ABSTRACT
Today, most healthcare is delivered by physicians within institutions—whether they be health maintenance organizations, hospitals, or clinics. 1 This care is paid for by employers, government insurance, or by third-party insurance—thus subjecting the physician to a range of not only direct pressures, but indirect incentives to maintain costs in patient management—a practice that 30 years ago was unknown. This shift from patient-centered beneficence to cost containment promotes fears that the long-prized fiduciary relationship between doctor and patient will be weakened to such a degree that contemporary physicians will no longer be viewed as trusted counselors because their economic ties to profit-seeking businesses force them to consider their patients as customers. 2
