Does Managed Care Threaten the Therapeutic Relationship? Or When a Third Party Comes between a Doctor and Patient

Abstract

When a patient goes to a doctor’s office to have a boil lanced, the patient expects the physician to pick up a scalpel and make an incision. The patient then thanks the doctor and says good-bye after paying the fee. This is a contract which binds two parties. The scenario is explicit: two players appear within the framework of a duo or dyad which is the archetype of the “singular dialogue”. In other words, a third party is excluded. In contrast, when a third party intervenes an entirely different context arises: that of the triad. Managed care creates a triad (with whose advantages and pitfalls we are to become familiar). We shall also learn about the ethical questions which will arise.