Overview

Abstract

The changing economics of medicine have fundamentally, permanently altered the relationship between physician and patient. Traditionally, that relationship has been dyadic. Patient and physician, usually consulting only with each other or perhaps with family members, would do whatever they thought best. Until fairly recently, the physician had relatively little to offer the patient other than his¹ own personal knowledge, skill, and effort. And as useful technologies emerged, third-party payers covered their costs, enabling the physician to continue to focus almost exclusively on his patient. These payers stood, not as participating members of the relationship, but mainly as silent partners to finance and facilitate whatever physician and patient chose to do. Although the physician sometimes faced competing obligations, as for instance to other patients or to the patient’s family, his professional obligation was overwhelmingly centered on each patient, to promote his interests above all others’.