for the Physician
The relationship between physicians and their patients is special in nature. It is characterized by power and trust. Both of these give rise to distinctive rights and obligations on part of the physician towards the patient. To gage the nature of this relationship, and to evaluate its implications with respect to its informatic implications, it may be useful to begin with a broader look at the relationship in its social embedding.
An important characteristic of medicine as a profession is that, in most jurisdictions, it is a service provider monopoly. 1 That is to say, in those jurisdictions where medicine is recognized as a profession, 2 only someone who is a duly accredited (licenced) member of the medical profession may provide medical services. Violations of this provision are punishable by law.
This has several implications. One of the more important is that physicians function as gatekeepers for access to medical services. This puts them into a position of power with respect to the delivery of health care since patients are dependent on physicians to facilitate this access. A correlative of this position of power, which psychologically is not unexpected, is that patients trust their physicians to exercise this power not only in a responsible fashion, but also in the best interests of the patients themselves.
A second characteristic of medicine is that as the profession has evolved, physicians generally have greater knowledge in medical matters than do their patients: not only with respect to diagnosis and prognosis, but also with respect to possible treatment modalities. 3 Consequently they are frequently in a position to control the choices that patients might make by