The growth of managed care was accompanied by concern about the impact that changes in health care organization would have on the doctor-patient relationship. We now are in a “post-managed care era,” where some of these changes in health care delivery have come to pass while others have not. A re-examination of the DPR in this setting suggests some surprising results. Rather than posing a new and unprecedented threat, managed care was simply the most recent of numerous strains on the (...) DPR that have occurred throughout the century. These strains are a constant, inevitable consequence of the varying needs and concerns of patient and physicians as they seek to balance their desires for a certain type of DPR with their simultaneous desire for other aspects of care such as lower costs, greater technological sophistication, and improved outcomes. (shrink)

Changes in healthcare financing increasingly rely upon patient cost-sharing to control escalating healthcare expenditures. These changes raise new challenges for physicians that are different from those that arose either under managed care or traditional indemnity insurance. Historically, there have been two distinct bases for arguing that physicians should not consider costs in their clinical decisions—an “aspirational ethic” that exhorts physicians to treat all patients the same regardless of their ability to pay, and an “agency ethic” that calls on physicians to (...) be trustworthy advisors to their patients. In the setting of greater patient cost-sharing, physicians' aspiration and agency roles increasingly conflict. Satisfactorily navigating the new terrain of consumer-driven healthcare requires physicians to consider these two roles and how they can best be reconciled so as to maximize quality of care while respecting the heterogeneity of patients' financial resources and willingness to pay. (shrink)

Plutarch, in his work,_ Peri __Deisidaimon_ia_ __,_ presents a striking portrayal of superstition in the First Century. The Philosopher who also served for decades as a priest of Apollo portrays the pernicious effects of some supposed religious practices as worse than the outcome of atheism. His position constitutes a forceful explanation to ostensibly controversial socio-religious behaviours. This article discusses some of the priest’s concerns as well as his rebuff of religious attitudes that are borne out of what he describes as (...) misrepresentation of the gods or superstition. Plutarch’s essay is seen as illustrating a reason for a socio-religious situation in Africa, a continent that shares a similar religious background with the world of the writer. Specifically, with the example of the hard fight against street begging in some parts of Nigeria, the article shows how social reform programmes could fail when effects of traditional African beliefs and cultural practices remain potent. __. (shrink)

Late in the second part of the Therapeutikê methodos, which Galen was completing after a twenty-year gap since beginning the work as a whole, the text in Kühn includes a comment which looks like a Galenic aside made parenthetically to himself while dictating. The sentence reads: ἐκεῖθεν οὖν αὐτὰ μεταφέρειν ἐνταῦθα σκοπούμενον ὅτῳ βέλτιον ἐξ αὐτῶν χρῆσθαι, ‘So to consider transferring them to here from there to make better use of them’. The rendering in the new Loeb volume 3, p. (...) 345 is not clear. (shrink)