ETHICAL PRACTICE IN MANAGED CARE - A DOSE OF REALISM

This article examines the ethics of medical practice under managed car e from a pragmatic perspective that gives physicians more useful guida nce than do existing ethical statements. The article begins with a fra mework for constructing a realistic set of ethical principles, namely, that medical ethics derives from physicians' role as healers; that et hical statements are primarily aspirational, not regulatory; and that preserving patient trust is the primary objective. The following concr ete ethical guidelines are presented: Financial incentives should infl uence physicians to maximize the health of the group of patients under their care; physicians should not enter into incentive arrangements t hat they are embarrassed to describe accurately to their patients; phy sicians should treat each patient impartially without regard to source of payment, consistent with the physician's own treatment style; if p hysicians depart from this ideal, they should inform their patients ho nestly; and it is desirable, although not mandatory, to differentiate medical treatment recommendations from insurance coverage decisions by clearly assigning authority over these different roles and by physici ans advocating for recommended treatment that is not covered.