title: Professionalism and clinical autonomy in the practice of medicine.
abstract: Professionalism in medicine requires a reasonable measure of freedom for physicians to determine patients  needs based on their own judgment. However, because virtually every medical decision is also a spending decision, third-party payers concerned about rising health care costs have introduced cost-containment tactics that significantly limit physicians  accustomed autonomy. In response, groups of physicians have filed class-action lawsuits against managed care plans, alleging causes of action such as fraud, breach of contract, extortion, and violations of federal RICO (Racketeer-Influenced and Corrupt Organizations) law. Such litigation may have merits, but it also faces significant obstacles, in part because the contracts involved may not actually have promised the broad measure of clinical autonomy that the physicians allege was promised, then denied. As physicians seek to restore and retain their professional autonomy, it will be important for them to be increasingly proactive in structuring or modifying the contracts under whose terms they practice   as some physicians have successfully done.
authors.affiliation: University of Tennessee, Department of Human Values and Ethics, 956 Court Avenue, Suite B324, Memphis, TN 38163, USA.
authors.forename: E Haavi
authors.initials: EH
authors.lastname: Morreim
mesh_terms: D015510:Clinical Medicine / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007603:Jurisprudence; D008329:Managed Care Programs / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D010820:Physicians / Q000331:legislation & jurisprudence / Q000458:organization & administration* / Q000592:standards; D017009:Professional Autonomy; D011361:Professional Competence / Q000592:standards; D035521:Supreme Court Decisions; D014481:United States