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From the Neurology Section (Dr. Bernat), Department of Medicine, Dartmouth Medical School, Hanover, NH; Department of Neurology (Dr. Ringel), University of Colorado Health Sciences Center, Denver, CO; Department of Neurology (Dr. Vickrey), UCLA School of Medicine, Los Angeles, CA; and the American Academy of Neurology (C. Keran), Minneapolis, MN.
Address correspondence and reprint requests to Dr. James L. Bernat, Neurology Section, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.
We surveyed attitudes of US neurologists about the ethical dimensions of managed care by administering a written instrument containing paradigmatic cases portraying conflicts of physicians, patients, and managed care organizations (MCOs). After each case, we assessed neurologists' attitudes by asking them their degree of agreement with a series of statements. We found that neurologists (1) generally were willing to follow clinical practice guidelines if they were created by medical societies; (2) experienced frequent conflicts of interest or conflicts of obligation in the care of their MCO patients; (3) feared legal ramifications of their clinical decisions on MCO patients; (4) were unwilling to employ deception or gaming to achieve what they perceived to be good patient care; (5) believed that their professional prerogatives and autonomy were under attack by MCOs; and (6) felt that the good of their patients should not be sacrificed for the good of society.
Presented at the 48th annual meeting of the American Academy of Neurology, San Francisco, CA, March 1996.
Received July 1, 1996. Accepted in final form October 31, 1996.
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