Can the patient-physician relationship survive in the era of managed care?

The author discusses the history of the patient-physician relationship and considers how recent developments in the health care system have affected the viability of that relationship. He first considers the justification for maintaining such a relationship and concludes that the patient-physician relationship must be preserved because it has a long history, is humane and ethical, and is cost effective. The author then reviews the ethical basis that forms the foundation of the patient-physician relationship. He discusses issues related to competency, commitment, compassion, equanimity, and patient advocacy. The article concludes with a consideration of the medical-ethical dilemmas created in the patient-physician relationship by managed care.