摘要：The premise underlying this issue of Virtual Mentor is that there has been a change in the role that doctors play in society. It has occurred in small steps, over roughly 30 years. Although the process may have been imperceptible at any given time, as the small steps added up, they became substantial. And so a doctor today does not merely have new protocols for treating diseases or interacting with patients; he has a fundamentally different role in society. To be specific, as late as the 1970s, doctors practiced with an autonomy that is almost unimaginable today. They did not face the severe cost-cutting pressures that came about with the rise of HMOs and other managed care systems. Because malpractice lawsuits were less common, they did not feel obliged to practice the “defensive medicine” so familiar to doctors today. They shared information without HIPAA (Health Insurance Portability and Accountability Act) restrictions. And their patients did not come armed with challenging questions culled from Internet research, because the Internet did not exist.
