Ethical issues in managed care: can the traditional physician-patient relationship be preserved in the era of managed care or should it be replaced by a group ethic?

Over the last decade managed care has become the dominant form of health care delivery, because it has reduced the cost of health care; however, it has also created serious conflicts of interest for physicians and has threatened the integrity of the traditional physician-patient relationship. In this Article, Dr. Grochowski argues that the efficiencies created by managed care are one time savings and will not in the long run reduce the rate of rise of health care expenditures without a concomitant plan to ration health care. He explores the traditional physician-patient relationship and concludes: a) that while rationing of health care is inevitable, physicians must not ration care at the bedside; b) that physicians must be advocates for their patients; c) that physicians must avoid conflicts of interest whenever possible; d) that physicians must put the needs of the patient before their own self-interests; and e) that physicians must act in ways to promote trust in their relationship with patients.     

Intimate partner violence research in the health care setting: what are appropriate and feasible methodological standards?

The past 20 years of research has exposed the profound cost of intimate partner violence (IPV) in health care problems and health care dollars for victims and bystanders. As a result, professional organizations encourage clinicians to identify IPV victims and to refer them to community resources. To date there is little evidence to show the value of these efforts, and many completed studies are criticized for methodological weaknesses. IPV studies are challenging to design, and the double-blind randomized controlled trial may be an impossible standard. To move forward, funders and study committees are encouraged to reassess the standards for IPV research methodologies.     

Aligning physician decision-making with the goals of health care organizations: are there any lessons from law firms?

In order to achieve efficiency in the delivery of health care services, it is essential to align more closely the behavior of physicians with the goals of the health care organization with which they are affiliated. Achieving alignment presents a number of challenges, including legal constraints, a long tradition of physician independence, a tendency for physicians to become involved in procurement decisions, and a scarcity of comparative effectiveness data that could serve as a basis for treatment protocols and purchasing decisions. The article discusses these challenges and suggests some partial solutions. In addition, it compares the incentives that affect physicians in health care organizations and partners in law firms and suggests that there may be some lessons that health care organizations can learn from the firms.     

The relationship of the outcome and procedural fairness: How does knowing the outcome influence judgments about the procedure?

Justice theories distinguish between fair procedures and fair or favorable outcomes. However, it is not clear whether people can clearly separate judgments about procedures from knowledge of the outcomes of those procedures. Two experiments are reported which address that question. In both studies respondents evaluate the fairness of decision-making procedures. In one case those evaluations occur prior to knowing the outcome of the procedure (behind the veil), while in the other the outcome is known before the procedural evaluation (in front of the veil). Two hypotheses about outcome influence are tested: that knowing the outcome changes themeaning of procedural fairness and that knowing the outcome changes theweight given to procedural fairness. Findings of both studies suggest that prior knowledge about the outcome does not change the way people define the meaning of the fairness of a procedure. However, people place less weight on their judments about procedural fairness when evaluating the decision maker if they make those judgments already knowing the outcome of the procedure.     

Who are the Unclaimed Dead?

Unclaimed dead are deceased persons with no known next of kin (NoK) or NoK was located but did not claim the deceased. Unclaimed dead in Marion County, Indiana, 2004–2011, are examined. Comparisons are provided of the unclaimed to the claimed dead population and county death patterns. Race, gender, marital status, age, location, manner and cause of death, NoK, and days to disposition are analyzed. The unclaimed dead were disproportionately male, slightly more likely to be Black, younger at death, died from natural causes, had unknown marital status, were equally likely as not to have NoK, did not die in a hospital, and were subject to autopsy. Nearly half the unclaimed had NoK who did not claim the body; the other half had no identifiable NoK. Unclaimed were more likely to have an autopsy and to die from external causes. Most unclaimed were identified by means outside fingerprints or DNA.     

Fairness and organizational citizenship behavior: What are the connections?

A view of organizations as social contracts recognizes self-interests of individuals but does not explain the occurrence of unselfish contributions such as are denoted by organizational citizenship behavior (OCB). We propose that the concept of fairness, as applied to systems of relational contracts, provides a high-leverage construct for understanding the fusion of self-interest and self-denial. A review of the empirical literature suggests that fairness, rather than job satisfaction, accounts for OCB; and that the evidence points toward procedural and interactional fairness as both empirically and conceptually critical in the fairness-OCB relationship. However, we explain why distributive fairness still should not be deemphasized.