that health systems owned by general investors and managed by MBAs would be more likely to abuse patients than would health systems owned by investors with MD degrees and managed by physicians. I suspect that the next decade