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Maintaining Trust in an Era of Multiple Accountabilities

Stephen M. Shortell, PhD; Teresa M. Waters, PhD; Kenneth W. B. Clarke, MHA, MBA; Peter P. Budetti, MD, JD

JAMA. 1998;280:1102-1108.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

HISTORICALLY, a physician's primary, and arguably exclusive, responsibility has been to his or her patients. The Oath of Hippocrates taken by physicians across the nation calls for a physician to practice medicine and prescribe treatment for "the benefit of his or her patients and abstain from whatever is deleterious and mischievous." More modern versions of this oath include references to purity of purpose and holiness of life, directing "every word and deed . . . solely to the welfare of these patients." Although some may argue that this oath is anachronistic and in need of revision, a physician's dedication to serving the needs of his or her patients has remained the "immutable bedrock of medical ethics."¹

Many view managed care organizations as a direct threat to a physician's ability to fulfill . . . [Full Text of this Article]

METHODS

Physicians as Double Agents

Dissolution of Trust and Implications for Accountability

RESULTS

Population-Based Medicine

Incentive Alignment

Governing and Managing Physician Groups

Developing Effective Care Management Practices

Outcomes Management and Reporting Systems

A Challenge

COMMENT

From the School of Public Health, Division of Health Policy and Management, University of California, Berkeley (Dr Shortell); the Institute for Health Services Research and Policy Studies, Northwestern University, Evanston, Ill (Drs Waters and Budetti); and the Henry Ford Health System, Health Alliance, Detroit, Mich (Mr Clarke).

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