Nearly every doctor I know thinks that managed care is the worst thing that could have happened. Decreased reimbursement rates. An expanded physician- labor pool. Redistributed clinical work to less-expensive practitioners. Physicians will get little sympathy from patients who fail tests or cannot decipher the language of an invoice.
Ethics is no better than either defensive medicine or the new economics.
The language of millennial medical ethics has become nearly impenetrable armor, strangely protecting itself but not much else. If medicine is conducted as a war on disease, then bioethics, according to John Fletcher, Ph.D., of the University of Virginia, is a disarmament movement. It's a disarmament movement without a prayer, because it takes a doctoral degree in the right subfield to understand what most bioethicists say. Bioethics could showcase the details of patient cases as ways of understanding the humility that medicine teaches. The language of ethics makes the commonplace rare, and the rare seem common and incredibly important.