Private and public medical practice - any potential differences?

The term "fiduciary" accurately describes the type of relationship that I would promote both in public
and in private practice. Under the ethical principle of beneficence, it is a doctor's duty to promote the important and legitimate interests of the patient. A fiduciary relationship best describes this important concept.

Illness potentially interferes with a person's ability to cater for their own self interests. In spite of the ubiquity of medical information it is the role of the doctor to interpret this information in a fashion that is individualised for that particular patient. The patient needs to be able to trust the doctor.

The term "fiduciary" is derived from the Latin "fidere" to trust. The word fiduciary is now often used in a more legal sense but I think it should be utilised in the medical context because our professional relationship truly reflects the original definition of the term; namely "to hold someting in trust for another"

In the complex milieu of financial arrangements that now characterise medical practice; ranging from incentives under managed care to fee for service, such arrangements increasingly have the potential to limit a doctor's freedom to act on behalf of their patients.

In essence; the more distant the financial arrangement in the patient /doctor relationship, the more likely will that professional relationship be reflected in the prevailing codes of ethics which universally direct doctors to use their skills to heal and comfort the sick. In doing so they will be likely to approach the ideal of a fiduciary relationship