IF THE physician fails to maintain the primacy of patient advocacy, he has failed his profession and his patient. The "negative" incentives to save money for prospective payment systems, a health maintenance organization, or a governmental socialized medical system are as bad as the "positive" incentives of a fee-for-service system to overtest or overtreat for physician aggrandizement. Physicians must practice on behalf of their patients. They cannot divide their loyalty, and I am concerned that this basic role is seriously threatened.
In view of rapid changes in the provision of medical care in our country, a recent case in England1 (the differences in jurisprudence and health care access) may be a distant early warning to us in the United States. I believe it illustrates a standard of consent adopted in England that differs substantially from the more complete disclosure in the United States. The English