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barriers to trust in health care, medicine as a business, physician-patient relationship, trust as a commodity in health care



  1. Bruhn, John G. PhD


Physicians argue that the advent of managed care has turned medicine into a business and that they spend more time learning the art of doing business than practicing medicine, while losing their professional spirit, patient loyalty, autonomy, and income. Medicine was a business before it was a science. Holding on to Hippocratic ideals in a world of on-demand consumers has made the covenantal physician-patient relationship ineffective and devoid of mutual trust. Physicians have argued that trust is time-dependent and a casualty of time-bound managed care guidelines. The author suggests that the principle of trust is not outdated, not exclusively time-dependent, and is still relevant to a modern Hippocrates loyalist. A relationship of trust is built on the style and quality of verbal and nonverbal communication. Trust is not an acquired trait; it is an expectation resulting from an interactive process of human concern and caring.