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April 21, 1978

We Physicians Are Fiduciary Failures

JAMA. 1978;239(16):1629-1630. doi:10.1001/jama.1978.03280430045013

IT IS difficult for most members of the medical profession to think of themselves in the role of a fiduciary, especially since many of us not versed in financial jargon do not even know what a fiduciary is. In essence, a fiduciary is a person (or an institution) who holds something of value for another in trust.

When one looks at the costs of medical care today, it should become apparent that we are responsible for more than just the physical well-being of the patient; we are in a position to bankrupt him or the society that pays for his care. Every time we order a test or a roentgenogram, send a patient for a consultation, prescribe a medicine or a therapeutic procedure, or admit a patient to the hospital, we are investing his money on his behalf, supposedly for his own health. It is the same as though a