Adapting informed consent to contemporary managed care.

Patients' autonomy and rights have become inalienable values in most western countries. The instrument by which de facto patient autonomy in the healthcare system is practiced is the "informed consent" form. Despite the unquestionable importance of this tool, there are numerous inadequacies in this practice. One of the reasons is due to the fact that the physicians' autonomy to offer their patients the best care available has undergone considerable diminution due to financial considerations in the managed care environment. The healthcare system is a multifaceted one, made up of many agents and interested parties who lay down the laws and make the rules of the game. A physician-patient encounter does not take place in a void, and physicians are far less free to act than they have ever been before. This diminished independence is particularly felt in the milieu of managed care and has led to informed consent taking on a new and much greater significance when there are patient-"unfriendly" agendas.