I would like to address the issue of trust as it pertains to medical and especially to surgical practice. Surgery is undergoing a series of phenomenal changes at this time, not least of which has been the response to the frightening escalation of health care costs. Public confidence in particular has suffered with the inability of indemnity insurance and private fee-for-service practice to control the never-ending inflation of costs. Managed care, ie, the corporate and commercial interests that have appropriated administration of the health care industry, is now the dominant mechanism for private health care financing throughout the United States. Our government has also adopted the mechanisms of managed care as its method of operation. The primary relationship between the patient and the physician, in which the patient's best interests are the principal ethical obligation and goal of the physician, has been disrupted by a third party whose commercial interests
Heer FW. The Place of Trust in Our Changing Surgical Environment. Arch Surg. 1997;132(8):809–814. doi:10.1001/archsurg.1997.01430320011001
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