TRUST AND TRUSTWORTHY CARE IN THE MANAGED CARE ERA

Trust is essential to the doctor/patient relationship, but trust in ph ysicians' fiduciary ethic has become less plausible as a protector of patients' interests. The rise of managed care often is seen as undermi ning the fiduciary ethic and lessening the trustworthiness of care. Bu t can managed care enhance that trustworthiness? Four possible sources of trustworthiness in managed care are discussed: ethical standards i n the managed care industry, nonprofit organizations, physician contro l, and performance monitoring by purchasers. Limitations on all of the se fronts suggest the continuing importance of a strong fiduciary ethi c on the part of physicians who make patient care decisions.