When two parties enter into a business contract, they usually share an unspoken "gentlemen's agreement" that neither one will start bad-mouthing the other. But in the often shaky relationships between managed care plans and physicians, what was once assumed has increasingly become codified. Just a few years ago, little one- or two-sentence clauses began popping up in physicians' contracts with managed care plans around the country, which managed care plans call confidentiality clauses. The house of medicine calls them gag rules and says they are just another strong-armed tactic to stifle physicians' abilities to act as patient advocates.
当双方签订商业合同时，他们通常会达成一种不言而喻的“君子协定”，即双方都不会开始诋毁对方。但在管理式医疗计划与医生之间常常不稳定的关系中，曾经被默认的事情越来越多地被编纂成条文。就在几年前，全国各地医生与管理式医疗计划签订的合同中开始出现一些简短的一两句条款，管理式医疗计划称之为保密条款。医学界称它们为限制言论规则，并表示这些条款只是压制医生作为患者代言人能力的又一种高压手段。
