Commentary: Customer Disservice?

Editor's Note:In February 2002, Annals of Internal Medicine and Lancet published the Charter on Medical Professionalism. The American Board of Internal Medicine Foundation, the American College of Physicians Foundation, and the European Federation of Internal Medicine developed the Charter to provide an ethical framework to guide physicians as they practice in the world of 21st-century medicine. In an effort to help our readers remember the principles of the Charter and apply them, Annals is publishing a series of commentaries to accompany selected On Being a Doctor and On Being a Patient essays. We're grateful to Dr. Troyen A. Brennan for his contribution to this series.

This vignette raises what is arguably the key question of our era in medicine: Does providing cost-effective care inevitably conflict with serving the interests of the customer/patient? For me, the answer is clearly no, but the question is critical. As cost control comes …