Gray B H
Health Aff (Millwood). 1997 Jan-Feb;16(1):34-49. doi: 10.1377/hlthaff.16.1.34.
Trust is essential to the doctor/patient relationship, but trust in physicians' fiduciary ethic has become less plausible as a protector of patients' interests. The rise of managed care often is seen as undermining the fiduciary ethic and lessening the trustworthiness of care. But can managed care enhance that trustworthiness? Four possible sources of trustworthiness in managed care are discussed: ethical standards in the managed care industry, nonprofit organizations, physician control, and performance monitoring by purchasers. Limitations on all of these fronts suggest the continuing importance of a strong fiduciary ethic on the part of physicians who make patient care decisions.
信任对于医患关系至关重要，但作为患者利益的保护者，对医生信托伦理的信任已变得不那么可信。管理式医疗的兴起常常被视为破坏了信托伦理并降低了医疗的可信度。但是管理式医疗能否提高这种可信度呢？本文讨论了管理式医疗中可信度的四个可能来源：管理式医疗行业的道德标准、非营利组织、医生控制以及购买者的绩效监测。所有这些方面的局限性表明，做出患者护理决策的医生秉持强烈的信托伦理仍然至关重要。
